Giant Cell Reparative Granuloma Research Articles

Peripheral giant cell granuloma of orbit: A case report

Giant cell reparative granuloma (GCRG) is a rare locally aggressive benign lesion of orbit with a total of less than 15 reported cases worldwide. A 35-year-old male presented with a left upper eyelid mass. Contrast-enhanced computed tomography orbit revealed a soft-tissue density lesion of the extraconal compartment of the left orbit. Wide local excision was done. Histopathology showed peripheral giant cell granuloma of the orbit with fibroosseous component. No recurrence has been seen after eight months. Definite diagnosis of GCRG is only possible by excision biopsy. Early intervention is important to differentiate from malignant lesion.

Giant cell tumor of the clivus misdiagnosed as calcifying fibrous tumor

Abstract Introduction/Objective Giant cell tumors of bone (GCTs) are generally benign, locally aggressive lesions accounting for approximately 4% of primary bone tumors. GCTs of the skull are rare and constitute <1% of all reported GCTs as they typically occur in the epiphysis of long bones. Specifically, in the clivus location, these tumors are exceedingly rare with fewer than 10 articles in English literature. The purpose of this report is to describe a case of GCT in this unusual location that was misdiagnosed as giant cell reparative granuloma on biopsy and subsequently calcifying fibrous tumor on resection. Methods/Case Report A 34-year-old male presented with history of headache, visual disturbance, epistaxis, and nausea. MRI demonstrated a large soft tissue mass eroding the clivus. A biopsy was interpreted at an outside institution as giant cell reparative granuloma. The patient was treated with denosumab and subsequently underwent resection of the mass due to worsening symptoms. Post-treatment pathology was interpreted as calcifying fibrous tumor. The patient presented to our institution for further management and outside pathology was reviewed. Histologically, the initial tumor was composed of a bland spindle cell proliferation with admixed osteoclast-type giant cells. In this location, the differential diagnosis includes Brown tumor, giant cell reparative granuloma, and, rarely, GCT. HG34W immunostain was positive in the tumor cells confirming the diagnosis of GCT. The post-therapy specimen showed abundant woven bone formation and a lack of giant cells. Post-denosumab GCT are known to show these features. Follow up imaging showed a slow growing moderately enhancing mass at the resection site. Patient is alive with disease 36 months after initial diagnosis. Results (if a Case Study enter NA) NA Conclusion With rare exceptions, bone tumors frequently follow generalized patterns of involvement. Pathologists need to be aware of these exceptions. Appropriate panel of immunohistochemical stains help clinching the right diagnosis, especially in unusual clinical settings.

Giant Cell Tumor and Giant Cell Reparative Granuloma of Bone of the Head: CT and MR Imaging Findings.

This study aimed to determine the features and differentiation of Giant Cell Reparative Granuloma (GCRG) and Giant Cell Tumor (GCT) of the head on CT and MRI. This retrospective study included six patients with histopathology-confirmed head GCRG and 5 patients with histopathology-confirmed head GCT. All images were independently reviewed by two radiologists. The growth pattern, bone changes, MRI signal intensity, enhancement patterns and other image features were recorded. All patients received CT scans and MR images. All the lesions were located centrally in the bone. Osteolytic bone destruction and expansive growth patterns were observed on CT images. Four of six cases broke the cortical bone with residual cortical bone, and the last two showed a thin cortex in GCRG. Five cases broke the cortical bone with residual cortical bone in GCT. There were enhancing septations in GCT lesions on contrast- enhanced T1-Weighted Images (T1WI) while enhancing septations were not present in GCRG cases. The size of GCT lesions was larger than that of GRCG. GCRG and GCT showed iso-low signals on T1WI and iso-high signals on T2-Weighted Images (T2WI). There was a case with cystic or necrotic lesions in each of the two types of lesions. Osteolytic bone destruction and expansive growth patterns were observed in GCTs and GCRGs. The size of the GRCG lesion was smaller than that of the GCT. The presence of enhancing septations and the size of the lesion may distinguish GCTs from GCRG.

Significance of Histone H3.3 (G34W)-Mutant Protein in Pathological Diagnosis of Giant Cell Tumor of Bone.

This study aimed to examine the expression of Histone H3.3 glycine 34 to tryptophan (G34W) mutant protein in Giant Cell Tumor of Bone (GCTB). This analytic observation research used a cross-sectional study design on 71 bone tumors. The cases involved 54 tissue samples diagnosed as GCBT. It was divided into GCTB primer (n=37), recurrent GCTB (n=5), GCTB with metastasis (n=9), and malignant GCTB (n=3). There were 17 samples mimics of GCTB also tested, including chondroblastoma (n=1), giant cell reparative granuloma (n=2), giant cell of tendon sheath (n=7), chondromyxoid fibroma (n=2), aneurysmal bone cyst (n=2), and giant cell-rich osteosarcoma (n=3). The Immunohistochemistry was used to evaluate the expression of G34W-mutated protein in these bone tumors. The representation H3.3 (G34W) was expressed in the nuclei of mononuclear stromal cells but not stained on osteoclast-like giant cells. This study was analyzed by the Chi-square test, Fisher's test, specificity test, and sensitivity test. We obtained p = 0.001 for Histone H3.3 (G34W) mutant expression in GCTB vs Non-GCTB. Statistically, there was no significant difference in the expression level of Histone H3.3 (G34W) in the GCTB and its variants p-value = 0.183. We also obtained that the specificity of Histone H3.3 expression on GCTB was 100% and the sensitivity of Histone H3.3 on GCTB was 77.8%. Histon H3.3 mutant as a mutated driver gene in an Indonesian GCTB can assist to diagnose GCTB and compare it from other bone tumors.

An Unusual Entity: Giant Cell Tumour of Soft Tissue in the Nasal Cavity

Giant cell tumour of soft tissue (GCT-ST) are rare soft tissue tumours, with the first case reported in the 1970s. Involvement of the head and neck region, particularly in the nasal cavity is extremely uncommon. GCT-ST are considered the bone counterpart given the striking histological and immunohistochemical resemblance. Despite that, GCT-ST and GCT of bones are genetically distinct. Microscopically, GCT-ST exhibit numerous osteoclast-type multinucleated giant cells within a background of mononuclear stromal cells. They are locally aggressive and can potentially recur. It is important to distinguish GCT-ST from giant cell reparative granuloma (GCRG) as they both share similar clinical and morphological characteristics, however, they have different treatment modalities. We report a case of GCT-ST occurring in the nasal cavity, an unusual site of presentation.

Central Giant Cell Reparative Granuloma (CGCRG) of the Jaw in Children Treated with Neoadjuvant Bisposphonates: Review and a Case Report.

Central giant cell reparative granuloma (CGCRG) of the jaw is a neoformation localized in the mandible or in the maxillary bone and characterized by fibrous tissue, osteoclast-like giant cells and reactive bone formation. The CGCRG is a less frequent benign tumor but sometimes it is characterized by an aggressive behavior with a very rapid growth. It affects the young adults mainly and the children occasionally. Nowadays no medication therapy is approved for CGCRG in pediatric cases. We present a case of an aggressive form of a mandibular CGCRG in a 5-year child with Arnold-Chiari syndrome. This case is unique for the use of bisphosphonates (BPs) as neoadjuvant therapy in pediatrics. The therapy were administrated with the purpose of arresting the rapid growth of the tumor in order to avoid a demolitive surgery to the young patient. The child was without symptoms and presented an unusual swelling in the left mandible developed in a few weeks. The lesion was diagnosed by a CT scan and it was confirmed by a biopsy performed for histopathological assessment a few days later. The drug therapy consisted of seven cycles iv of Zoledronate associated to Calcium Gluconate. The child was closely observed through clinical and serological evaluations during the following months. About five months after the last cycle of BPs the child underwent CT scan and a conservative surgical treatment, consisted in a deep curettage, was programmed. Seven months after surgery the aesthetic profile of the patient improved and CT scan reported a significant calcic neoapposition in the area of the previous bone lesion. After more than one year from surgery, no relapse was observed. This case report demonstrates that BPs can be used safely in pediatric patients with CGCRG. Especially BPs could have a role as neoadjuvant therapy: If administrated before surgical treatment BPs avoid the necessity of resective surgery and reduce the risk of recurrence in pediatric CGCRG after conservative curettage.

PATH-40. A GIANT CELL LESION RESEMBLING REPARATIVE GIANT CELL GRANULOMA WITH FN1-TEK FUSION, IN THE SPECTRUM OF CALCIFIED CHONDROID MESENCHYMAL NEOPLASM?

Abstract A newly described entity called “calcified chondroid mesenchymal neoplasms” includes chondroid neoplasms with variable amounts of calcification and FN1 fusions [Liu et al, Mod Pathol 2021]. We report a case of a left temporal bone giant cell granuloma-like lesion that also shows an FN1-TEK fusion. Close monitoring with MRI images after surgery has showed no recurrence. Case report: a 33-year-old male developed left jaw pain and he was diagnosed with a temporomandibular joint disorder. He felt left ear fullness and 2 years later experienced severe pain and swelling in the left temporal region. Imaging showed an expansile osseous lesion with multi-cystic components involving the left sphenoid bone as well as all portions of the temporal bone including the mastoid, middle ear cavity, and glenoid fossa. Pathology showed a hemorrhagic giant cell lesion that was negative for H3G34W mutation and USP6 rearrangement, suggesting a reparative giant cell granuloma. A subsequent NGS with the Tempus 648 gene panel did not identify somatic or germline mutations, but an additional Tempus RNA fusion test found a FN1-TEK fusion suggesting the possibility of neoplasia. Close monitoring with brain MRI over past 9 months has shown no signs of recurrence. DISCUSSION A recent small series describes a novel entity called calcified chondroid mesenchymal neoplasm that has FN-1 fusions including a FN1-TEK fusion in one case. The case in that series with FIN1-TEK fusion also showed prominent giant cells. It is unclear whether giant cell granuloma-like lesions with FN1-TEK fusion belong in the calcified chondroid mesenchymal neoplasm spectrum or are a separate non-neoplasm entity that shares the same alteration. More studies are warranted.

Diagnostic utility of CSF1 immunohistochemistry in tenosynovial giant cell tumor for differentiating from giant cell-rich tumors and tumor-like lesions of bone and soft tissue

BackgroundTenosynovial giant cell tumor (TSGCT) is a benign fibrohistiocytic tumor that affects the synovium of joints, bursa, and tendon sheaths and is categorized into localized TSGCT (LTSGCT) and diffuse TSGCT (DTSGCT). LTSGCT and DTSGCT are characterized by recurrent fusions involving the colony-stimulating factor 1 (CSF1) gene and its translocation partner collagen type VI alpha 3 chain. The fusion gene induces intratumoral overexpression of CSF1 mRNA and CSF1 protein. CSF1 expression is a characteristic finding of TSGCT and detection of CSF1 mRNA and CSF1 protein may be useful for the pathological diagnosis. Although there have been no effective anti-CSF1 antibodies to date, in situ hybridization (ISH) for CSF1 mRNA has been performed to detect CSF1 expression in TSGCT. We performed CSF1 immunohistochemistry (IHC) using anti-CSF1 antibody (clone 2D10) in cases of TSGCT, giant cell-rich tumor (GCRT), and GCRT-like lesion and verified its utility for the pathological diagnosis of TSGCT.MethodsWe performed CSF1 IHC in 110 cases including 44 LTSGCTs, 20 DTSGCTs, 1 malignant TSGCT (MTSGCT), 10 giant cell tumors of bone, 2 giant cell reparative granulomas, 3 aneurysmal bone cysts, 10 undifferentiated pleomorphic sarcomas, 10 leiomyosarcomas, and 10 myxofibrosarcomas. We performed fluorescence ISH (FISH) for CSF1 rearrangement to confirm CSF1 expression on IHC in TSGCTs. We considered the specimens to have CSF1 rearrangement if a split signal was observed in greater than 2% of the tumor cells.ResultsOverall, 50 of 65 TSGCT cases, including 35 of the 44 LTSGCTs and 15 of the 20 DTSGCTs, showed distinct scattered expression of CSF1 in the majority of mononuclear tumor cells. MTSGCT showed no CSF1 expression. Non-TSGCT cases were negative for CSF1. FISH revealed CSF1 rearrangement in 6 of 7 CSF1-positive cases on IHC. On the other hand, FISH detected no CSF1 rearrangement in all CSF1-negative cases on IHC. Thus, the results of IHC corresponded to those of FISH.ConclusionWe revealed characteristic CSF1 expression on IHC in cases of TSGCT, whereas the cases of non-TSGCT exhibited no CSF1 expression. CSF1 IHC may be useful for differentiating TSGCTs from histologically mimicking GCRTs and GCRT-like lesions.

Giant cell Granuloma

Central giant cell granulomas (CGCG) constitute about 10% of benign jawbone lesions. Approximately one-third of CGCG exhibit local aggressive behavior with bone destruction and a tendency to recur.1 Jaffe (1953) was the first to distinguish central giant cell granulomas (CGCG) of the jawbones from other giant cell lesions of bones and originally called them“central giant cell reparative granulomas” since they were believed to be a reactive-reparative process that might heal spontaneously.1 Recently the World Health Organization has defined it as localized benign but sometimes aggressive osteolytic proliferation consisting of fibrous tissue with hemorrhage and haemosiderin depo­sits, presence of osteoclast-like giant cells and reactive bone formation. Many authors have established the differences with other lesions of giant cells. The clinical behavior of CGCG varies from a slowly asymptomatic swelling to an aggressive lesion that manifests with pain, cortical perforation, and root resorption.2 On the other hand the peripheral giant cell granuloma is a reactive exophytic lesion of the gingiva and alveolar ridge that usually occurs as a result of local irritating factors such as plaque, calculus, chronic infection, chronic irritation, tooth extraction, inproperly finished filling, unstable dental prosthesis, and impacted food which originates from the periosteium or periodontal ligament.

Central giant cell reparative granuloma of the maxilla in a 5-year-old child- A case Report

Central Giant Reparative Granuloma is a non-neoplastic lesion that most commonly affects the mandible and is uncommon in children. This case-report detailed the clinical features, diagnosis, treatment, and recall of a 5-year-old boy. The oral lesion is erythematous and consists of a 4x3 cm well-demarcated swelling on the anterior maxilla that extends across the midline and covers the entire length of the palate till the junction of the hard and soft palate. Upon radiographic and histologic investigation, it was conclusive of Central giant cell reparative granuloma (CGCG). The treatment comprised of a conservative approach that included excision of the lesion, thereby reducing the risk of tooth and bone loss.

Diagnosis of giant cell reparative granuloma of the bones of the hands and feet

Clinical, roentgenologic and morphologic features of giant cell reparative granuloma in wrist and foot bones are presented. Analysis of 2 cases and literature review shows that giant cell reparative granuloma is a rare benign fibrous osseous proliferative process of unknown etiology. No clinical symptoms and roentgenologic signs have specifical features and do not differ a lot from chondroma, giant cell tumor of bone, aneurysmal cyst, brown tumor in hyper- parathyroidism. Correct diagnosis could be made on the base of histologic study taking into account Ca, P and alkaline phosphatase content in blood. The main histologic signs of giant cell reparative granuloma are the following: presence offibroblasts, histiocytes, multinuclear osteoclast-like cells, microbloodstrokes, microcysts, osseous bridges of different maturity degree and not numerous mitoses in connective tissue stroma. Surgical treatment using currettage results in high local recurrence rate (mean 33 39%). The most adequate treatment is surgical intervention with observance of oncologic principles: marginal resection, electrocoagulation and auto- or alloplasty of none defects; in case of severe bone lesions - segmental resection or bone extirpation.

Giant cell reparative ethmoid granuloma: a clinical case with a review of the literature

Giant cell reparative granuloma (GCRG) is a rare benign tumor that develops in the first two decades of life. Data on the incidence of GCRGin children vary significantly depending on the number of observations and methods of statistical data processing. GCRG is more common inlong bones, but rare cases of damage to the bones of the facial skeleton, which account for only 2–12 %, have been described. The etiologicalfactors of GCRG are unknown, but genetic predisposition and intraosseous hemorrhages after an injury are the predisposing factors. Despiteits benign nature, the process can be locally aggressive. Rapid invasive growth, complex anatomy of the base of the skull in childhood makesurgical treatment in this place quite difficult. The clinical symptoms of ethmoid GCRG are nonspecific and depend on the site involved andthe degree of local destruction. Distinctive morphological features of this neoplasm are the presence of multinucleated giant cells, cellularfibrous tissue and hemorrhages. Diagnostics of this disease includes endoscopic examination of the nasal cavity and nasopharynx, magneticresonance and X-ray computed tomography of the skull base, paranasal sinuses with intravenous contrast, radioisotope research methods.We report a case of the development of GCRG in a 6-year-old child, along with the clinical picture, X-ray, scintigraphic and morphologicaldata. The method of choice for the treatment of GCRG was its complete surgical removal.

Multiple giant cell reparative granuloma of craniofacial bone: a case report

本文报道了蚌埠医学院第一附属医院收治的1例颅颌面多发性骨巨细胞修复性肉芽肿病例。患者女性，21岁，以面部不对称半年余入院，初步诊断为下颌骨囊肿，进一步影像学检查发现患者枕骨、蝶骨、颞骨、下颌骨体部和髁状突多发性海绵样改变，于全身麻醉下行下颌骨病灶刮治术，术后病理为巨细胞修复性肉芽肿。术后患者面型较前无明显变化，随访12个月影像学显示下颌骨病灶区较之前有新生骨质形成。.

“Lesões de células gigantes” dos maxilares: possibilidades e limitações do diagnóstico histológico

The authors studied the «giant cell lesions» calling attention for the necessity of submit X rays and a good clinic history to the patologist. They believe not in the diferencial diagnosis, in histologic level, between giant cell reparative granuloma and Done manifestations of hyperparatireoidism. In such cases blood chemistry has the last word. They believe in the histologic identification of the true giant cell tumor. Also in the histologic identification of cherubism, but consider easy in this case, the simultaneous study of the x rays and clinical history.

Central Giant Cell Granuloma of Maxilla: A Case Report.

Central giant cell granuloma formerly called giant cell reparative granuloma is a non neoplastic proliferative lesion of an unknown aetiology. It occurs most commonly in mandible, but can also occur in maxilla. The case described here involved maxilla which was treated with surgical excision.

Giant Cell Reparative Granuloma of the Sphenoid and Orbit: Case Report-Tripoli-Libya

This case describes a case of giant cell reparative granuloma(GCRG) of the sphenoid and orbit, which is rarely affect these locations .Our case is a 48 years old female, who presented with proptosis in her left eye; imaging demonstrated a large sphenoid mass affecting the lateral wall of the orbit which was resected via an intracrainial approach. Based on immunohistochemeistry stain, was proved to be a GCRG.

Giant Cell Reparative Granuloma Presented as Nasal Mass: A Rare Entity

Giant Cell Reparative Granuloma (GCRG) is an unusual non-neoplastic lesion which most commonly involves maxilla and mandible. We present a case of GCRG of the nasal cavity in a young female presented with the complaint of progressively nasal obstruction. Radiological findings are usually nonspecific in this entity, therefore a good clinical, radiological and pathological correlation is needed for final diagnosis and to differentiate it from other giant cell lesions. Surgical excision is the preferred treatment modality over simple curettage.

“Central Giant Cell Granuloma of Maxilla- A Case Report”

Central giant Cell granuloma (CGCG) formerly called giant cell reparative granuloma is a benign bony lesion and etiology is unclear. It occurs most commonly in mandible and also occur in maxilla. 1%-7% of all benign lesions of jaws are central giant cell granuloma. It affects children and adults. it is usually a slow growing lesion, fast growing lesions also reported. The fast growing CGCG has an aggressive behavior mimicking a malignant lesion through it has the innocent histological appearance. CGCG sometimes resemble a wide variety of conditions that led to a misdiagnosis both on clinical and radiographic examination. Histological examination confirms as CGCG. The case described here involved maxilla which was treated with surgical curettage. The patient has been followed up for 11/2 years with no post operative complications and no recurrence. Keywords: Central giant cell granuloma, maxilla, benign, jaw

Giant cell reparative granuloma of the phalanx in a violinist.

Giant cell reparative granuloma (GCRG) is a rare, pseudotumoural intraosseous lesion, considered a reactive injury after repeated trauma. Reactive lesions and benign bone tumours may show aggressive clinical and radiographic findings. Differential diagnosis must be performed in order to offer suitable treatment to the patient. Excisional biopsy and curettage of the lesion are the preferred methods of treatment. We present the first case of a GCRG of the distal phalanx of the left little finger in a professional violinist.

Aggressive Giant Cell Reparative Granuloma of the Hard Palate with invasion of the Nasal Cavity.

While seldom seen, giant cell reparative granuloma (GCRG) is a benign lesion; it can affect the area of the head and neck, primarily in the mandible and less frequently in the maxilla. In the first three decades of life, GCRG typically grows, but can be seen at any age, and seen more often in women than in men. It can be locally aggressive with bone degradation and loss of teeth, although its benign nature. A 16-year-old female patient was admitted to our clinic with symptoms of FB sensation in the roof of her mouth with palatal swelling that she had noticed 3 months ago, along with nasal obstruction mostly on the right side. In the physical examination, a 2.5 cm × 3 cm sized mass was located in the midline of the hard palate. Under general anesthesia, Surgical excision was done through a transoral approach with safety margins. Buccinator muscle flap was harvested and repair of the defect of the hard palate and nasal floor was done and the operation was finished successfully. Histopathological examination shows a high number of giant cells in a stroma rich with fibroblasts and a lesion of new bone formations. Upon these findings, the case was diagnosed with GCRG‏. Post-operative follow-up, it was found that the epithelization process was complete and the defect was healed with no recurrence.