7. Giant Cell Lesions Flashcards
What is the common denominator of Giant Cell Lesions?
Similar histology
- Cellular mononuclear round and spindly cell stroma studded by clusters of foreign body-type giant cells (big cell with lots of nuclei, that looks like osteoclasts
What is the most common Giant Cell Lesion?
Central Giant Cell Granuloma
What is the pathogenesis of the Central Giant Cell Granuloma?
Reactive lesion, but we aren’t sure what it is reacting to.
What population is affected by Central Giant Cell Granulomas?
- 10 - 20 yrs, rare after age 25
- Female 2:1
Where can a Central Giant Cell Lesion occur, and which location is the most common? (4)
ONLY in jaws
- Anterior Mandible most common
- Can be almost anywhere
- Rare posterior to 2nd molars
- Won’t be seen in the 3rd molar or ramus area
What is the radiographic appearance of the Central Giant Cell Granuloma?
-
Ill-defined multilocular, periapical RL causing root resorption, and destroying crestal bone
- Always RL, no RO
- No respect for midline
What is the gross appearance of the Cental Giant Cell Granuloma?
Brown, liver-like curetting’s
What is the standard treatment for the Central Giant Cell Granuloma? (2)
- Curretage is standard treatment that makes alot of them go away
- Must get serum calcium test to rule out Giant Cell Lesion of Hyperparathyroidism, especially if they are over age 25
What is the treatment for the large, fast growing or recurrent lesions of Central Giant Cell Granuloma? (4)
- Shrink the lesions then curettage
- Steroid injections and Calcitonin to shrink
- Bisphosphonates
- Alpha interferon, but it has risky side effects = Lupus Erythematous
- If non-responsive to curretage then Block Excision
What is the prognosis for Central Giant Cell Granuloma?
-
Overall recurrence rate = 15-20%
- 50% for aggressive lesions
- 2 year follow-up, it will not recur after 2 years
What makes a Central Giant Cell Granuloma more likely to be aggressive? (6)
- > 3cm
- Ramus, even though not expected here
- Very young children (2-3 yrs old)
-
Resorb roots, displace teeth or perforate bone
- already being aggressive
- Pain
- Rapid growth
What is the single most important histologic predictor of aggressiveness in Central Giant Cell Granulomas?
No osteoid formation
The formation of osteoid on the perimeter of the lesion is a good sign, that indicates that it is trying to heal
What is the pathogenesis of the Aneurysmal Bone Cyst?
- Not a true cyst
- A metabolic condition caused by hyperparathyroidism
- Excess PTH mobilizes calcium out of bone
- Replaced by a mass of vascular granulation tissue containing osteoclastic giant cells
- Often associated with other lesions:
- Might represent a Giant Cell Granuloma that has maintained vascular channels, allowing it to continue to grow
What is the behavior of the Aneurysmal Bone Cyst?
- Crazy fast growing (within a week)
- Painful, tender swelling, causing deformity simulating infection or malignancy
Where do Aneurysmal Bone Cysts occur?
Long Bones, rare in jaws
Who is affected by Aneurysmal Bone Cysts?
- Most cases in children and young adults
- Equal M:F
What is the radiographic appearance of the Aneurysmal Bone Cyst?
- Unilocular or multilocular BLOWOUT of affected bone
What are the surgical findings of the Aneurysmal Bone Cyst?
- At surgery a blood-filled honeycombed mass is found and curetted out
- Care is needed to identify any associated lesion (fibro-osseous lesion)
- Follow-up for 50% recurrence
What are the other names for Osteitis Fibrosa Cystica?
- von Recklinghausen Disease of Bone
- Brown Tumor of Hyperparathyroidism
What is the radiographic appearance of Osteitis Fibrosa Cystica?
- Unilocular RL destroying bone
What is the histology of Osteitis Fibrosa Cystica?
- Same as CGCG so differentiate with calcium levels
What population does Osteitis Fibrosa Cystica affect?
Adult Females
What are the typical presenting symptoms of Osteitis Fibrosa Cystica?
- Hyperparathyroidism
- Elevated serum calcium
What is the gross appearance of Osteitis Fibrosa Cystica?
Red in the mouth, turns brown in formalin
What is the etiology of Cherubism?
Autosomal Dominant
100% penetrance in males
50-75% penetrance in females
What age group is affected by Cherubism?
Begins in childhood > 2 yrs, continuing until puberty “chipmunck cheeks”
Stabalizing, then regressing until it disappears by age 30
What is the clinical presentation of Cherubism?
- Slow, painless, symmetrical, bilateral jaw expansion
- Severe cases destroy tooth buds and interefere with speech, swallowing, and breathing
What is the classic radiographic presentation of Cherubism?
- Bilateral, multilocular RL
- Always begins in the posterior mandible continuing towards the midline
- May continue anteriorly to affect the entire mandible with multilocular lesions
- Always bilateral in posterior mandible and ramus
- Condyles are spared
What is the radiographic presentation of Cherubism if the maxilla is affected? (3)
- Starts in the posterior and moves anteriorly
- Bilaterally affects maxillary tuberosity, palate and orbits
- Raises cheeks and causes eyes to gaze upward toward heaven
What is the treatment for Cherubism?
- Do nothing - it resolves spontaneously
- Genetic Counseling
- In severe cosmetic, malfunctioned or life threatening cases, surgery can be performed
- Surgery = rapid regrowth of grotesque deformity
What treatment is contraindicated in pts with Cherubism?
Radiation contraindication, it can cause sarcomatous transformation
What is the other name for the True Giant Cell Tumor?
Osteoclastoma
Where do True Giant Cell Tumors occur?
Low grade malignancy of the long bones
NOT IN JAWS
How do True Giant Cell Tumors present in the extremely rare case that they present in the jaws?
In the mandibular symphysis and may be associated with Paget’s Disease
What population do True Giant Cell Tumors affect?
Young adults, > 20 yrs old
CGCG is rare in pts > 25, and prefers females
What is the prognosis for a pt with True Giant Cell Tumors?
50% recurrence with surgery - hard to remove
10% metastasize
