Diagnostic difficulty of an aggressive and recurrent giant cell granuloma: a short case report

Louis De Cidrac,Loredana Radoï,Thông Nguyen,Roch Pecorari,Mohamed Kadri

doi:10.1051/mbcb/2020054

Abstract

Introduction: The central giant cell granuloma (CGCG) is a rare benign lesion of the jaws, rarely aggressive,mostly affecting the mandible in children and young adults. The diagnosis may be difficult, complementaryhistological analyses being necessary to differentiate it from other giant cell tumours. Observation: A 28-year-old woman consulted for a painful gingival swelling surrounding the inferior right second molar. Cone Beam (CBCT) showed anunilocular radiolucent mandibular lesion. Histological examination performed after the curettage of the lesion could not differentiate between a peripheral GCG with bone extension, a giant cell tumour (GCT) or a CGCG. The patient was lost of view for 4 months until an aggressive recurrence. Asegmental mandibulectomy in disease-free margin was performed. Immunohistochemical and genetic testscomplementary to histology finally permitted to concludeto a CGCG. The patient presented no recurrence in 4 years of follow-up. Discussion: Surgical removal in disease-free margin is the gold standard treatment in aggressive CGCG. Nonetheless, literature reports alternative pharmacological treatments alone or in addition to surgery. In this case, the aggressiveness of the tumour and the absence of patient compliance for follow-up have led to the decision of a radical treatment of the recurrence. Conclusion: Aggressive CGCG requires a rapid diagnosis and a primary disease-free margin surgical resection to avoid mutilating treatment of the recurrence.

Highlights

Abstract -- Introduction: The central giant cell granuloma (CGCG) is a rare benign lesion of the jaws, rarely aggressive,mostly affecting the mandible in children and young adults
There was nothing relevant in her medical history. She undergone the removal of 3rd molars under general anaesthesia a year earlier
The extra-oral examination found a firm swelling in the posterior mandibular region with a moderate trismus and without lymphadenopathies

Summary

Introduction

Abstract -- Introduction: The central giant cell granuloma (CGCG) is a rare benign lesion of the jaws, rarely aggressive,mostly affecting the mandible in children and young adults. The panoramic X-Ray showed a circular, well limited unilocular radiolucent lesion behind the mandibular right 2nd molar with on its lower border a 2 mm radio-opaque image compatible with a residual dental apex (Fig. 2). Histological examination found a great number of multinucleated giant-cells (Fig. 3) but was unable to distinguish between peripheral GCG, CGCG or GCT.

Results

Conclusion