Treatment Of Central Giant Cell Granuloma Research Articles

Denosumab as treatment of central giant cell granuloma of the jaws. a scoping review.

Denosumab has been considered a treatment option for Central Giant Cell Granuloma (CGCG) a benign locally aggressive osteolytic lesion of the jaws. This study aimed to perform a scoping review of CGCG treated with Denosumab. The research question was: What is Denosumab's effectiveness in treating CGCG of the jaws? Studies that used Denosumab as a treatment for CGCGs in the jaws were selected following PRISMA-ScR guidelines, using Pubmed/Medline, Scopus, and Springer Link databases, among others. Demographics, clinical information, dosing, efficacy, adverse drug reactions (ADRs), and imaging tests used to assess the evolution of the lesions were extracted. Twenty-one studies were selected. Sixty patients with a mean age of 23.2years were treated with Denosumab, 42% with 120mg subcutaneously monthly, additional doses on days 1, 8, and 15 for month 1 in adults. In children, dosing was adjusted by weight to 60 or 70mg. To avoid ADRs 500mg of calcium and 400IU of vitamin D orally were used. Initial effective response was reported after 1-3months, with recurrence of 19.6% and ADRs in 74% of cases. Denosumab is effective for CGCG with monthly subcutaneous doses of 120mg, 60 or 70mg in patients < 45 or 50kg for ≥ 12months with calcium and vitamin D supplementation until remission changes are observed. Extensive or refractory lesions were the main indications. Common ADRs were hypo and hypercalcemia. Further studies are needed to define dose and supplementation protocols to avoid ADRs during and after therapy.

Denosumab, an adjunctive method in central giant cell granuloma treatment: A case report

&#x0D; &#x0D; &#x0D; Central giant cell granuloma (CGCG) is a benign intraosseous pathology. A 17 years old male pa- tient was referred and diagnosed with CGCG from mandibular right first molar to mandibular left second premolar. Enucleation and curettage of the lesion were completed as the main treatment. Involved teeth on the right, 41, 42, 43, 44, and 45 (FDI) were extracted. As adjunctive therapy, 120 mg Denosumab was injected subcutaneously. The patient received sixteen sessions of therapy through 11 months. Two, sixteen, and eighteen months follow-up after the first session of injection showed an acceptable improvement in bone contour. The patient experienced no functional or aesthetic impairment. Alongside the promising results of Denosumab as adjunctive therapy in the management and treatment of diseases such as CGCG, some questions have remained unanswered and no protocol has been determined. The authors of the current study recommend further re- searches to confirm Denosumab as a potential adjunctive or alternative in the treatment of CGCG.&#x0D; &#x0D; &#x0D;

Non-surgical treatment as an alternative for the management of central giant cell granuloma: a systematic review.

To evaluate the effectiveness of non-surgical treatment as an alternative in the management of central giant cell granuloma (CGCG). A literature search was carried out in accordance with the PRISMA statement in order to answer the question "Are non-surgical treatments effective as an alternative in the treatment of CGCG?". Two examiners independently assessed eligibility, risk of bias, and extracted data, which included therapeutic protocol, side effects, and need for surgical supplementation. Among 1712 studies, 15 were included, totaling 145 patients. Calcitonin, intralesional corticosteroids, and denosumab were the medications used. For calcitonin (n = 61), complete remission was found in 30 cases. For intralesional triamcinolone (n = 68), reduction in size was observed in most cases (n = 39). Four cases received subcutaneous denosumab and showed absence of active bone metabolism in the region, of which three presented ossification. Combination of drug therapies (n = 29) was reported in one study and included subcutaneous interferon and oral imatinib. More and less side effects were found for interferon and corticosteroids, respectively. Forty percent of patients required additional surgical treatment. Despite the side effects presented and the need for additional surgery in some patients, in general, all non-surgical treatments could provide positive results as an alternative for the management of CGCG, especially with regard to reducing the size of the lesion. CGCG is a benign bone lesion that mainly affects young individuals. Although the most common therapy is surgery, its contraindication in some patients, the large extension, and high recurrence rate of the aggressive variant have led the search for non-surgical therapies.

The Use of Corticosteroid in the Treatment of Central Giant Cell Granuloma

Central giant cell granuloma (CGCG), an infrequent disease, is a non-neoplastic bone lesion. Clinically, it may be asymptomatic or it may show an aggressive and painful condition that can cause root resorption, cortical bone destruction. The aim of this report is to emphasize the importance of intralesional corticosteroid injection, which is a less invasive technique in the treatment of CGCG. 24 years old female patient came to our clinic with pain and swelling in the left side of the mandible. In intraoral examination, a red-purple swelling, which was found to have been present for 6 months, was detected in this region. Radiographic examination showed a multilocular radiolucent lesion and root resorption. Biopsy was done under local anesthesia. After the histopathological examination, the diagnosis of CGCG was done. Intralesional corticosteroid injection was applied. During routine follow-up, the lesion was observed to decrease and disappear.

Treatment of central giant cell granuloma in children with denosumab.

Central giant cell granuloma (CGCG) is a benign but locally aggressive intraosseous lesion of the mandible. Historically, it is treated by curettage or resection. Medical therapy is indicated when surgery is associated with increased morbidity or in adjuvant setting to decrease recurrence. Treatment of CGCG with denosumab, a receptor activator of nuclear factor kappa-beta (RANK) ligand inhibitor, is not well studied, especially in children. Here, we describe our experience with the use of denosumab in the treatment of six children with CGCG. All patients had a favorable response with manageable side effects, which suggests that denosumab is an effective treatment option without increased morbidity.

Surgical treatment and reconstruction of central giant cell granuloma (CGCG) of mandible of aggressive behaviour – case report and literature review

Introduction Central giant cell granuloma (CGCG) is a benign tumor-like lesion of a bone, mainly localized in mandible. It usually occurs in children and young adults under 30 y.o., predominantly in females. The etiology of the disease remains unknown. Clinically, two different types of CGCG have been distinguished – an unaggressive one, in which the granuloma grows slowly, often asymptomatically, and aggressive type which is characteristic for increased bone destruction, severe pain, large size, rapid growth, high recurrence rate and complications such as root resorption, tooth displacement or cortical bone perforation. The treatment of CGCG depends on its type. In cases of granulomas of aggressive behaviour the following therapeutic procedures have been proposed: intralesial corticosteroid injections, interferon and calcitonin therapy as well as immunotherapy with anti-bone resorptive human monoclonal antibody like denosumab. However, in most cases nonsurgical management remains insufficient. Also, local curettage of the lesion results in high risk of recurrence. Therefore, radical surgical resection, commonly combined with bone reconstruction, is the most recommended way of treatment for aggressive of CGCG. Case report The authors present a case of a 31-year-old female patient treated at the Department of Oncological and Reconstructive Surgery, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology in Gliwice due to central giant cell granuloma of a mandible. The resection of CGCG localized in mandible on the right side together with fibular free flap reconstruction has been performed, with satisfactory aesthetic effect. Positive staining for CD68 and CD31 was found in immunohistochemic examination and expression of Ki67 marker was 13%. No complications were reported in the postoperative period. The six-month follow up revealed no recurrences. Conclusions The authors claim that radical surgical management should be performed in all patients with CGCG of aggressive behaviour. Fibular free flap is recommended for reconstruction in large bone defects. It results in tumor-free margins at the resection and satisfactory cosmetic outcome. Quality of life and facial appearance can be improved with dental implantation after certain disease-free period. A regular follow-up is essential as an element of holistic oncological process.

Rare agressive form of giant-cell granuloma: a three years follow-up case report and discussion about medical therapeutic solutions

Introduction: Central giant cell granuloma (CGCG) is a rare and benign intraosseous lesion that usually occurs in the mandible and the maxilla. It might be aggressive. Nowadays, several treatments exist. Observation: This case report, with a three years follow-up, was about an aggressive and recurring form of CGCG exclusively managed by surgical approach. Comments: Several pharmacologic approaches are possible (intralesional injections of glucocorticoids, administration of calcitonin, alpha-2a interferon, denosumab) and could be an interesting alternative or complement to the surgical management when CGCG is aggressive, recurring, or non resectable. Conclusion: Surgical approach is the gold standard for the treatment of CGCG but sometimes, pharmacologic approaches could be proposed. According to the scientific literature, denosumab appears as a reliable and effective treatment but more prospective studies are needed.

Management of Central Giant Cell Granuloma With Subcutaneous Denosumab Therapy

In recent years, the treatment of central giant cell granuloma (CGCG) has become focused on the inhibition of osteoclast differentiation and proliferation. Medications that were developed for the treatment of giant cell tumor of bone and bone resorption from metastatic skeletal disease have shown some success in the treatment of CGCG. The present report describes 2 cases of CGCG of the mandible that were treated effectively with subcutaneous denosumab. Two cases of histologically diagnosed CGCG of the mandible were treated with monthly subcutaneous injections of denosumab 120 mg primarily or after intralesional corticosteroid therapy. Clinical and radiographic follow-ups were recorded over a period of 24 months (case 1) and 15months (case 2). In the 2 cases, progressive radiodensity and osseous regeneration were noted 4 to 6 months after denosumab therapy was initiated. A decrease in lesion size and improvement in bone contour and facial symmetry were seen in the 2 cases. The major radiographic, clinical, and histologic responses seen in these 2 cases suggest that denosumab may represent a viable alternative or adjunctive procedure to eliminate or decrease the extent of surgical intervention and morbidity in the treatment of CGCG. Future prospective studies with a larger sample would provide more comprehensive information about the long-term effects and possible adverse side effects of treating CGCG of the jaws with denosumab.

Central Giant Cell Granuloma in Pediatric Maxilla

Central giant cell granuloma (CGCG) is an intraosseous lesion consisting of fibrous cellular tissue that contains multiple foci of hemorrhage, multinucleated giant cells, and occasional trabeculae of woven bone. An 8-year-old boy presented himself complaining of a painless swelling in the left maxilla that had started 1 year. Computed tomography (CT) scan confirmed a poorly defined multilocular radiolucent lesion in the left maxilla crossing the midline. The patient underwent enucleation through an intraoral approach of the lesion. The biopsy revealed multinucleated giant cells in a fibrous stroma. A CT was taken approximately 1 year postoperatively. There was no clinical or radiographic evidence of recurrence. Therefore, surgical treatment of CGCG can be performed, trying to preserve the surrounding anatomic structures, which can be maintained in case the lesion does not show an aggressive clinical behavior, avoiding large surgical defects which are undesirable in children.

Management of a locally invasive Central Giant Cell Granuloma (CGCG) of mandible: Report of an extraordinary large case

Central Giant Cell Granuloma (CGCG) is a benign tumour of the jaws. The site most frequently involved is the anterior part of mandible, especially in females under 30 years of age. The traditional treatment of CGCG is curettage. Resection is indicated in locally aggressive cases. This report presents the management of a massive CGCG in a 13-year-old girl with its non-surgical and surgical treatments. The non-surgical treatment with corticosteroid therapy was difficult and unsuccessful. Surgical treatment was performed successfully and at 2-year follow-up showed no recurrence of the lesion.

Intralesional injection of triamcinolone hexacetonide as an alternative treatment for central giant-cell granuloma in 21 cases

Central giant-cell granulomas are benign, but occasionally aggressive, lesions that traditionally have been treated surgically. 21 cases of central giant-cell granuloma of the jaw were treated with intralesional injection of corticosteroids. The treatment protocol adopted was intralesional injection of 20mg/ml triamcinolone hexacetonide diluted in an anaesthetic solution of 2% lidocaine/epinephrine 1:200,000 in the proportion 1:1; 1.0ml of the solution was infiltrated for every 1cm(3) of radiolucid area of the lesion, totalling 6 biweekly applications. Ten patients had aggressive lesions and 11 nonaggressive. Two patients showed a negative response to the treatment and underwent surgical resection, 4 showed a moderate response and 15 a good response. 8 of the 19 who had a moderate-to-good response to the drug treatment underwent osteoplasty to reestablish facial aesthetics. In these cases, only mature or dysplastic bone was observed, with the presence or absence of rare giant multinucleated cells. The advantages of this therapy are its less-invasive nature, the probable lower cost to the patient, lower risk and the ability to treat the lesion surgically in the future, if necessary.