Aggressive Central Giant Cell Granuloma Research Articles

Vascularity and angiogenesis level correlations with the clinical behavior of the central and peripheral giant cell granulomas of the oral cavity

Purpose: The aim of the current study was to compare vascularity and angiogenic activity in peripheral and central giant cell granulomas (GCGs) of the jaws as reflected by vascular endothelial growth factor (VEGF). Patients and Method: 3 males and 7 females complaining of peripheral giant cell granuloma (PGCGs) and fifteen (5 males & ten females) with central giant cell granuloma (CGCGs) were selected to assess and compare the VEGF immunoexpression in multinucleated giantcells, and mononuclear surrounding stroma. Results: The expression levels of VEGF were greater in CGCGs compared to PGCGs and in aggressive CGCG more than non-aggressive. Conclusion: The vascularity and level of angiogenesis within aggressive CGCGs are higher than those in non-aggressive lesions. The stronger VEGF expression, the higher clinical behavior aggressiveness of the different giant cells granuloma lesions.

Giant Cell Granulomas of Jaws: a Clinicopathologic Study.

ABSTRACTObjectivesThe purpose of present study was to investigate and correlate the histological findings in central giant cell granuloma and peripheral giant cell granuloma of jaws with clinical and radiographic interpretations of the lesion.Material and MethodsIn present study, data from 14 cases of central giant cell granuloma (CGCG) and 9 cases of peripheral giant cell granuloma (PGCG) were analysed, focusing on demographic, clinical and radiographic features. For each patient, microscopic slides were assessed in terms of histologic features of giant cells i.e. number of giant cells, mean number of nuclei/giant cell, pattern of distribution, size and relative size index of giant cells, percentage fractional surface area (FSA) occupied by giant cells and stromal characteristics. Data collected was subjected to statistical analysis. Fisher-exact test, Pearson’s correlation coefficient, one-way ANOVA test and Student’s t-test were used for analysis.ResultsNo significant difference was found between PGCG and CGCG in relation to all the traits that were evaluated. It was observed that mean number of giant cells and mean FSA was more in aggressive CGCG as compared to non-aggressive CGCG.ConclusionsFurther studies on large sample size are required to confirm the relationship between histomorphometric features of giant cells and behaviour of giant cell granulomas of jaws.

Intralesional Steroid Treatment of Aggressive Central Giant Cell Granuloma of the Mandible

Central giant cell granuloma (CGCG) is a non-neoplastic lesion that affects children and young adults. Various treatment modalities have been suggested for CGCG. The most commonly applied is surgery with possible variable recurrence rates. Other treatment modalities such as calcitonin and intralesional steroid have been used with good results. In the current case report, a 14-year old boy presented with an aggressive CGCG of the mandible that had been treated with six weekly intralesional injections of steroids that provided very good results.

Central giant cell granulomas of the jaws: retrospective radiographic analysis of 13 patients.

This study was performed to retrospectively analyse the imaging features of 13 patients with central giant cell granulomas (CGCGs) examined at a single institution. The orthopantomography and cone beam computed tomography images of 13 patients histopathologically diagnosed with CGCGs were retrospectively analysed. Patients aged > 30years underwent measurement of their calcium and parathyroid hormone levels. No cases of hyperparathyroidism were identified in the study group. Thirteen lesions of 13 patients (7 female, 6 male) were included in this study. The patients' ages ranged from 8 to 79years at the time of presentation. Among the 13 lesions, 2 (15.4%) were in the maxilla and 11 (84.6%) were in the mandible. Eight lesions (61.5%) were unilocular and 5 lesions (38.5%) were multilocular with a soap bubble appearance. Three of the lesions were > 5cm, and the remaining ten lesions were < 5cm; five of these smaller lesions met at least three of the aggressiveness criteria. Therefore, according to these criteria, eight aggressive and five non-aggressive CGCGs were examined in this series. The distinction between aggressive and non-aggressive CGCGs is extremely important because it leads to changes in the individual treatment protocol that is applied. It may be possible to minimise recurrence after treatment by detecting findings such as cortical perforation or thinning, cortical bone expansion, and the presence of root resorption.

An aggressive central giant cell granuloma in a pediatric patient: case report and review of literature

BackgroundCentral giant cell granulomas are benign tumours of the mandible, presenting in children and young adults. Divided into non- and aggressive subtypes, the aggressive subtype is relatively rare and can occasionally progress rapidly, resulting in significant morbidity.Case presentationWe present a case of an aggressive central giant cell granuloma (CGCG) in a six year-old female. The lesion originated in the right mandibular ramus and progressed rapidly to involve the condyle. Diagnosis was made using a combination of imaging and pathology. A timely en bloc resection of the hemi-mandible was performed with placement of a reconstructive titanium plate and condylar prosthesis.ConclusionOur case demonstrates the importance of considering CGCG in the differential diagnosis of rapidly progressive mandibular lesions in the pediatric population. Prompt diagnosis and management can greatly improve long-term outcomes.

Aggressive central giant cell granuloma – A case series with literature review

Central giant cell granuloma (CGCG) of the maxillofacial region is generally present as an asymptomatic slowly growing localised disease to aggressive neoplasm-like rapid expansive progression typically present with localised disease. It is an uncommon benign lesion with a low incidence that occurs in the craniofacial region especially in jaw bones. It is a localised osteolytic lesion with varied biologic behavior of aggression which affects the jaw bones. There is much controversy regarding it arising as a result of trauma and its connection with the giant cell lesion seen in the long bones. As it is uncommon, it does not possess any characteristic clinical or radiologic features and resembles neoplasms; the diagnosis is initially some odontogenic or non-odontogenic neoplasm till a definitive histologic diagnosis of CGCG is made. We report five cases of an aggressive form of CGCG at different sites of involvement in the jaw bones.

Hypoxia Induced Chemo-Resistance of Aggressive Central Giant Cell Granulomas and Their Treatment Options based on Cytogenetic Analysis of Bcl2 Gene

Hypoxia Induced Chemo-Resistance of Aggressive Central Giant Cell Granulomas and Their Treatment Options based on Cytogenetic Analysis of Bcl2 Gene

An insight into the cannibalistic behavior of giant cell granulomas of the jaws.

Background:Cellular cannibalism is defined as a large cell engulfing a smaller one within its cytoplasm. It is predominantly a feature of aggressive malignancies but has recently been demonstrated in giant cell (GC) lesions such as GC tumor of tendon sheath, central GC granuloma (CGCG) and peripheral GC granuloma (PGCG).Aim:The aim of the study is to assess the cannibalistic GCs in CGCG and PGCG and correlate with aggressiveness of the lesion.Settings and Design:Archival data of histopathologically confirmed cases of CGCG (n = 40) and PGCG (n = 25) were studied in the Department of Oral Pathology, Maulana Azad Institute of Dental Sciences.Materials and Methods:Quantification of cannibalistic cells was performed using H&E stain on microscopic sections. One hundred GCs were examined in each slide, and the number of cannibalistic cells was expressed in percentage.Results:GC cannibalism was observed in all cases. The mean number of cannibalistic GCs in CGCG was 44.67 which was significantly higher (P = 0.028) than PGCG (mean 28.04). In aggressive (n = 18) CGCG, the mean number of cannibalistic GCs was 51.27 which was significantly higher (P = 0.019) than cannibalistic GCs in nonaggressive (n = 22) CGCG (mean 39.27). No significant difference was observed between the number of cannibalistic cells in recurrent (mean = 52.9) and nonrecurrent (mean = 49.2) cases of CGCG (P > 0.05). Two of the nine cases treated initially by steroid showed fewer and smaller cannibalistic GCs with vesicular nuclei.Conclusion:There was a clear distinction in the mean cannibalistic count between aggressive and nonaggressive CGCG. Hence, the aggressiveness of the lesion could be assessed following which appropriate treatment modality can be constituted.

Denosumab Treatment for Aggressive Multiple Recurrent Familial Central Giant-cell Granulomas.

Background:Aggressive familial giant-cell granulomas of the jaws can be severely deforming. Surgical and nonsurgical treatments may be associated with multiple recurrences. Denosumab, a new generation antiresorptive drug, is an osteoclast inhibitor, which may be particularly useful to manage such potentially disfiguring lesions.Materials and Methods:Two sisters, both with a history of multiple recurrent aggressive central giant-cell granuloma (CGCG)-like lesions in both jaws, were referred for management. All lesions were histologically consistent with the diagnosis of CGCG. The lesions were treated surgically with curettage and perilesional injection of triamcinolone. In particular, the older sister had four separate anatomic sites where some of her lesions had multiple recurrences necessitating three repeat procedures. A course of subcutaneous denosumab was administered following the last giant-cell granuloma removal in both sisters.Results:Bony healing was normal. No further recurrences were observed over 3.5 years of follow-up after denosumab therapy in either sister.Conclusions:In this small cohort comprising two sisters with multiple aggressive recurrent giant-cell granuloma lesions at multiple sites in the mouth, subcutaneous denosumab administration was associated with success over 3.5 years of follow-up. This report cautiously adds to the clinical experience in the use of denosumab for the treatment of recurrent aggressive familial CGCG lesions.

Aggressive central giant cell granuloma of the maxilla in a patient with neurofibromatosis type 1 — case report and review of literature

Background: Central giant cell granuloma (CGCG) is a benign osseous lesion that predominantly involves jaws with variably aggressive behaviour. It characterised by accumulation of multinucleated giant cells in a background of cellular vascular fibrous tissue and spindle-shaped stromal cells. Neurofibromatosis type 1 (NF-1) is an autosomal dominant trait associated with multiple neurofibromas, cafe-au-lait pigmented skin lesions, optic nerve glioma, Lisch nodules and distinct osseous dysplasia. In 1971 Kerl reported multiple giant cell granulomas in a patient with Recklinghausen's neurofibromatosis, few literatures showed this rare coincidence. Objectives: We report a case of NF-1 with aggressive maxillary CGCG and reviewed on the proposed coincidental association or true genetic linkage. Methods: A complete search on the web was done and all the related articles studied and concluded. Findings and Conclusion: In NF-1 patients genetic drawbacks such as NF-1 haploinsufficiency or underling mechanisms that cause decreased neurofibromin function, may result in decreased bone ability to respond to functional demands, thus the skeleton is more prone to develop intraosseous defects.

Central Giant Cell Granuloma of the Jaws: Correlation between Vascularity and Biologic Behavior

Introduction: Giant cell lesions of the bone comprise a group of jaw bone pathologies. Different pathogeneses such as reactive, vascular or neoplastic have been proposed for these lesions. In addition, differentiating between aggressive and nonaggressive central giant cell granuloma (CGCG) of the jaws based on histopathologic features is still impossible and due to different treatment protocols for the two groups, correct diagnosis is necessary. The purpose of this study was to compare the expression of CD34 between aggressive and nonaggressive CGCGs of the jaws. Methods & Materials: This retrospective study was carried out on 16 paraffin blocks in each aggressive and nonaggressive CGCGs group. The expression of CD34 was evaluated with immunohistochemical technique. Afterwards, t-test was used for quantitative evaluation and comparison of CD34 expression among the two groups. Eventually, statistical analysis was performed using Spss20 software. Significance was assigned at p < 0.05. Results: In the present study, the average age of patients in aggressive and nonaggressive groups was 20.93±8.08 and 26.18±16.97, respectively. In both groups, female predilection was observed. Mandible was the most common site of involvement in the aggressive group and the distribution of nonaggressive lesions was equal between both jaws. Although the expression of CD34 in the aggressive group was higher than the nonaggressive group, no statistically significant difference was seen (p=0.15). Conclusion: According to the results of the current study, it appears that CD34 protein cannot be used for identifying the clinical behavior of CGCGs.

Aggressive central giant cell granuloma: A rare case report

Giant cell granuloma is a benign proliferative pathological lesion of the bone accounting for less than 7% of lesions of the jaw, predominant in females and most commonly seen in anterior segment of jaws. Mandible is more commonly affected. Radiographically, the lesion may present with diffuse or irregular borders, sometimes leading to expansion of cortex, displacement of teeth, or root resorption. We present a case of aggressive central giant cell granuloma in a 45-year-old female patient in the right mandibular alveolar ridge presenting as an irregular mass causing displacement of teeth.

Extensive Aggressive Central Giant Cell Granuloma of the Mandible: Conservative Steroids Treatment in a Pediatric Patient

Central giant cell granuloma (CGCG) is a relatively rare intraosseous lesion, described by the World Health Organization as a localized proliferation consisting of fibrous tissue with hemorrhage deposits, the presence of osteoclast-like cells, and reactive bone formation. In this article, the authors present their experience in managing a wide, aggressive CGCG of the whole tooth-bearing mandible in a 9-year-old pediatric patient. The extension of the lesion and the age of the patient have presented a double challenge concerning treatment and outcome. If fact the main objective remains a correct therapeutic treatment, focused on healing the patient and avoiding recurrences, the clinician must be careful in preventing an excessive morbidity. The authors decided to treat the young patient with intralesional corticosteroid therapy, reserving surgery in case of non-response or for subsequent refinements. In this article is presented the authors’ conservative treatment protocol with intralesional corticosteroid injection and their results are compared with literature's data.

Pharmacological and surgical therapy for the central giant cell granuloma: A long-term retrospective cohort study.

This is a retrospective cohort study of patients with a central giant cell granuloma (CGCG) treated at a single center to assess and compare the different surgical and non-surgical approaches. A cohort with a single histologically proven non-syndrome-related CGCG was selected and reviewed. Patients were allocated to group I (surgery), group II (pharmacotherapy), and group III (pharmacotherapy and surgery). The primary outcome was long-term radiologic response using computed tomography. Secondary outcomes were intermediate radiologic responses and occurrence and severity of side effects. Thirty-three subjects were included in the study. The surgical group (n=4) included 1 patient with progression during follow-up and a relatively high post-surgical morbidity. Twenty-nine patients started on various pharmacological treatment regimens (groups II and III). Fourteen patients could be managed without additional surgery. One of these lesions showed progression during follow-up. The other 15 lesions underwent additional surgery, and none showed progression during follow-up. Interferon treatment was associated with the most side effects. Pharmacological agents have a role in the treatment of aggressive and non-aggressive CGCGs by limiting the renewed progression during long-term follow up and the extent and morbidity of surgical treatment.

Co-occurrence of Calcifying Odontogenic Cyst, Aggressive Central Giant Cell Granuloma and Central Odontogenic Fibroma: Report of a Very Rare Entity and Its Surgical Management

Calcifying odontogenic cyst (COC), Central odontogenic fibroma (COF) and aggressive central giant cell granuloma (CGCG) are rare pathologic diseases affecting the jaws. While the Co-existence of two of them is reported in the literature, existence of all three conditions in one patient is an extremely rare entity. In the present report, initial biopsy revealed fibrosarcoma, therefore mandibular resection was performed for the subject. Sectional Histopathologic evaluation revealed the co-existence of three conditions through histopathologic evaluation. This report emphasizes the importance of precise microscopical evaluation of jaw lesions and thorough sectional examination of the lesions to reach the precise diagnosis. Treatment modalities and follow-up radiographs are also provided to help clinicians manage these entities.

Cellular cannibalism in giant cells of central giant cell granuloma of jaw bones and giant cell tumors of long bones.

The aim of the present study was to investigate the relationship of central giant cell granuloma (CGCG) and giant cell tumor of long bones (GCT) with respect to cannibalistic giant cells (GCs). Sixteen cases each of CGCG and GCT were histopathologically analyzed for cannibalistic GCs. One hundred GCs were examined in each section, and the number of cannibalistic GCs was expressed in percentage. Cannibalistic GCs were seen in all cases of CGCG and GCT (100%). GCT showed significantly higher mean cannibalistic GC frequency (44.81 ± 1.013) than CGCG (32.06 ± 1.398), aggressive CGCG (38.17 ± 1.579), non-aggressive CGCG (28.40 ± 0.6360), non-recurrent CGCG (30.42 ± 1.417), and recurrent CGCG (37.00 ± 2.483). In aggressive CGCG, the mean cannibalistic GC frequency was significantly higher (38.17 ± 1.579) than the non-aggressive variant (28.40 ± 0.6360). Recurrent CGCG cases showed significantly higher mean cannibalistic GC frequency (37.00 ± 2.483) than non-recurrent cases (30.42 ± 1.417). Similarly, recurrent GCT showed significantly higher mean cannibalistic GC frequency (47.4 ± 4.97) than non-recurrent GCT (43.63 ± 3.1). The distinctness of CGCG and GCT was observed in terms of mean cannibalistic GC count. The assessment of cannibalistic GC in CGCG and GCT could help in predicting the biological behavior and grading of the tumor.

Can calcitonin nasal spray reduce the risk of recurrence of central giant cell granuloma of the jaws? A double-blind clinical trial

Recurrence is a major problem following the treatment of aggressive central giant cell granuloma (CGCG). The aim of this study was to compare the frequency of recurrence between patients who received calcitonin nasal spray after curettage of CGCGs and those who did not. A double-blind clinical trial was designed. Patients were allocated to one of two groups: those in the calcitonin group underwent curettage and received calcitonin salmon nasal spray 200IU/day once a day for 3 months after surgery; those in the control group underwent curettage of CGCGs and received a placebo once a day for 3 months after surgery. All patients were followed for 5 years after surgery. Twenty-four patients were treated in the two groups. There was no difference in age, sex, tumour size, or tumour location between the two groups (P>0.05). Eight of the 24 patients (33.3%) had recurrences during the follow-up period: one in the calcitonin group (9.1%) and seven in the control group (53.8%). Analysis of the data demonstrated a significant difference between the two study groups (P=0.033). It appears that calcitonin nasal spray may reduce the frequency of recurrence in aggressive CGCGs in the mandible and maxilla.

Expression of Ki67, CD31, CD68 and P53 in Peripheral and Central Giant Cell Granuloma of the Jaws

Introduction: Giant cell granuloma is a relatively common lesion in oral cavity. Central giant cell granuloma usually treated with surgical excision with good prognosis. However in few cases, the lesion exhibits more aggressive behaviour, high recurrence rate and poor prognosis. It is difficult to identify these cases based on histological features so the need for diagnostic markers is of paramount importance to spare patients unwanted effects. Aim: To investigate expression of Ki67, CD31, CD68 and P53 proteins in peripheral and central (aggressive and non-aggressive) giant cell granuloma and whether their expression level can be used to differentiate between aggressive and non-aggressive types. Material and methods: A total of 33 cases; 15 cases of peripheral giant cell granuloma, 10 cases of nonaggressive central giant cell granuloma and 8 cases of aggressive central giant cell granuloma were tested for Ki64, CD31, CD68 and P53 expression using immunohistochemical staining. Results: Ki67 was expressed in all study cases with significantly higher levels in aggressive variant. CD31 expressed in all cases with significantly higher levels in peripheral giant cell granuloma. CD68 was expressed in all cases with no significant differences. P53 was only identified in central giant cell granuloma with significantly higher levels in aggressive type. Conclusion: Ki67 and P53 expression might be useful markers to identify aggressive central giant cell granuloma.

Alternative Treatment Modality of Recurrent Central Giant Cell Granuloma in the Maxilla: Seven Year Follow-up Case Report

Objectives: The aim of this unique report was to evaluate the long term outcome of an aggressive central giant cell granuloma (CGCG) lesion by using surgical removal and corticosteroid injection technique.CGCG is an uncommon benign bony lesion that occurs in the mandible and maxilla. Methods: A 14 year-old female was admitted to our clinic with a complaint of hard swelling in the left maxillary anterior vestibule cortex. The lesion was surgically removed by enucleation which was carried out under local anesthesia. Histological investigation revealed a diagnosis of central giant cell granuloma. Patient’s recovery was uneventful. During follow-up for eight months, the mass was opened and deep curettage was performed. After that, at same seance, corticosteroids was injected. The injection was repeated at the same rate once a week for 6 following weeks. Results: At the follow-up examination after seven years, lesion and left maxillary canine were stable and asymptomatic. There was no recurrence of lesion. Conclusion: Surgical removal combined with intralesional corticosteroid injection is a promising treatment approach for CGCG, and it can be suggested to reduce the recurrence of the lesion.

Management of a Large Central Giant Cell Granuloma of Maxilla using a Combined Medical- Surgical Protocol

Central giant cell granuloma is a rare, benign intraosseous lesion which presents in the mandible of young adults below 20 years of age. This case report discusses the clinical and radiographic presentation, diagnosis and management of a large aggressive central giant cell granuloma in maxilla of a 45 year old woman. A conservative medical- surgical protocol of weekly intralesional steroid injections followed by a conservative curettage and liquid nitrogen cryotherapy was followed to prevent recurrence and at the same time avoiding the morbidity of an aggressive resection. Surgically unapproachable residual tumor remaining in superiormost part of medial antral wall was removed with functional endoscopic sinus surgery as well as providing a functional ostium for drainage of nasal secretions and relieving nasal blockage.