14-year-old female with an
expansile,
painless, anterior mandible lesionDiscussion:
Giant cell granuloma can be central or peripheral depending on its intra
or extraosseous location. Histologically they can look alike and are
composed of fibrous stroma with numerous capillaries with endothelial
proliferation and variable number of multinucleated giant cells. Foci of
hemorrhage with hemosiderin laden macrophages are characteristic findings.
Mitoses can be seen.
Central giant cell granuloma occurs less frequently than its peripheral
soft tissue counterpart. These are locally aggressive and destructive
lesions of the maxillofacial bones. The exact etiology of this condition
is controversial (reactive vs neoplastic). These lesions are more common
in young women (75% are <30 yrs).
About 75% of the lesions are seen in the mandible and maxilla anterior to
the first permanent molars. Rare cases involving the temporal and
paranasal sinuses have been reported. Clinically they present as a painless mass. On radiographs they have
a multiloculated or soap bubble
appearance. Expansion and thinning of the cortical plate is seen.
Displacement of the teeth and pathological fractures may be noted.
Peripheral giant cell granuloma is a non-neoplastic proliferative
lesion probably secondary to trauma, local irritation or chronic
infection. This lesion is seen in young children as well as the elderly. Women are
more often affected than men. This lesion presents as firm, painless, pedunculated or
sessile mass. It often arises from the periodontal ligament or periosteum.
Radiographically it looks like a superficial, saucer-like erosion of the
bone. Surgical excision of the lesion followed by the curettage is the
treatment of choice.
Differential Diagnoses
Aneurysmal bone cyst of the mandible: Numerous blood- filled non-endothelialized
cavities are seen. Commonly seen in young females. Metaphysis of the long
bones and vertebrae are common sites. It can be associated with other
benign and malignant lesions of the bone. Twelve percent of the tumors
occur in head and neck. On radiograph an expansile, unilocular or multilocular
radiolucency is seen.
Giant cell tumor: Commonly seen in sphenoid, temporal or ethmoid
sinuses rather than mandible and maxilla. Epiphysis is the common site. On
radiograph there are no distinguishing features; like in GCT of long bones,
there may be destructive lytic lesions.
Malignant giant cell tumor: Can metastasize, commonly to the
lungs. Has sarcomatous component and unequivocal areas of benign GCT.
Reference:
Shafer, Hine, & Levy. A Textbook of Oral Pathology, (4th ed.).
