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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 2  |  Issue : 1  |  Page : 41-45

Central giant cell granuloma: A rare clinical entity


1 Department of Pedodontics and Preventive Dentistry, K D Dental College and Hospital, Mathura, Uttar Pradesh, India
2 Department of Oral Medicine and Radiology, K D Dental College and Hospital, Mathura, Uttar Pradesh, India
3 Department of Pedodontics and Preventive Dentistry, Vaidik Dental College and Research Centre, Daman and Diu, India

Date of Web Publication2-May-2017

Correspondence Address:
Gurpreet Kour
K D Dental College and Hospital, NH #2, Delhi Agra Highway, P.O. Chhatikara, Mathura - 281 006, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpr.ijpr_6_17

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  Abstract 

Central giant cell granuloma (CGCG) is a benign intraosseous lesion of the jaws that is found predominantly in children and young adults. CGCG is an asymptomatic lesion which shows a clinical behavior ranging from nonaggressive to aggressive variant and becomes evident during a routine radiographic examination or by the visible expansion of the affected jaw. The common therapy is aggressive curettage, peripheral osteotomy or resection, which may be associated with loss of teeth and in younger patient's loss of dental germs. This paper presents a case of CGCG involving the mandibular anterior region in a male child patient with clinical, radiological, histopathological, and surgical aspect of the lesion.

Keywords: Aggressive, giant cells, granuloma


How to cite this article:
Masih U, Kour G, Mahay P, Joshi S. Central giant cell granuloma: A rare clinical entity. Int J Pedod Rehabil 2017;2:41-5

How to cite this URL:
Masih U, Kour G, Mahay P, Joshi S. Central giant cell granuloma: A rare clinical entity. Int J Pedod Rehabil [serial online] 2017 [cited 2022 Jan 23];2:41-5. Available from: https://www.ijpedor.org/text.asp?2017/2/1/41/205473


  Introduction Top


Jaffe, in 1953, separated giant cell tumors from other jaw lesions and termed them as giant cell reparative granulomas.[1] They were found in the first two decades of life, more frequently in females (approximately 2:1).[2] Giant cell lesions are benign, nonodontogenic, relatively uncommon tumors of the oral cavity, developing peripherally in soft tissues (gingiva) or centrally (in bone).[3] With the power and influence of evidence, it is concluded that the lesion once recognized as a central giant cell granuloma (CGCG) is actually a benign tumor of osteoclast precursors and must be accurately termed a “central giant cell tumor.”[4] It accounts <7% of all benign jaw lesions.[5]


  Case Report Top


A 9-year-old male child presented to the Department of Pedodontics and Preventive Dentistry with a swelling on the right side of the face for 4 months. The swelling was reported to be insidious in onset and had progressed slowly from a small lesion to the present size. It was also reported that two of his lower anterior teeth had become mobile 2 weeks back. The swelling was not associated with any systemic symptoms [Figure 1].
Figure 1: Extraoral examination showing a single, diffuse swelling on the right side of the face in mandibular region.

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On examination, intraorally, swelling of the buccal vestibule and high tooth mobility was seen. Swelling was extending from the mandibular right permanent central incisor to the first deciduous molar obliterating the buccal sulcus [Figure 2]. Medical history and family history were noncontributory.
Figure 2: Intraoral photograph of the lesion.

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The patient did not report of any deleterious oral habits. Extraoral examination revealed mild swelling in the chin region. The overlying skin was normal. The swelling had no localized elevation of temperature. There was no associated lymphadenopathy. Panoramic radiographs showed a multilocular radiolucent area in the anterior mandible extending from tooth 41 to tooth 84, causing resorption of 41, 42, and 84 [Figure 3] and [Figure 4].
Figure 3: Radiograph showing the lesion in mandible.

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Figure 4: Orthopantomogram showing the extension of the lesion.

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An incisional biopsy was performed, which showed multinucleated giant cells surrounded by a disorganized stroma with intense inflammatory cell infiltrates [Figure 5], [Figure 6], [Figure 7]. There were mainly mononuclear infiltrates with numerous hemorrhagic areas and viable bone tissue surrounding the lesion. Based on these characteristics, the final diagnosis was central giant cell lesion. The results of blood tests were normal, and after ruling out the possibility of the injury being associated with hormonal disorders (hyperparathyroidism), the proposed treatment was surgical excision of the lesion [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12] followed by placement of an acrylic stent on it, to enhance healing of the surgical site as it helped to keep the site clean by avoiding deposition of food debris on it [Figure 13], [Figure 14], [Figure 15]. The patient was recalled every month for periodic checkup and for evaluating healing of the surgical site. Complete healing could be seen after 9–10 months and after that, a removable partial denture was fabricated and delivered to the patient [Figure 16] and [Figure 17].
Figure 5: Biopsy of the lesion.

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Figure 6: Tissue taken for biopsy.

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Figure 7: Wound closure after biopsy.

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Figure 8: Surgical intervention of involved area.

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Figure 9: Sample of involved tissue.

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Figure 10: Surgical removal of the tissue and extraction of teeth involved.

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Figure 11: Sutures given after surgery.

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Figure 12: Multinucleated giant cells with dense inflammatory infiltrate.

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Figure 13: Postoperative intraoral photograph.

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Figure 14: Acrylic stent fabricated.

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Figure 15: Acrylic stent in place.

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Figure 16: Removable partial denture fabricated and delivered.

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Figure 17: Removable partial denture delivered.

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  Discussion Top


CGCG is a benign bone lesion located in the jawbones more commonly in the mandible.[6] The etiology and pathogenesis of CGCG of jawbones have not been explicitly defined or recognized clearly. However, it has been supposed that it could result as a response to previous trauma or as a reactive granulomatous response to local changes in the blood flow to the bone.[7]

The clinical behavior of CGCG is marked by differences ranging from slow-growing, asymptomatic swelling with a significant facial asymmetry to an aggressive, painful lesion. Suspect bone area palpation may exhibit tenderness. The lesions develop without paresthesia, and the teeth in association with the lesion are vital but may become mobile.[8]

The radiological findings of the lesion may show a unilocular or multilocular radiolucency which may be well- or ill-defined. These features may be confused with that of many other lesions of jaws.[9],[10],[11],[12],[13] Hence, the final diagnosis eventually depends on histopathology.[9] Normal serum calcium, parathyroid hormone, alkaline phosphatase, and phosphorous levels distinguish CGCG from other conditions such as a brown tumor of hyperparathyroidism.[10],[12]

The presence of multinucleated giant cells surrounded by a disorganized stroma with intense inflammatory infiltrates, mononuclear infiltrates with numerous hemorrhagic areas, and viable bone tissue surrounding the lesion present case was the characteristic feature of the lesion.

Treatment of CGCG ranges from curettage to resection. Intralesional injections of corticosteroids, as has the systemic administration of calcitonin in the form of subcutaneous injections or nasal spray, have been used successfully.[14],[15],[16] However, surgery is the traditional and most accepted form of treatment for CGCG although the extent of tissue removal ranges from simple curettage to en bloc resection.[17]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Jaffe HL. Giant-cell reparative granuloma, traumatic bone cyst, and fibrous (fibro-oseous) dysplasia of the jawbones. Oral Surg Oral Med Oral Pathol 1953;6:159-75.  Back to cited text no. 1
    
2.
Pogrel AM. The diagnosis and management of giant cell lesions of the jaws. Ann Maxillofac Surg 2012;2:102-6.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Duarte Ruiz B, Riba García Fde A, Navarro Cuéllar C, Bucci T, Cuesta Gil M, Navarro Vila C. Reparative giant cell granuloma in a pediatric patient. Med Oral Patol Oral Cir Bucal 2007;12:E331-5.  Back to cited text no. 3
    
4.
Marx RE, Stern D. Oral and Maxillofacial Pathology. A Rationale for Diagnosis and Treatment. 1st ed. USA: Quintessence Publishing Co., Inc.; 2003.  Back to cited text no. 4
    
5.
Austin LT Jr., Dahlin DC, Royer RQ. Giant-cell reparative granuloma and related conditions affecting the jawbones. Oral Surg Oral Med Oral Pathol 1959;12:1285-95.  Back to cited text no. 5
    
6.
Sun ZJ, Cai Y, Zwahlen RA, Zheng YF, Wang SP, Zhao YF. Central giant cell granuloma of the jaws: Clinical and radiological evaluation of 22 cases. Skeletal Radiol 2009;38:903-9.  Back to cited text no. 6
    
7.
Ustündag E, Iseri M, Keskin G, Müezzinoglu B. Central giant cell granuloma. Int J Pediatr Otorhinolaryngol 2002;65:143-6.  Back to cited text no. 7
    
8.
Sholapurkar AA, Pai KM, Ahsan A. Central giant cell granuloma of the anterior maxilla. Indian J Dent Res 2008;19:78-82.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Nikhade P, Jaiswal M, Patil S. Central giant cell granuloma: A potential endodontic misdiagnosis. Int J Dent Clin 2011;3:59-61.  Back to cited text no. 9
    
10.
Gupta MK, Naidu SG, Maheshwari VJ. Giant cell lesion of the jaws: A case report in a child. Peoples J Sci Res 2011;4:63-7.  Back to cited text no. 10
    
11.
Shrivastava S, Samadi FM, Priya S, Singh A. Central gaint cell granuloma of the jaw bones: A review. J Dentofacial Sci 2012;1:11-5.  Back to cited text no. 11
    
12.
Ciorba A, Altissimi G, Giansanti M. Giant cell granuloma of the maxilla: Case report. Acta Otorhinolaryngol Ital 2004;24:26-9.  Back to cited text no. 12
    
13.
Horner K. Central giant cell granuloma of the jaws: A clinico-radiological study. Clin Radiol 1989;40:622-6.  Back to cited text no. 13
    
14.
de Lange J, van den Akker HP, van den Berg H. Central giant cell granuloma of the jaw: A review of the literature with emphasis on therapy options. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:603-15.  Back to cited text no. 14
    
15.
Carlos R, Sedano HO. Intralesional corticosteroids as an alternative treatment for central giant cell granuloma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:161-6.  Back to cited text no. 15
    
16.
Harris M. Central giant cell granulomas of the jaws regress with calcitonin therapy. Br J Oral Maxillofac Surg 1993;31:89-94.  Back to cited text no. 16
    
17.
Verma S, Mohan RP, Singh U, Agarwal N. Primary oral tuberculosis. BMJ Case Rep 2013;2013. pii: Bcr2013010276.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13], [Figure 14], [Figure 15], [Figure 16], [Figure 17]



 

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