Conversion of a traumatic bone cyst into central giant cell granuloma: Implications for pathogenesis—a case report

Abstract

Central giant cell granuloma (CGCG) is an intraosseus jaw lesion that consists of cellular fibrovascular tissue containing foci of hemorrhage, multinucleated giant cells, and occasional trabeculae of reactive bone. In 1953, Jaffe1 proposed the term “giant cell reparative granuloma” to distinguish this jaw lesion from the typical giant cell tumor of long bones. The classic clinical presentation of CGCG is a painless swelling of the jaw. The teeth are usually vital, and in the early stages, there is neither root mobility nor root resorption. Although a CGCG is a benign lesion, occasionally it behaves aggressively, causing extensive bone destruction. The lesion exhibits a tendency to recur after excision. To date, the pathogenesis of CGCG remains unknown. The lesion has been thought to have a relationship to trauma, repair,1,2 or faulty development. There also is some suggestion that CGCGs may be related pathogenetically to aneurysmal bone cysts (ABCs)3 or to simple bone cysts (SBCs), which are also known as traumatic bone cysts (TBCs). The traditional management of CGCG is surgical, which occasionally results in major defects. In younger patients, the loss of teeth or tooth germs is a frequent consequence. In recent years, there have been reports of the treatment of CGCGs with corticosteroids,4 radiation,5 and calcitonin.6,7 We present the case of a patient with CGCG who had an unusual clinical course; the initial diagnosis was TBC on the basis of clinical and radiographic findings.