Aggressive Central Giant Cell Lesion Research Articles

Unravelling the role of immunohistochemistry in giant cell lesions of jaws: A systematic review.

Controversies exist in literature regarding nature, pathogenesis, and behaviour of giant cell lesions (GCLs) of jaws. Studies were attempted to solve these mysteries with immunohistochemical analysis, using various biological markers. Thus, the aim of this review is to appraise the role of immunohistochemistry (IHC) in evaluating the pathogenesis, cellular phenotype, nature, and behaviour of GCLs of jaws. PubMed, PubMed Central, and Clinical Key (Medline) databases were searched electronically irrespective of date of publication with assortment of several independent terms. Fifty-five articles that fulfilled the eligibility criteria were included in the review. Out of 55 included articles, 49 were associated with nature, pathogenesis, and behaviour and six articles were associated with treatment and outcome prediction. Although IHC solved some of the controversies associated with GCLs of jaws such as the osteoclastic phenotype of multinucleated giant cells, immunoexpression of proliferative markers does not distinct non-aggressive from aggressive central GCL but the nature, histogenesis, pathogenesis, and exact behaviour still remain debatable. With regard to formulation of treatment plan, immunohistochemical analysis revealed that expression of glucocorticoid and calcitonin receptors could act as a tool to decide the therapeutic strategy and aid in therapeutic adjustments according to evolution of the lesion.

Aggressive Central Giant Cell Granuloma of the Jaw and Adjuvant Denosumab Therapy: Decreased Morbidity and Preserved Function in a 3 Patient Case Series

We show the benefits of denosumab as adjuvant treatment of gnathic central giant cell granulomas (CGCGs) in 3 female patients, ages 18 to 65. This case series contributes to the growing experience in the medical therapy of these aggressive lesions, and demonstrates denosumab’s potential to decrease surgical morbidity. Central giant cell lesions of the jaw can be locally aggressive and thereby result in severe tissue destruction. Several medications have been evaluated as adjuvant therapy for CGCGs, with investigation of denosumab being the most recent. Our goal was to definitively treat patients with large CGCGs while minimizing unnecessary tissue and function loss. All 3 patients were offered adjuvant therapy with denosumab, since surgical resection alone would have resulted in large segmental defects requiring jaw reconstruction with free tissue transfer. Treatment instead consisted of lesion curettage and adjuvant denosumab therapy. The denosumab treatment protocol we used was based on what is currently recommended for unresectable giant cell tumors of bone (GCTB). Patients have been monitored for 40 months with clinical and radiographic exams, and 2 of them have also had histological evaluation following initiation of denosumab treatment. The 3 patients improved subjectively after the first few denosumab injections and had objective clinical and radiographic improvement after less than 6 months of therapy. Medication treatment length ranged from 10 to 15 months. Radiographic exams showed cortical thickening, resolution of cortical perforations, and calcification within a previously radiolucent region. Our findings are consistent with previous reports, and further support for the use of denosumab in locally aggressive central giant cell lesions. Our patients have thus far avoided large segmental resections, temporomandibular joint disarticulation, and sensory loss which would have resulted from surgical treatment alone. These 3 cases show that denosumab can be effective as adjuvant therapy in the treatment of aggressive gnathic CGCGs.

POSITIVE OUTCOMES OF DENOSUMAB IN THE TREATMENT OF CENTRAL GIANT CELL LESIONS: CASE SERIES

Pharmacologic approaches have emerged as alternatives to radical surgery for the treatment of aggressive central giant cell lesions (CGCL). We report three cases of CGCL managed with denosumab. Two of the patients were female adults presenting symptomatic lesions in maxilla. They received 120 mg subcutaneous denosumab monthly for 6 and 12 months (2 extra doses in the first month). The other was a 16-year-old male patient with Noonan syndrome, previously treated with calcitonin, who had mandibular and maxillary lesions. He received 60 mg denosumab for 6 months, followed by 30-mg doses for the next 2 months. No relevant adverse events were reported. After denosoumab therapy, all patients showed lesion calcification and significant recovery of the oral mucosa; however, little reduction in swelling was seen. Complementary recontouring surgery and curettage of the remaining lesion were proposed for all patients. Both female patients already undergone surgery, showing no recurrence at 3-year and 6-month follow-up.

Is calcitonin prior to surgery an effective management for aggressive central giant cell lesion?

Is calcitonin prior to surgery an effective management for aggressive central giant cell lesion?

Case report of aggressive central giant cell lesion treated with denosumab

Case report of aggressive central giant cell lesion treated with denosumab

Aggressive Central Giant Cell Lesion: Case Report of Unsuccessful Treatment with Intralesional Corticosteroid

Aggressive Central Giant Cell Lesion: Case Report of Unsuccessful Treatment with Intralesional Corticosteroid

Surgical Treatment of Aggressive Central Giant Cell Lesion in the Mandible

Surgical Treatment of Aggressive Central Giant Cell Lesion in the Mandible

ANALYSIS OF GLYCOLYTIC METABOLISM AND OSTEOCLASTOGENESIS IN GIANT CELL LESIONS OF THE JAW

The aim of this study was to evaluate the immunohistochemical expression of glut transporter type 1 (GLUT-1) and macrophage-colony stimulating factor (M-CSF) in central giant cell lesion (CGCL) and peripheral giant cell lesion (PGCL), in an attempt to contribute to a better understanding about the pathogenesis of these lesions. 20 aggressive CGCLs, 20 non-aggressive CGCLs and 20 PGCLs were submitted to immunohistochemical analysis using anti-GLUT-1 and anti-M-CSF antibodies. A semi-quantitative assessment was performed based on intensity and percentage of immunoreactivity mononuclear cells (MCs) and multinuclear giant cells (MGCs). Concerning GLUT-1 expression, the groups showed an increasing gradient in MCs, with lower values for PGCLs, followed by non-aggressive and aggressive CGCLs. For M-CSF, staining intensity in MCs and MGCs showed significant differences between PGCLs and non-aggressive CGCLs, and between non-aggressive and aggressive CGCLs. These findings suggest that GLUT-1 play an important role in providing energy for cell metabolism. Moreover, M-CSF may contribute to osteoclastogenesis and bone resorption mechanism in the studied lesions.

Comprehensive Genomic Profiling of Aggressive Central Giant Cell Lesions

Comprehensive Genomic Profiling of Aggressive Central Giant Cell Lesions

Aggressive Central Giant Cell Lesion Involving Anterior Mandible

Aggressive Central Giant Cell Lesion Involving Anterior Mandible

Comprehensive Genomic Profiling of Aggressive Central Giant Cell Lesion Identifies Targeted Therapy Treatment Option With Subsequent Response

Aggressive central giant cell lesions (CGCL) of the jaws are managed with surgical and/or medical therapy (corticosteroid injections or systemic calcitonin, denosumab, or interferon-α). These therapies can cause significant morbidity and/or adverse effects, and a subset of aggressive CGCL are refractory to some or all of these measures. In a patient with locally advanced, multiply recurrent, and refractory CGCL, can comprehensive genomic profiling (CGP) identify clinically relevant genomic alterations (CRGA) and possible targeted medical therapy, a novel treatment concept for CGCL?

Treatment of Aggressive Central Giant Cell Lesion With Calcitonin Prior to Surgical Approach: A Case Report

Treatment of Aggressive Central Giant Cell Lesion With Calcitonin Prior to Surgical Approach: A Case Report

Aggressive Central Giant Cell Lesion in Mandible: A Case Report

Aggressive Central Giant Cell Lesion in Mandible: A Case Report

Glucocorticoids, calcitonin, and osteocalcin cannot differentiate between aggressive and nonaggressive central giant cell lesions of the jaws

To evaluate the expression of glucocorticoid receptor (GR), calcitonin receptor (CTR), and osteocalcin (OC) in aggressive and nonaggressive central giant cell lesions (CGCLs). The numbers of mitotic and multinucleated giant cells were also evaluated. Thirty-one cases of CGCL were submitted for immunohistochemistry. Mitotic figures and multinucleated giant cells were assessed through histochemical analyses. Positive staining for GR, CTR, and OC was observed in all cases studied. There were no differences between CGCL variants with regard to the expression of GR, CTR, or OC. The aggressive group showed a higher number of multinucleated giant cells compared with the nonaggressive group (P < .05). Nonaggressive and aggressive CGCLs cannot be distinguished by OC, CTR, or GR expression, although the number of multinucleated giant cells may help differentiate between CGCL types.

Treatment of an aggressive central giant cell lesion

Central giant cell lesion (CGCL) is an uncommon alteration of obscure etiology that, although benign, can be highly destructive. This paper presents the case of a patient with CGCL addressing its diagnosis and treatment. An 18-year-old male patient with facial asymmetry due to signifi cant volumetric increase in the right parotidmasseteric and submandibular regions with 9 months of evolution attended the Department of Dentistry of Mato Grosso Cancer Hospital. After clinical and imaginological examinations, an incisional biopsy was performed leading to the diagnostic of CGCL. With the negative results for hyperparathyroidism, the lesion reduction was attempted with corticosteroids infi ltrations. Due to the lesion extension and the lack of response to the infi ltrations, the resection was performed. The patient is in attendance for 2 years without any symptoms of recurrence. Although more prevalent among female, young adults and elderly, the CGCL may present in other patients and the professional must be aware. The therapy of choice in this pathology varies with the aggressiveness and extension of the lesion. More aggressive lesions can lead to more extreme clinical management and involve the need for surgical resection.

Aggressive Central Giant Cell Lesion of Maxilla in a Young Patient Nonresponsive to Intralesional Corticosteroid Treatment With 10 Years of Follow-Up: Case Report

Aggressive Central Giant Cell Lesion of Maxilla in a Young Patient Nonresponsive to Intralesional Corticosteroid Treatment With 10 Years of Follow-Up: Case Report

Intralesional corticosteroid injections in the treatment of central giant cell lesions of the jaws: A meta-analytic study

Objective: The aim of this study was to evaluate the response of treatment of central giant cell lesion to intralesional corticosteroid injections. Study Design: Review of articles indexed in PubMed on the topic between the years 1988 and 2011, and development of a descriptive meta-analysis of the results. Results: Sample of 41 patients primarily treated with intralesional corticosteroid injections was obtained, with a male female ratio of 1:0.95, being 23 aggressive and 18 non-aggressive central giant cell lesions. Triamcinolone acetonide and triamcinolone hexacetonide were the drugs used, and 78.0% cases were considered as good result, 14.6% were considered as moderate response and 7.3% were considered as negative result to treatment. Considering the aggressiveness, 88.9% of non-aggressive lesions presented a good response to treatment, in aggressive central giant cell lesions, 69.6% presented a good response to intralesional corticosteroid injections. Conclusion: In view of the results analyzed, intralesional corticosteroid injections could be considered as first treatment option for central giant cell lesion. Key words:Central giant cell lesion, corticosteroids injections, triamcinolone hexacetonide, triamcinolone acetonide.

Overexpression of matrix metalloproteinase (MMP)-1 and -9 in central giant cell lesions of the jaws: implications for clinical behavior

The aim of this study was to investigate the relationship between the immunohistochemical expression of MMP-1 and MMP-9 with the clinical behavior of central giant cell lesions (CGCLs) of the jaws. Paraffin-embedded tissue from 30 aggressive and 12 nonaggressive CGCLs was assessed for the expression of MMP-1 and MMP-9 using immunohistochemistry. Although cellular immunolocalization patterns of MMP-1 and MMP-9 were similar, mean values of expression estimation/SID scores of each protease were significantly higher in aggressive CGCLs in comparison with nonaggressive lesions. Moreover, linear regression analysis showed that there was a reasonably good correlation not only between the expression estimation but also among SID scores of the 2 proteolytic enzymes. The findings of this study suggest a role for MMP-1 and MMP-9 in the resorptive activity of different cellular groups in CGCLs and indicate that differences in immunoreactivity of these 2 proteolytic enzymes may underlie the distinct clinical behavior.

Complications of alpha-interferon therapy for aggressive central giant cell lesion of the maxilla

Treatment of giant cell lesions of the jaws is currently a subject of acute interest in the maxillofacial community. Based on their presumptive histological and biological similarities to both the "brown tumors" of hyperparathyroidism as well as proliferative vascular lesions, both calcitonin and interferon alpha administration have been attempted in patients suffering from these lesions. We present a case report of one young female in which both of these treatment modalities were instituted. We also discuss a rarely reported complication consisting of drug-induced lupus erythematosis and pancreatitis secondary to interferon alpha use.