Benign Bony Lesions Research Articles

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.

Clinical value of whole-body magnetic resonance imaging in health screening of general adult population.

BackgroundWhole-body magnetic resonance imaging (WB-MRI) and angiography (WB-MRA) has become increasingly popular in population-based research. We evaluated retrospectively the frequency of potentially relevant incidental findings throughout the body.Materials and methods22 highly health-conscious managers (18 men, mean age 47±9 years) underwent WB-MRI and WB-MRA between March 2012 and September 2013 on a Discovery MR750w wide bore 3 Tesla device (GE Healthcare) using T1 weighted, short tau inversion recovery (STIR) and diffusion weighted imaging (DWI) acquisitions according to a standardized protocol.ResultsA suspicious (pararectal) malignancy was detected in one patient which was confirmed by an endorectal sonography. Incidental findings were described in 20 subjects, including hydrocele (11 patients), benign bony lesion (7 patients) and non-specific lymph nodes (5 patients). Further investigations were recommended in 68% (ultrasound: 36%, computed tomography: 28%, mammography: 9%, additional MRI: 9%). WB-MRA were negative in 16 subjects. Vascular normal variations were reported in 23%, and a 40% left proximal common carotid artery stenosis were described in one subject.ConclusionsWB-MRI and MRA lead to the detection of clinically relevant diseases and unexpected findings in a cohort of healthy adults that require further imaging or surveillance in 68%. WB-MR imaging may play a paramount role in health screening, especially in the future generation of (epi)genetic based screening of malignant and atherosclerotic disorders. Our study is the first which involved a highly selected patient group using a high field 3-T wide bore magnet system with T1, STIR, MRA and whole-body DWI acquisitions as well.

Osteochondroma of the mandibular condyle: A case report

Introduction: Osteochondromas or osteocartilaginous exostoses are the most common benign tumors of the bones. It is characterized as a type of overgrowth that can occur in any bone where cartilage forms bone. It is uncommon in this part of body because of intramembranous origin of craniofacial bones. Osteochondromas do not result from any injury and the exact cause remains unknown. recent research has indicated that multiple osteochondromas is an autosomal dominant inherited disease. the treatment choice for osteochondroma is surgical removal of solitary lesion or partial excision of the outgrowth when symptoms cause motion limitations or nerve and blood vessel impingements. Osteochondroma of the mandibular condyle is extremely rare. case report: A 45-year-old female presented to our department with diffuse swelling in her left side of face and pain in her left ear while opening the mouth since last six months. clinically, mouth opening was limited with deviation of mandible towards right side while opening mouth. there was unilateral posterior crossbite on the right side. Protrusive movement and lateral excursions of mandible were restricted. the lesion appeared to be benign bony lesion and complete surgical excision of the whole tumor mass along with condylectomy was performed under general anesthesia. conclusion: As osteochondroma is a benign neoplasm, various treatment modalities include resection of tumor along with condylectomy, condylectomy with reconstruction of the resected condyle if indicated or selected tumor removal without condylectomy. the prognosis of osteochondroma is usually excellent after adequate excision. this case showed no recurrence after the treatment. Malignant transformation of the lesion is exceedingly rare.

Fibrous dysplasia of femur, treated with fibular bone graft

Background: Fibrous dysplasia is a benign bony lesion managed surgically with curettage, bone grafting, and, in some cases, internal fixation. Aims: Study result of cortical bone grafting with fibular strut graft in patient of symptomatic dysplastic lesion without varus deformity of proximal femur. Case Report: A 25-year-old female presented with pain in left hip for 3 months which increased in intensity during walking. Clinically there was no swelling or deformity and tenderness. Range of hip joint movement was normal. The patients had no endocrine disturbances. X-rays of left proximal femur showed radiolucent cystic area involving trochanter, neck, and 30% head at postero-inferior aspect. No pathological fracture was seen. Image showed homogeneous loss of the normal trabecular pattern, with a ground-glass appearance caused by fibrous dysplasia. Patient underwent dual autogenous non-vascularized fibular strut grafts. The dual fibular graft was used as a bridge in the dysplastic lesion in femoral neck and it was securely anchored to the head of femur as well as lateral femoral cortex. The fibular graft was providing excellent structural support without any need for any form of internal fixation. At routine follow-up at 8 months, patient was found ambulating at her own without any substantial pain at the hip joint. Conclusion: For carefully selected patients (symptomatic dysplastic lesion without varus deformity of proximal femur) cortical bone grafting with fibular strut graft is an excellent procedure which provide strong structural support to biomechanically weakened bone.

BRODIE'S ABSCESS MIMICKING AS OF MALIGNANCY: CASE REPORT WITH RADIOLOGICAL FEATURES

Brodie's abscess is described by a localized collection of abscess usually found in metaphysic of long bones. On imaging it may mimic other malignant and benign bony lesions which need histopathological correlation. After confirming the diagnosis, it can be successfully treated with surgical debridement and proper antibiotics. We report a case of 15 year old female with chronic infection of tibia mimicking as malignancy for which MRI and histopathology was confirmatory in our diagnosis.

Comparative Case Series of Exostoses and Osteomas of the Internal Auditory Canal

Exostoses and osteomas are benign bony lesions of the auditory canal. Although common in the external auditory canal, they are rare and difficult to distinguish in the internal auditory canal (IAC). In this literature review and case presentation, we define radiologic and histologic criteria to differentiate exostoses from osteomas of the IAC. Two patients with exostoses and 1 patient with an osteoma of the IAC are described here. Patient 1 presented with disabling vertigo and was found to have bilateral exostoses with nerve impingement on the right. After removal of the right-sided exostoses via retrosigmoid craniotomy, the patient had complete resolution of her symptoms over 1 year. Patient 2 presented with bilateral pulsatile tinnitus and vertigo and was found to have bilateral IAC exostoses. Patient 3 presented with hearing loss and tinnitus, and a unilateral IAC osteoma was ultimately discovered. Because of the mild nature of their symptoms, patients 2 and 3 were managed without surgery. We show that IAC osteomas can be differentiated from exostoses by radiographic evidence of bone marrow in high-resolution computed tomography scans, or by the presence of fibrovascular channels on histologic analysis. Management of these rare entities is customized on the basis of patient symptoms.

Surgical treatment and reconstruction for central giant cell granuloma of the jaws: A review of 18 cases

Central giant cell granuloma (CGCG) is an uncommon benign bony lesion that occurs in the mandible and maxilla. The clinical behaviour of CGCG ranges from a slow-growing asymptomatic swelling to an aggressive lesion that presents pain, local bone destruction, root resorption and tooth displacement. Therapeutic options have varied greatly over the years. Non-surgical treatments with alpha interferon (alpha-IFN), calcitonin and corticosteroids have been described and their benefits may be worthy of consideration. Surgery is considered the traditional treatment and it is still the most accepted one, however in the literature not all authors agree on the type of surgery which should be performed. Although en bloc resection provides the lowest recurrence rate, only a few single case reports describe the use of this technique followed by reconstruction with autogenous bone grafts. The authors report their experience with en bloc resection of 18 wide CGCGs which had not been previously treated medically. Immediate reconstruction was carried out for all cases and in one, a fibula free flap was used to reconstruct the mandible. No recurrence was observed. After complete healing of the graft, prosthetic rehabilitation via implants was performed. This allowed the best functional and aesthetic results.

Intra-osseous lesions in Greek children and adolescents. A study based on biopsy material over a 26-year period

The purpose of this retrospective study was to investigate the spectrum of oral intra-osseous lesions in a Greek population, consisting of children and adolescents under 18 years of age. Data was obtained from the histopathological reports that accompanied biopsy request forms, which were retrieved from the files of the Oral Pathology Department, Faculty of Dentistry, University of Athens, during a 26-year period. A retrospective analysis with respect to patients' age and gender, frequency and location of the lesions was performed. The lesions were classified into cystic (odontogenic and non-odontogenic) and solid lesions (odontogenic and non-odontogenic). The patients were divided into three age groups: a) 0-6 years old, b) 7-12 years old and c) 13-18 years old. 474 intra-osseous lesions were detected and represented 2.38% out of a total of 19933 biopsies. Male/female ratio was 1.25/1. The majority of the lesions was located in the mandible (49.8%) and occurred in the third age group of patients (58.7%). Odontogenic cysts represented the most frequent intraosseous lesion (64.1%) followed by non-odontogenic solid lesions representing 22.5% of the intra-osseous population. The most frequently encountered lesions in descending order were radicular (36.3%) and dentigerous (18%) cysts, keratocysts (9.5%), apical granulomas (7.6%), odontomas (6%) and fibrous dysplasia (5%). Only 6 malignant lesions were reported (1.3%). This clinicopathologic study revealed that a broad spectrum of mostly benign bony lesions may occur during childhood.

Central giant cell granuloma

The central giant cell granuloma (CGCG) is an uncommon benign bony lesion that accounts for less than 7% of all benign lesions of the jaws in tooth-bearing areas. Its etiology is unknown and its biological behavior is poorly understood. This condition is a slow-growing, asymptomatic lesion that usually affects children and young adults, predominantly females. The following report illustrates the differential diagnosis, surgery, final diagnosis and pathology of a fast-growing CGCG in a 4-year-old girl.

Cytological diagnosis of skeletal lesions. Fine-needle aspiration biopsy in 110 tumours.

We have previously shown that cytological diagnosis based on fine-needle aspiration biopsy (FNAB) is a safe and efficient method for the discrimination between benign, primary malignant and metastatic bony lesions. We have now studied metastatic lesions to assess the diagnostic accuracy and to ascertain whether FNAB allows identification of the primary lesion. Between 1990 and 1997, 447 patients were referred for diagnosis of skeletal lesions of unknown type. Of these 119 proved to have metastatic disease, either myeloma or lymphoma. Nine were excluded leaving 110 consecutive patients with metastatic carcinoma (80), myeloma (16) or lymphoma (14). FNAB gave a correct diagnosis in 102 of the 110 patients (93%). In eight it was inconclusive. It correctly diagnosed 15 of 16 patients with myeloma, 12 of 14 with lymphoma, and 75 of 80 with metastatic carcinoma. Furthermore, the site and type of malignancy were correctly suggested in two-thirds of patients with metastatic carcinoma. Overall, only seven open biopsies were carried out. We conclude that time-consuming and costly investigations can be reduced by choosing FNAB as the initial diagnostic method for skeletal lesions of unknown origin. The choice of radiological examinations, laboratory tests and surgical biopsies can be determined by using FNAB.

The Differential Diagnosis of Benign and Malignant Bony Lesions in Bone Scanning

For the evaluation of bony metastases in cancer patients, bone scanning has become an important tool, but some limitations exist. One of these is the differential diagnosis of benign and malignant bony lesions, in which bone scanning shows one or more lesions in the spine. To help solve this, bone scintigraphy was performed 4 and 24 hours after intravenous injection of Tc-99m MDP; the ratio of radiouptake in the lesion and normal spine was measured as 24-hr/4-hr (T/F) ratio. Fifty-four patients with an average age of 56 years were studied and divided into two groups. Group A included 34 patients (17 women and 17 men) with bony metastases. Group B included 20 patients (8 women and 12 men) with radiographically proven benign bony lesions and no evidence of cancer. An LFOV Elscint Apex 400 digital gamma camera and an Informatek Simis 5 nuclear minicomputer were used. The results showed that the T/F ratio of Group A was 1.3 +/- 0.15 (mean +/- SD) and that of Group B was 1.0 +/- 0.12 (mean +/- SD). The P value was less than 0.001. We conclude that the ratio of radiouptake of lesions and normal spine at 24 and 4 hours may be a reliable method of differentiating benign bony lesions from malignant lesions.

Clinical Study of Pathological Fractures Due to Benign Bony Lesions in Extremities

Clinical Study of Pathological Fractures Due to Benign Bony Lesions in Extremities