Central giant cell granuloma

Central giant cell granuloma (CGCG) is a benign condition of the jaws. It is twice as likely to affect women and is more likely to occur 20 - 40 year old people. Central giant cell granulomas are more common in the mandible and often crosses the midline.

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Overview

CGCG is a benign intraosseous lesion found in the anterior of the maxilla and the mandible in younger people (before age 20). It is characterized by large lesions that expand the cortical plate and can reabsorb roots and move teeth. It is composed of mulitnucleated giant cells. It has a slight predilection for females.

Radiographically it appears as multilocular radiolucencies of bone.

There are two types of CGCG's, Non-aggressive and aggressive. The former has a slow rate of growth and thus less likely to absorb roots and perforate the cortical plate. The aggressive form has rapid growth and thus is much more likely to absorb roots and perforate the cortical plate. It also has a high rate for recurrence and can be painful and cause paresthesia.

Differential diagnosis to include: OKC, ameloblastoma, odontogentic myxoma, hemangioma, central odontogenic fibroma, hyperparathyroid tumor, and cherubism.

Histology

The histology of CGCG is one that is composed of many multinucleated giant cells. There is evidence that these giant cells represent osteoclasts,(bone-eating cells), others suggest more like macrophages. The giant cells may be diffusely located throughout the lesion, or focally aggregate in the lesion. The giant cells are large and round or small and irregular, they vary greatly in size and shape.

Treatment

The treatment for CGCG is thorough curettage. A referral is made to oral surgeon. Recurance ranges from 15%-20%. In aggressive tumors, three alternatives to surgery are undergoing investigation. . corticosteroids . calcitonin (salmon calcitonin) . interferon α-2a. These therapeutic approaches provide positive possible alternatives for large lesions. The long term prognosis of giant cell granulomas is good and metastases do not develop.

References

• Kahn, Michael A. Basic Oral and Maxillofacial Pathology. Volume 1. 2001.
• Neville, Brad et al. Oral and Maxillofacial Pathology, second edition. 2002.