Fibrovascular Connective Tissue Research Articles

Central giant cell granuloma in the posterior region of mandible mimicking a fibro-osseous lesion and hemangioma: a case report

BackgroundA central giant cell granuloma (CGCG) is a benign, proliferative, intraosseous, and non-odontogenic lesion occurring primarily in children and young adults. On the histological level, it is characterized by numerous multinucleated giant cells scattered randomly throughout a sea of spindle-shaped mesenchymal stromal cells which are dispersed throughout the fibrovascular connective tissue stroma containing areas of haemorrhage. When it comes to radiographic features, CGCG can have an array of variations, ranging from well-defined expansile lesions to ill-defined and destructive lesions, with or without expansion.Case presentationThis case report reviews an 11-year-old Caucasian patient with a chief complaint of slow-growing swelling involving the right posterior mandibular region. The cone beam computed tomography (CBCT) revealed an ill-defined mixed lesion mimicking both fibro-osseous lesion and hemangioma. However, microscopic examination revealed multinucleated giant cells in a fibrous stroma suggestive of central giant cell granuloma.ConclusionOur intent in reporting this case is to highlight the importance of thorough clinical, radiographical and histopathological examination for accurate diagnosis and therapeutic interventions as well as to emphasize the importance of taking different possibilities into consideration when examining bony swellings in the head and neck region.

High-throughput screening of transient receptor potential (TRP) channels in pterygium.

Pterygium is a hyaline degenerative disease of the conjunctiva characterized by the progression of fibrovascular connective tissue from the bulbar conjunctiva to the cornea. The mechanism of pterygium formation is still not fully understood. Transient receptor potential (TRP) channels are a group of ion channels with distinct characteristics. Recent indications suggest TRP channels may play a significant regulatory role in pterygium development, but previous studies have mainly focused on in silico analysis. Accordingly, in the present study, we aimed to decipher the expression signatures and role of TRP channels in pterygium development. The study encompassed a cohort of 45 patients matched for age and gender distribution, comprising 30 individuals with primary pterygium (PP) and 15 individuals with recurrent pterygium(RP). The control group consisted of unaffected conjunctival tissue obtained from the same set of patients. High-throughput screening of differentially expressed TRP channels in pterygium tissues was achieved with the help of Fluidigm 96.96 Dynamic Array Expression Chip and reactions were held in BioMark™ HD System Real-Time PCR platform. Statistically significant increases were found in the expression of 21 genes, mainly TRPA1 (p = 0.021), TRPC2 (p = 0.001), and TRPM8 (p = 0.003), in patients with PP, and in TRPC5 (p = 0.05), TRPM2 (p = 0.029), TRPM4 (p = 0.03), TRPM6 (p = 0.045), TRPM8 (p = 0.038), TRPV1 (p = 0.01) and TRPV4 (p = 0.025) genes in RP tissues. Collectively, TRP channel proteins appear to play pivotal roles in both the development and progression of pterygium, making them promising candidates for future therapeutic interventions in patients afflicted by this condition.

Case report on aggressive central giant cell granuloma of mandible

Central giant cell granuloma (CGCG) is an uncommon, benign but aggressive osteolytic neoplasm of the craniomaxillofacial region, histologically characterized by an abundance of evenly distributed multinucleated giant cells within a sea of spindle-shaped mesenchymal stromal cells, scattered throughout the fibrovascular connective tissue stroma containing areas of hemorrhage. A rapid diagnostic assessment, together with an adequate histopathologic verification, is essential to improve the management and the prognosis of this locally destructive lesion. A rare case of a large destructive CGCG involving the entire right side of mandible, causing extensive bony resorption, and buccal, medial as well as inferior border cortical expansion, in a young female is presented. It was treated successfully by surgical excision under general anesthesia.

Central giant cell granuloma mimicking a malignant lesion of mandible: A case report

Central giant cell granuloma (CGCG) is a relatively uncommon benign osseous lesion with sometimes aggressive nature. The nature of this lesion is unknown and although the exact cause is unclear, the three theories about possibility of its nature are: developmental anomaly, reactive lesion or benign neoplasm. Histologically by presence of multinucleated giant cells within a stroma of spindle-shaped mesenchymal and fibro vascular connective tissue along with containing of hemorrhagic areas is characterized. This case report presents the diagnosis and management of a CGCG in a 50 years-old man with biopsy and surgical treatments. The lesion involve the left side of mandibular. Diagnosis plan was designed based on the combination of pathology and imaging. Finally after en bloc resection of involved regions of mandible, a titanium plate prosthesis was used for the jaw reconstruction. Since some of CGCG lesions can be highly invasive and inclinically and radiographic features can mimic as malignancy lesions.

Traumatic bone cyst of the mandible: a case report

Background: Traumatic bone cyst (TBC) is defined as a non-neoplastic osseous lesion and is considered a pseudocyst since it lacks an epithelial lining. There is a lack of understanding of the etiology and pathogenesis of this lesion. About 90%-95% of TBC cases involve the metaphysis of long bones. This article presented a case of TBC in the mandible. Case Presentation: A 21-year-old male patient was presented with no history of trauma. Intra-oral examination revealed normal soft tissue. The lesion was asymptomatic and the teeth in the affected area responded normally to the vitality test. Orthopantomograph showed a well-defined unilocular radiolucent lesion, altered bone trabeculations with slightly increased bone density from the distal root of tooth # 46 to the distal root of tooth # 48, and mild thinning of the inferior mandibular borders. Cone-beam computed tomography showed a well-defined periapical lesion with a scalloping border around the roots at the same site and the inferior alveolar canal was displaced. The patient was draped and prepared for an incisional biopsy. A scant soft tissue and fragment of bony material were sent for histopathological examination to confirm the diagnosis. Microscopic examination of the specimen revealed a fragment of vital trabecular bone surrounded by fibrovascular connective tissue, and areas of hemorrhage were also observed that were managed by surgical curettage. Osseous regeneration was reported after 12 months of follow-up. Conclusion: Swelling of the mandible without symptom in a young patient, with or without a trauma history would rise the suspension of a solit ary bone cyst.

The impact of polydeoxyribonucleotide on early bone formation in lateral-window sinus floor elevation with simultaneous implant placement.

The aim of this study was to evaluate the impact of polydeoxyribonucleotide (PDRN) on histologic outcomes when implant placement and lateral sinus floor elevation are performed simultaneously. Three bimaxillary premolars (P2, P3, and P4) were extracted from 4 beagle dogs 2 months before lateral sinus floor elevation. After lateral elevation of the sinus membrane, each sinus was allocated to either the test or control group. Sinuses underwent either 1) collagenated synthetic bone graft with PDRN following lateral sinus floor elevation (test group) or 2) collagenated synthetic bone graft without PDRN after lateral sinus floor elevation (control group). Eight weeks after the surgical procedure, all animals were euthanised for a histologic and histomorphometric assessment. Augmented height (AH), protruding height (PH), and bone-to-implant contact in pristine (BICp) and augmented (BICa) bone were measured. The composition of the augmented area, which was divided into 3 areas of interest located in coronal, middle and apical areas (AOI_C, AOI_M, and AOI_A), was calculated with 3 parameters: the area percentage of new bone (pNB), residual bone graft particle (pRBP), and fibrovascular connective tissue (pFVT). AH, PH, BICp, BICa total, BICa coronal, and BICa middle values were not significantly different between sinuses in the control and test groups (all P>0.05). The BICa apical of sinuses in the test group (76.7%±9.3%) showed statistically higher values than those of sinuses in the control group (55.6%±22.1%) (P=0.038). pNB, pRBP, and pFVT showed statistically significant differences between the 2 groups in AOI_A (P=0.038, P=0.028, and P=0.007, respectively). pNB, pRBP, and pFVT in AOI_C and AOI_M were not significantly different between samples in the control and test groups (all P>0.05). The histologic findings revealed that lateral sinus floor elevation with PDRN might improve early new bone formation and enable higher bone-to-implant contact.

Changes in Visual Acuity and Keratometry Readings following Pterygium Excision: A Study in A Public Medical College Hospital

Introduction: Pterygium is a degenerative, triangular wing shaped, fibro vascular connective tissue of bulbar conjunctiva towards and onto the cornea, leading to significant astigmatism. It is a common ophthalmic condition of tropical and sub-tropical country like Bangladesh where there is dry sunny hot dusty climate.
 Purpose: To find out the change in visual acuity and keratomety before and after pterygium excision and effect of different grades of pterygium on the final outcome.
 Methods: This prospective study was carried out from March 2021 to December 2021 at Ophthalmolgy Department, Sher-E-Bangla Medical College & Hospital, Barishal. Total 68 patients with different grades of pterygium were operated for pterygium excision with conjunctival autograft and were studied and analyzed. All the eyes underwent detailed ocular examination like visual acuity measured by Snellen’s chart; refractive astigmatism measured by automated keratometry and slit lamp biomicroscopy and fundus examination.
 Results: Pterygium is more common in males (61.76%) than females (38.23%) where 45.59% cases were in age group of 31-40 years followed by 33.82% in 41-50 years and rare (2.94%) in more than 60 years; so, 86.76% cases are in the age group of 31-60 years. Preoperatively mean±SD of K1 (Horizontal meridian) was 42.428±1.853 D and 3 month after the surgery it was 42.061±0.563 D. On the other hand mean±SD of K2 (vertical) readings before surgical excision were 44.185± 0.871 D and postoperatively after 3 months it was 42.691±0.384 D. Pre and post-operative BCVA in Grade I pterygium cases were 6/6-6/9 both pre & post -operatively. In patients of Grade II preoperative VA was 6/18-6/36 which was postoperatively 6/12-6/18; in Grade III pre and postoperative VA was 6/24-6/36 and 6/12-6/18 respectively. While in Grade IV pterygium VA were 6/36-6/60 preoperatively and 6/18-6/24 postoperatively.
 Conclusion: We conclude that, the greater the grade of pterygium the lesser is the outcome of visual acuity after surgery; the greater was the change in keratometry reading. It was inferred that, timely and appropriate surgery at Grade II & Grade III can result in not only a good visual outcome but also less complications.
 J. Natl. Inst. Ophthalmol. 2022; 5(2):25-30

Langerhans Cell Histiocytosis Occurring in the Wall of a Dentigerous Cyst: Presentation of a Case

<h3>Objective</h3> The dentigerous cyst (DC) is the most common developmental odontogenic cyst. It most frequently oc- curs in association with impacted mandibular third molars. The typical radiographic presentation comprises a well-defined unliocluar radiolucency extending from the cemento-enamel junction. Yet, it is well-documented in the literature that a variety of other pathologic entities may demonstrate overlapping clinical and radiographic features. Here we present a case of Langerhans cell histiocytosis (LCH) occurring in the wall of a DC. LCH is charac- terized by infiltrates of CD1a positive cells. Disease may involve a diverse array of tissues and can be solitary or mul- tifocal. LCH occurs across the age range, yet is most commonly diagnosed in the pediatric population. BRAFV600E mutations have been identified in approximately 50% of cases tested. Here we describe the clinical, radiographic, histopathologic, immunohistochemical (IHC) and molecular findings of a case of LCH occurring in the wall of a DC. <h3>Clinical Presentation</h3> An otherwise healthy 12-year-old male presented for evaluation of an impacted right maxil- lary canine. Imaging demonstrated a 2.9 × 2.0 cm wellcircumscribed unliocluar radiolucency associated with tooth #6. <h3>Intervention and Outcome</h3> The impacted canine was extracted and the cyst enucleated under general anesthesia. Microscopic review showed a cystic lining of non-keratinized stratified squamous epithelium with an inflamed fibrovascular connective tissue wall. The inflammatory infiltrate included plasma cells, lymphocytes, numerous eosinophils, and histiocytoid cells. The histiocytoid cells stained positive for S-100 and CD1a IHC confirming the diagnosis of LCH. Analysis for BRAFV600E was negative. The patient was referred to pediatric hematology and oncology for management. <h3>Conclusion</h3> This case of LCH occurring in the wall of a DC highlights the importance of submitting all excised tissue for histopathological review. It also underscores the need for careful attention in examining the microscopic features of inflammatory infiltrates present in the walls of cystic entities.

Surgical management of central giant cell granuloma of mandible and prosthetic rehabilitation in a nine year girl: A case report

Central giant cell granuloma (CGCG) is an uncommon, benign, idiopathic, osteolytic lesion of jaws, histologically characterized by multinucleated giant cells distributed in fibrovascular connective tissue stroma. Accurate diagnosis of the lesion is essential for the successful management and the prognosis of this locally destructive lesion. In this paper, a rare case of large destructive CGCG involving anterior region of mandible, causing expansion of labial cortical plate and mobility of teeth in a nine-year girl is presented. It was treated successfully by enucleation and curettage with satisfactory preservation of the continuity of mandible. Nine months post operatively, the child was rehabilitated with a temporary partial denture to improve esthetics, phonetics and function. One year clinical and radiographic follow up showed new bone formation and no evidence of recurrence.

Dysplasia in Papilloma at the Tip of the Tongue; A Rare Entity-Importance of on Time Prevention

Background: Oral papilloma is benign lesion while there is concern about high-risk types of Human Papilloma Virus (HPV) for cancer. Case Presentation: The patient was a 30-year-old woman who presented to the School of Dentistry, Semnan University of Medical Sciences for orthodontic treatment. Intraoral examinations revealed a prominent white papule on the tip of the tongue. Histopathologic exanimation revealed the proliferation of hyper keratinized stratified squamous epithelium arranged in projections with fibrovascular connective tissue cores, cell irregularity with hyperchromatic nucleus and koilocytes within the epithelium which confirmed the diagnosis of squamous papilloma (SP) with mild to moderate dysplasia. The patient was instructed to take care of the sexual behaviors and the injection of Gardasil vaccine was recommended. A month later, there was no evidence of a lesion. Conclusion: Though SPs are common lesions in the oral cavity, occurrence of dysplasia on SPs on the anterior part of the mouth is rare. Surgical removal supplemented by administration of Gardasil vaccine can be the treatment of choice in these cases. The significance of close attention to the oral lesions and consultation with an Oral and Maxillofacial Medicine Specialist is highly recommended in order to accurate diagnosis and timely treatment.

A rare coexistence of central giant cell granuloma and parathyroid adenoma: Case report

Central giant cell granuloma is a reparative bony lesion characterised by abundant multinucleated giant cells within a sea of spindle shaped mesenchymal stromal cells. Giant cells are scattered throughout the fibrovascular connective tissue stroma containing hemorrhage. Its coexistence with parathyroid adenoma is very rare. Brown tumour is a close differential in this scenario. Herein we present the case of a central giant cell granuloma of maxilla and parathyroid adenoma diagnosed almost during the same time in a 58 years old male.

Tarsal villonodular tenosynovitis (giant cell tumor of tendon sheath) in a dog

ABSTRACT: A 12-year-old female mixed-breed dog presented with lameness, pain, and an enlarged, non-ulcerated, nodular mass in the region proximal to the tarsal joint of the right pelvic limb. Surgical excision was performed, revealing a 6.5 cm mass adherent to the deep flexor tendon and adjacent tissues. The cut section had cysts filled with blackened clotted material, which exuded reddish serous fluid. Microscopically, the cysts were filled with red blood cells and were either denuded or covered by synoviocytes. In addition, the mass was characterized by marked fibrovascular connective tissue associated with siderophages and multinucleated giant cells. These findings were consistent with those of pigmented villonodular tenosynovitis, a rare condition affecting several animal species and humans.

S1916 Liposarcoma Associated with Fibrovascular Polyp of the Esophagus

INTRODUCTION: Liposarcomas arise from adipocytes of soft tissue however usually in the body wall or extremities. Gastrointestinal involvement is rare. CASE DESCRIPTION/METHODS: 72-year-old man with a history of GERD presented with progressive dysphagia for a few weeks. He also reported an unintentional weight loss of about 35 lbs. He denied any family history of esophageal or gastric cancer. He denied any tobacco or alcohol use. He underwent an upper endoscopy which showed a large 14 cm pedunculated polyp in the esophagus extending from the upper esophageal sphincter (UES) to about 2 cm above the gastroesophageal junction occupying about 70% of the esophageal lumen, suspicious for a fibrovascular polyp (Figure 1). The polyp was resected by endoscopic submucosal dissection of the wide base, about 1 cm from the UES (Figures 2 and 3). Following the procedure, the patient's diet was advanced and he was discharged home. Histological evaluation revealed a polypoid lesion with a core of fibrovascular connective tissue and normal overlying squamous epithelium. Small areas of atypical lipomatous tissue was seen with amplified expression of MDM2 which was consistent with the diagnosis of a well-differentiated liposarcoma. The base of the polyp was clear of any malignant cells. DISCUSSION: Fibrovascular polyps (FVP) are benign tumors of the esophagus usually composed of a combination of fibrous, vascular and adipose tissue. We present a case of an FVP with malignant progression of the adipose tissue within the polyp. While this is a very rare occurrence, the goal of endoscopic resection is to resect the polyp with an intact base for histological evaluation of the margin.Figure 1.: Esophageal Polyp in Middle Third of Esophagus.Figure 2.: Upper third of esophagus during Mucosal Resection.Figure 3.: Polyp Retrieval During Resection.

ORAL CONDYLOMA ACUMINATUM IN CHILDREN: A CASE REPORT

Condyloma acuminatum is induced disease by human papillomavirus that commonly affects the genital region and is rarely observed on oral mucosa. Pathogenesis is associated with sexual contact or trauma, and when it develops in children it can indicate sexual abuse. Based on this, we aimed to report a case of condyloma acuminatum in a child. A 9-year-old male patient clinically presented verrucous nodule, asymptomatic, with history of evolution of 18 months, measuring 1 cm, and localized in left side of lower lip. No signs of other lesions in the skin were present. Clinical hypothesis was squamous papilloma or condyloma acuminatum. Excisional biopsy was performed, and histopathologic analysis revealed hyperplasia of parakeratinized squamous epithelium, with exophytic projections exhibiting acanthosis and exocytosis. Clear cytoplasm cells, suggestive of koilocytosis, were also observed. Subjacent fibrovascular connective tissue was also seen. Based on histopathologic findings, final diagnosis was condyloma acuminatum. After 12 months of follow-up, no sign of recurrence was observed. Condyloma acuminatum is induced disease by human papillomavirus that commonly affects the genital region and is rarely observed on oral mucosa. Pathogenesis is associated with sexual contact or trauma, and when it develops in children it can indicate sexual abuse. Based on this, we aimed to report a case of condyloma acuminatum in a child. A 9-year-old male patient clinically presented verrucous nodule, asymptomatic, with history of evolution of 18 months, measuring 1 cm, and localized in left side of lower lip. No signs of other lesions in the skin were present. Clinical hypothesis was squamous papilloma or condyloma acuminatum. Excisional biopsy was performed, and histopathologic analysis revealed hyperplasia of parakeratinized squamous epithelium, with exophytic projections exhibiting acanthosis and exocytosis. Clear cytoplasm cells, suggestive of koilocytosis, were also observed. Subjacent fibrovascular connective tissue was also seen. Based on histopathologic findings, final diagnosis was condyloma acuminatum. After 12 months of follow-up, no sign of recurrence was observed.

LIPOMA OF THE TONGUE IN AN ELDERLY PATIENT: A CASE REPORT

Lipomas are mesenchymal neoplasms consisting of mature adipocytes, which account for only 1% to 5% of all oral benign tumors. These lesions are occasionally altered by an admixture of other mesenchymal elements that comprise an intrinsic part of the tumor. A 76-year-old white woman was referred for evaluation of a painless, slow-growing swelling on the tongue that had been identified 3 years earlier. Her medical history was unremarkable. Intraoral examination revealed a yellowish, soft, sessile nodule on the right lateral border and ventral surface of the tongue, measuring approximately 2 cm. Under the diagnostic hypothesis of lipoma, an excisional biopsy was performed. Histopathologic analysis revealed a well-delimited proliferation of mature adipocytes arranged in lobules and separated by thin septa of fibrovascular connective tissue. The final diagnosis was lipoma. Eight months after surgical excision, clinical signs of recurrence were not detected. The patient remains under clinical follow-up.

Rare type of grade ii lipid-rich canine mammary carcinoma

A Daschund intact bitch had a single spherical, multinodular and greyish white mass, measured about 6.5cm, on the left caudal abdominal mammary gland. Fine needle aspiration biopsy examination revealed the presence of numerous epithelial clusters with malignant characteristic of nucleus and cytoplasm. Histopathological examination revealed that cysts were separated by fibrovascular connective tissue. Round to oval neoplastic cells with distinct cell borders. There were multiple small to large solitary vacuoles in the cytoplasm that pushed the nuclei to the periphery of the cell (Signet ring cell). Based on the cytological and histopathological examination the case was diagnosed as special type of Grade II lipid- rich carcinoma.

Subsynovial connective tissue development in the rabbit carpal tunnel.

The carpal tunnel contains the digital flexor tendons and the median nerve, which are embedded in a unique network of fibrovascular interconnected subsynovial connective tissue (SSCT). Fibrous hypertrophy of the SSCT and subsequent adaptations in mechanical response are found in patients with carpal tunnel syndrome (CTS), but not much is known about the development of the SSCT. This observational study describes the morphological development of SSCT using histology and ultramicroscopy in an animal model at four time points between late‐term fetuses through adulthood. A transition is seen between 3 days and 6 weeks post‐partum from a dense solid SSCT matrix to a complex multilayered structure connected with collagenous fibrils. These preliminary data show a developmental pattern that matches an adaptive response of the SSCT to loading and motion. Understanding the anatomical development aids in recognizing the pathophysiology of CTS and supports research on new therapeutic approaches.

Fatal Peritoneal Migration of Strongylus edentatus in a Foal

A 7-month-old female mixed breed foal with a 2-day history of recumbency and inability to open its mouth convulsed acutely and died and was submitted for necropsy examination. The foal was thin and large patches of haemorrhage were present throughout the peritoneal wall, the diaphragmatic surfaces and the retroperitoneum. Numerous nematode larvae were visible on the serosal surfaces and penetrated and embedded into the subserosa associated with the haemorrhages. The dorsal portion of the abdominal diaphragm had a partial tear and large numbers of nematodes were within the muscle fibres. Histologically, the larvae had a smooth cuticle, polymyarian/coelomyarian musculature and multinucleated intestinal cells, and were typically surrounded by haemorrhage, neutrophils, dense fibrovascular connective tissue and rare multinucleated giant cells. Parasitological examination identified the larvae as Strongylus edentatus based on the morphology of the buccal capsule. Additionally, there was severe muscle necrosis of the tongue and liver tissue analysis detected selenium deficiency. S. edentatus infections are uncommon in California, USA, and are typically non-lethal. In this case, the selenium deficiency may have led to immunosuppression, resulting in the hyperinfection with S. edentatus, and to the muscle damage and tear of the diaphragm. Although ivermectin treatment was indicated in the history, inadequate deworming or anthelmintic resistance may have played a role in the severity of infection.

A Systematic Review of Sellar and Parasellar Brown Tumors: An Analysis of Clinical, Diagnostic, and Management Profiles

To systematically review and analyze clinical, diagnostic, and management trends in sellar and parasellar brown tumors reported in existing literature. In this systematic review, PubMed, Ovid MEDLINE, Scopus, and Google Scholar databases were searched for reported cases of sellar/parasellar brown tumors. Relevant titles and abstracts were screened in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Articles meeting inclusion criteria were subjected to data extraction, summarization, and analysis. A rare case of parasellar brown tumor was also presented. Eight reports (including the current report) were eligible for inclusion. Mean patient age was 42.75 years. Reported symptoms included visual disturbances (n= 6), headache (n= 5), fatigue (n= 3), nausea/vomiting (n= 2), chest pain (n= 1), neck pain (n= 1), and dysphagia (n= 1). In cases where computed tomography findings were provided (n= 6), lesions were noted to be expansile and lytic. Lesions were hyperintense on T2-weighted magnetic resonance imaging (66.7%) and demonstrated contrast enhancement (83.3%). Histology unanimously showed multinucleated giant cells in a fibrovascular connective tissue stroma. Dramatic symptom resolution was noted in all patients who underwent resection of the sellar/parasellar brown tumor (n= 4; 50%). Sellar/parasellar brown tumors are a rare, tertiary manifestation of hyperparathyroidism and can be elusive to diagnose. Diagnosis requires a high index of clinical suspicion in addition to comprehensive biochemical testing, imaging, and histopathologic analysis. Surgical extirpation is favored in cases where the lesion is causing compressive symptoms, or if it is unresponsive to management of hyperparathyroidism.

Management of Central Giant Cell Granulomas of the Jaws: An Unusual Case Report with Critical Appraisal of Existing Literature.

Central giant cell granuloma (CGCG) is an uncommon, benign but aggressive osteolytic neoplasm of the craniomaxillofacial region, histologically characterized by an abundance of evenly distributed multinucleated giant cells within a sea of spindle-shaped mesenchymal stromal cells, scattered throughout the fibrovascular connective tissue stroma containing areas of hemorrhage. A rapid diagnostic assessment, together with an adequate histopathologic verification, is essential to improve the management and the prognosis of this locally destructive lesion. A rare case of a large destructive CGCG involving the entire right angle of mandible, causing extensive bony resorption, and buccal, medial as well as inferior border cortical expansion with multiple perforations, in a young child is presented. It was treated successfully by enucleation and aggressive curettage followed by peripheral ostectomy preserving the continuity of the mandible. Two adjunctive measures were employed; first, chemical cauterization of the residual bony walls to prevent possible recurrence, for which this tumor is notorious, and second, placement of fresh autologous platelet-rich fibrin within the bony defect to hasten bone fill and reossification, thus obviating the need for a bone graft.