Rare agressive form of giant-cell granuloma: a three years follow-up case report and discussion about medical therapeutic solutions

Grégoire Huguet,Philippe Lesclous,Jean-François Simon,Benoît Piot,Elisabeth Cassagnau

doi:10.1051/mbcb/2018021

Grégoire Huguet, Philippe Lesclous + Show 3 more

Open Access

https://doi.org/10.1051/mbcb/2018021

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Abstract

Introduction: Central giant cell granuloma (CGCG) is a rare and benign intraosseous lesion that usually occurs in the mandible and the maxilla. It might be aggressive. Nowadays, several treatments exist. Observation: This case report, with a three years follow-up, was about an aggressive and recurring form of CGCG exclusively managed by surgical approach. Comments: Several pharmacologic approaches are possible (intralesional injections of glucocorticoids, administration of calcitonin, alpha-2a interferon, denosumab) and could be an interesting alternative or complement to the surgical management when CGCG is aggressive, recurring, or non resectable. Conclusion: Surgical approach is the gold standard for the treatment of CGCG but sometimes, pharmacologic approaches could be proposed. According to the scientific literature, denosumab appears as a reliable and effective treatment but more prospective studies are needed.

Highlights

Central giant cell granuloma (CGCG) belongs to the family of nonodontogenic giant cell tumors (GCT) along with cherubism, GCT of bone, aneurysmal pseudo-cysts, and the brown tumors found in hyperparathyroidism [1,2]
Surgical treatment remains the gold standard for the initial management of CGCG, several pharmacological treatments exist
Denosumab is a monoclonal antibody used in the treatment of osteoporosis, bone metastases from solid cancers or multiple myelomas, and GCTs of bone found in the metaphyses of the long bones

Summary

Introduction

Central giant cell granuloma (CGCG) belongs to the family of nonodontogenic giant cell tumors (GCT) along with cherubism, GCT of bone, aneurysmal pseudo-cysts, and the brown tumors found in hyperparathyroidism [1,2]. Its diagnosis is difficult and histological analysis is necessary to confirm it It exists in two forms: aggressive and non-aggressive. J Oral Med Oral Surg non-indurated, distal swelling of this molar was found It was a bit painful but there was no sign of inflammation. Postoperative clinical checks at 1 and 4 months, revealed that the intraoral appearance was normal without any symptomatology. A fresh CBCT was performed at 4 months, which showed an osteolytic 22 Â 16 mm image having irregular contours with thinned lingual and vestibular cortices, near the distal root of 37. Laboratory tests were performed to rule out hyperparathyroidism (the brown tumors encountered in this pathology having a similar histological appearance to CGCG). At the 3-month and 1-year postoperative follow-ups, the patient reported no symptoms and the intraoral appearance was normal with a vital 37. A fresh CBCT showed reossification at the excision site (Fig. 6)

Discussion

Conclusion