A clinical, radiologic and histopathologic study of 26 cases ooo 2006. Central giant cell granuloma cgcg is an intraosseous lesion consisting of cellular fibrous tissue that contains multiple foci of hemorrhage, aggregations of multinucleated giant cells and occasionally. Giant cell reparative granuloma giant cell granuloma the term giant cell reparative granuloma gcrg was initially coined by jaffe in 195319 to describe a tumour of the jaw bones that had previously been. Central giantcell granuloma cgcg is a localised benign condition of the jaws. Clinicopathological profile of central giant cell granulomas. Central giant cell granuloma cgcg is a relatively uncommon benign bony lesion of a variably aggressive nature. Apr 17, 2015 central giant cell granuloma was 1st described in jaws by jaffe 1953. It is twice as common in females and is more likely to occur before age 30. The lesion was removed by curettage and a histopathological examination was carried out.
Central, giant cell, granuloma, aggressive, jaws introduction central giant cell granuloma cgcg of the jaw is one of the relatively rare pathologic processes and encountered, in less than 7% of all of the jaw lesions. Peripheral giant cell granuloma is a tumor like growth occurring relatively commonly in the oral cavity that represents a reactive process rather than a neoplasm. Clinical features, radiographic and histopathologic. We herein describe an intriguing case of a 21yearold male patient who was. Central giant cell granuloma cgcg is a lesion that appears to be unique to the jaws, 1115 although the socalled giant cell reaction of the hands and feet shares many features. Central giant cell granuloma anterior to first molars mandible maxilla expansile teens, adults periapical location, tooth bearing regions treatment intralesional steroids curettage aggressive. Full text pimary hyperparathyroidism as central giant.
Individual susceptibility varies greatly, and the low level of infectivity has sparked controversy about sexual transmission. F stavropoulos and j katz central giant cell granulomas. Peripheral giant cell granuloma pgcg is the infrequent, exophytic oral lesion that commonly contains giant cells. Peripheral giant cell granuloma is, for all practical purposes, a sitespecific variant of pyogenic granuloma embedded with osteoclastlike multinucleated giant cells and arising exclusively from the periodontal ligament enclosing the root of a tooth. Both are included in clinical differential diagnoses of common benign and. Granuloma inguinale is rare in temperate climates, but common in the tropics and subtropics. Histopathology showing connective tissue stroma with multinucleated giant cells. Central giant cell granuloma of the jaws and giant cell tumor.
Blood tests after histopathology demonstrated elevated serum calcium level. It usually presents as a purplishred soft tissue nodule consisting of multinucleated giant cells in. Also called giant cell reparative granuloma central if intraosseous. These tumors become severely invasive with the stimulus of surgery, resembling malignant tumors. It normally presents as a soft tissue purplishred nodule consisting of multinucleated giant cells in a background of mononuclear stromal cells and extravasated red blood cells.
Differential diagnosis of radiolucent lesions of the jaws. Central giant cell granulomma, cgcg, intraosseous, aggressive, anterior, mandible, maxilla introduction the central giant cell granuloma cgcg occurs most commonly in children or in. Giant cell tumour of soft tissue peripheral giant cell granuloma. Central giant cell lesions granulomas, also known as giant cell reparative cystsgranulomas, occurs almost exclusively in the mandible, although cases in the skull and maxilla have been reported. The central giant cell granuloma is an uncommon, benign and proliferative pathological condition accounting for less than 7% of all benign lesions of the jaws whose etiology is not clearly explained. Its etiology is unknown and its biological behavior is poorly understood. Case report central giant cell granuloma of posterior maxilla.
Thought to represent a reparative response to intrabony haemorrhage and inflammation, cgcg was once regarded as a reactive lesion. The referring doctor had suggested a diagnosis of eruption. Central giant cell granuloma was 1st described in jaws by jaffe 1953. Central giant cell granuloma cgcg formerly called giant cell reparative granuloma is a nonneoplastic proliferative lesion of unknown etiology. Central giant cell granuloma cgcg is a benign intraosseous lesion that occurs in long. Central giant cell granuloma of the anterior maxilla core. Central giant cell granuloma cgcg of the jaws and giant cell tumor gct of bone share a number of similarities and dissimilarities in respect of their histopathological, cytometric and.
It is an uncommon tumor in jaws, its etiology and pathogenesis is unknown. Central giant cell granuloma cgcg is a benign lesion of bone of variably aggressive. Undifferentiated pleomorphic sarcoma with giant cells. The appearance is generally distinctive with multinucleated giant cells spread throughout the lesion but often focal in distribution around areas of possible hemorrhage figure 4.
This article describes a case of central giant cell granuloma in the right posterior region of the mandible in a 10 yearold boy. Central giant cell granuloma cgcg is a benign intraosseous lesion that occurs in long bones. Immunoassay of parathyroid hormone pth level was found to be highly elevated. Central giant cell lesions granulomas, also known as giant cell reparative cystsgranulomas, occurs. Central giant cell granuloma anterior to first molars mandible maxilla expansile teens, adults periapical location, tooth bearing regions treatment intralesional steroids curettage aggressive variants recur ro hyperparathyroidism. Giant cell tumour of the jaw central giant cell granuloma. Central giant cell granuloma begins as apical lucency enlarges to multilocular lesion anterior to first molar. This condition is a slowgrowing, asymptomatic lesion that usually affects children and young adults, predominantly females.
The diagnosis and management of giant cell lesions of the jaws. Pathology outlines peripheral 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 toothbearing areas. Central giant cell granuloma a case report balaji p. Central giant cell granuloma is an uncommon benign intraosseus lesion of jaws. A granuloma, also granulomatous inflammation, is a distinctive histomorphologic finding.
Central giant cell granuloma cgcg has unpredictable biologic behavior, nonspecific radiographic features and is amenable to a plethora of treatment alternatives. The central giantcell granuloma of the jaws is not a common lesion. Central giant cell granuloma cgcg is an uncommon, benign, and. Jun 19, 2018 this peripheral giant cell granuloma involved the maxillary gingiva associated with an erupting central incisor of a 6yearold girl. Peripheral giant cell granuloma is a common benign and reactive gingival epulis in oral cavity. It is actually an asymptomatic lesion which becomes evident during routine radiographic examination or as a result of painless but visible expansion of.
This is in contrast to the giant cell tumor of long bones, where the giant cells are more. It was first described as central giant cell reparative granuloma by jaffe h l in the year 1953. Elastic stains show damaged elastic fibres that are engulfed by giant cells. It is often difficult to make a clinical diagnosis. Histopathology was reported as central giant cell granuloma. Central giant cell granuloma a case report balaji p, balaji. Nonsurgical treatment methods, such as intralesional. The neoplastic status of the central giant cell granuloma of the jaws remains an unsolved contro versy in anatomic pathology. There is a specific disease called chronic granulomatous disease. Peri apical granuloma is also enumerated into the immune and non immune granuloma 9,11,12.
Central giant cell granuloma of the mandibular condyle. Females are more commonly affected than males, in a 2. A peripheral giant cell granuloma with extensive osseous. This peripheral giant cell granuloma involved the maxillary gingiva associated with an erupting central incisor of a 6yearold girl. Peripheral giant cell granuloma pubmed central pmc. Diagnosis of central giant cell granuloma is normally made histologically from an incisional biopsy. The immune granuloma has a dense infiltration of chronic inflammatory cells chiefly lymphocytes and. Traditional treatment has been local curettage, although aggressive subtypes have a high tendency to recur. Central giantcell granuloma harvard school of dental. The term giant cell reparative granuloma gcrg was introduced by jaffe in 1953 as a benign lesion originating from an inflammatory response due to intraosseous hemorrhage following. Reactive gingival mass resembling pyogenic granuloma, which pushes teeth aside and may erode alveolar bone or involve periodontal membrane arises from periodontal ligament enclosing. The central giant cell granuloma is often found in the mandible commonly occurring in patients under. The case reported here resembled a wide variety of conditions that led to a misdiagnosis both on clinical and radiographic examination but was.
Based on the histopathology, the differential diagnosis was revised to include only lesions with a histology compatible with cgcg, as shown in table 2. Cgcg was formerly regarded as a reparative process and was, accordingly, called central giant cell reparative granuloma. Although central giant cell granulomas cgcgs appear to be benign, their radiographic findings are active. Subsequent histopathological examination figure 5a low power and. Central giant cell granuloma of the anterior maxilla. Peripheral giantcell granuloma an overview sciencedirect.
Because of its overwhelming incidence on the gingiva. These tumors become severely invasive with the stimulus of surgery, resembling malignant. The term giant cell reparative granuloma gcrg was introduced by jaffe in 1953 as a benign lesion originating from an inflammatory response due to intraosseous hemorrhage following trauma. Giant cell rich lesions encompass a relatively large group of biologically and morphologically diverse bone tumours. Clinically and radiologically, a differentiation between aggressive and nonaggressive lesions can be made. Pathology of granuloma inguinale dr sampurna roy md. This is in contrast to the giant cell tumor of long bones, where. Files are available under licenses specified on their description page. Cgcg lacks in clinical and radiographical pathognomonic features to distinguish from common lesions occurring in this region. Achieving the correct diagnosis is reportedly difficult because cgcgs are very similar to odontogenic jaw tumors. The condition was first identified in 1953 by jaffe, who initially termed this lesion as a central giant cell reparative granuloma, but nowadays the reparative word has been.
Pdf central giant cell granuloma is an uncommon, benign, and proliferative lesion whose etiology is not. Giant cell granuloma an overview sciencedirect topics. The differential diagnosis of peripheral giant cell granuloma includes lesions with very similar clinical and histopathological features such as. Areas of chronic inflammation acute involvement at the surface. Central giant cell granuloma of the jaws and giant cell. Central giant cell granuloma cgcg is a localised benign condition of the jaws. Peripheral giantcell granuloma pgcg is an oral pathologic condition that appears in the mouth as an overgrowth of tissue due to irritation or trauma. Cgcg is the most common giant cell lesion of the jaws. Cgcg lacks in clinical and radiographical pathognomonic features to distinguish from. Peripheral giant cell granuloma or so called giant cell epulis is the most common oral giant cell lesion. The case reported here resembled a wide variety of conditions that led to a misdiagnosis both on clinical and radiographic examinations but was histopathologically diagnosed as cgcg. Central giant cell granuloma of the maxilla bmj case reports.
Histopathology foci of multinuclear giant cells hemosiderin particles in a connective tissue stroma. Central giant cell granulomas are more common in the anterior mandible, often crossing the midline and causing painless swellings. It is also called as giant cell epulis, osteoclastoma, giant cell reparative granuloma or giant cell hyperplasian 1,2. Central giant cell granuloma, fibula graft, mandibular condyle. Central giant cell granuloma radiographic histopathology. New guinea, central australia, and india have the highest incidence. Central giant cell granuloma, histopathology, intraosseous, mandibular lesion, surgical excision a conservative surgical approach towards central giant cell granuloma.
Central giant cell granuloma, benign jaw tumor, molar, recurrent pericoronitis, multinucleated giant cells. Surgical treatment and reconstruction for central giant cell. Central giant cell granuloma is a benign intraosseous lesion of the jaws. Peripheral giant cell granuloma epidemiology the peripheral giant cell granuloma pgcg syn. Based on clinical, radiological, and histopathological findings provisional diagnosis of central giant cell granuloma was made. Central giant cell lesions granuloma radiology reference. It usually presents as a purplishred soft tissue nodule consisting of multinucleated giant cells in a background of mononuclear stromal cells and extravasated red blood cells.
Central giant cell granuloma resistant to calcitonin nasal. Central giant cell granuloma cgcg of the jaws is a benign, intraosseous, osteolytic lesion of debatable etiology. Central giant cell granuloma cgcg, formerly called giant cell reparative granuloma, is a nonneoplastic proliferative lesion of an unknown aetiology. The central giant cell granuloma cgcg is a relatively common lesion of the jaws. Central giant cell granuloma cgcg is a benign lesion of the jaws with an unknown etiology. All structured data from the file and property namespaces is available under the creative commons cc0 license. Central giant cell granuloma cgcg is a relatively uncommon benign bony lesion of a variably aggressive nature, accounting for less than 7% of all benign jaw lesions. Central giant cell granuloma venkateshwarlu et, al 6. Extremely aggressive behavior of central giant cell. Jan 26, 2017 peripheral giant cell granuloma is a tumor like growth occurring relatively commonly in the oral cavity that represents a reactive process rather than a neoplasm. A histological comparison of the giant cells in the central giant cell granuloma of the jaws and the giant cell tumor of long bone. It was described first by jaffe h l as central giant cell reparative granuloma in the year 1953 1. The referring doctor had suggested a diagnosis of eruption cyst. Extremely aggressive behavior of central giant cell granuloma.
The lesion was removed by curettage and a histopathological. It is a benign, generally asymptomatic, hyperplastic lesion arising from the attached gingiva or alveolar mucosa. The appearance is generally distinctive with multinucleated giant cells. Peripheral giant cell granuloma or the socalled giant cell epulis is the most common oral giant cell lesion. Annular elastolytic giant cell granuloma is an uncommon cutaneous disease that presents with recurring annular plaques with raised erythematous borders and subsequent residual scarring. Central giant cell granuloma cgcg as described by jaffe in 1953 is an idiopathic nonneoplastic proliferative intraosseous lesion consisting of cellular fibrous tissue that contains multiple foci of haemorrhage, aggregations of multinucleated giant cells and occasionally trabeculae of woven bone. Blood tests a er histopathology demonstrated elevated serum calcium level and alkaline phosphatase level. Immunohistochemical expression of p53, mdm2, ki67 and pcna in central giant cell granuloma and giant cell tumor. They are all related to one another by the presence of numerous multinucleated osteoclast. Peripheral giant cell granuloma and peripheral ossifying fibroma are clinicopathologically distinct gingival lesions. Blood tests after histopathology demonstrated elevated serum calcium level and alkaline phosphatase level.
Giant cell granulomas occurring within the bone are called central giant cell granuloma cgcg and those occurring on edentulous alveolar processes or gingivae are called pgcg. Central giant cell lesions are benign intraosseous proliferative lesions that have considerable local aggressiveness. Central giant cell lesions granuloma dr yuranga weerakkody and assoc prof frank gaillard et al. Barnes l, eveson jw, reichart p, sidransky d 2005 pathology. Central giant cell granuloma cgcg as described by jaffe in 1953 is an idiopathic nonneoplastic proliferative intraosseous lesion consisting of cellular fibrous tissue that contains multiple.
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