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Oral pathology > Giant Cell Lesions > Flashcards

Giant Cell Lesions Flashcards

1
Q

Classification for giant cell lesions?

A

Matthew 2016 based on cell of origin

  1. EPITHELIAL DERIVED
    - tzanck smear lesions e.g. Herpes viruses
  2. Monocyte/macrophages
    A. Inflammatory - langhan(TB, infectious)(Foreign body granuloma)
    B. Osteoclasts
    -primary (Pagets)
    - reactive (peripheral/central, cheribusm, ABC)
    - fibrous dysplasia, Brown’s tumour (pth)
    - toutons giant cell (xanthoma, xangranuloma, histocytoma)
  3. Tumours (GC)
    - GC fibroma
    - Hod lymph,
    - anaplastic neoplasm
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2
Q

What is a central giant cell granuloma?

A

Monocyte osteoclastic reactive lesion.

Benign intraosseous lesion (hemorrhage from trauma/inflammation )

Females <30, mandible (ant, midline)

Uni or multi with cortex expansion

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3
Q

What are the two subtypes of central giant cell granuloma?

A
  1. Aggressive: pain, rapid, root resoprtion, cortical perforation (paraesthesia possible)
    - if multiple suspect neurofibromatosis
  2. Non aggressive: asymptomatic, slow, no root resoprtion
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4
Q

What are the histological features of a central giant cell granuloma?

A

Vascular/fibrous multinucleated osteoclastic lesion.
Stroma contains spindle cells
Erythrocytic extravastion
Ostoid foci, RANKL receptors, IL1, IL6, TNF.

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5
Q

Is biopsy required for central giant cell granuloma diagnosis?

A

Yes

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6
Q

What are the treatment options for central giant cell granulomas?

A
  1. Enucleation and curratage. 11% reoccurrance
  2. Resection.
  3. Corticosteroid injections.
  4. Calcitronin injections 100units daily, 6-9months. Multiple/recurrent injections
  5. alpha interferon injections - antiangenic/surgery adjunct 1-3miv, 6-12 months. Chemo symptoms
  6. Densaumab 120mg monthly
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7
Q

What are the treatment options for central giant cell granulomas?

A
  1. Enucleation and curratage. 11% reoccurrance
  2. Resection.
  3. Corticosteroid injections.
  4. Calcitronin injections 100units daily, 6-9months. Multiple/recurrent injections
  5. alpha interferon injections - antiangenic/surgery adjunct 1-3miv, 6-12 months. Chemo symptoms
  6. Densaumab 120mg monthly
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8
Q

What is peripheral giant cell granuloma?

A

Monocytic osteoclastic reactive lesion
20-50s females, mandible
-soft tissue variant (aka giant cell epulis) presenting as red sessile or pedunculated lesion.

Ddx: pyogenic granuloma, hemagioma, kaposi

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8
Q

What is peripheral giant cell granuloma?

A

Monocytic osteoclastic reactive lesion
20-50s females, mandible
-soft tissue variant (aka giant cell epulis) presenting as red sessile or pedunculated lesion.

Ddx: pyogenic granuloma, hemagioma, kaposi

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9
Q

What are the histological features of a peripheral giant cell granuloma?

A

Fibrovascular with multinucleated osteoclasts.
Spindle shaped cells and extravastion of erythrocytes.
Grenz zone: ulceration seperated by fibrous tissue

May see surface cupping and reactive woven bone .

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10
Q

What are the treatment options for peripheral giant cell granulomas?

A

Remove cause/irritation with local excision

10% reoccurrance

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11
Q

What is an aneurysmal bone cyst?

A

Monocytic osteoclastic reactive lesion.

Due to reparative response to trauma or secondary to bone neoplasm. Displaces teeth.

Usp6 gene

<20s, usually long bones, mandible posterior/Ramus. Females

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12
Q

What are the features radiographically of an ABC?

A

Soap bubble , multilocular radiolucency. Thins cortex. Ct/MRI will shoe fluid levels.

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13
Q

What are the histological features of ABC?

A

Bloodfilled multicystic lesion without a lining. Multnucleated osteoclasts, spindle cells and reactive bone on Septa edges.
Ddx: ameloblastoma, cheribisum

5%solid ddx: CGCG.

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14
Q

What is the treatment for ABC?

A

Incisional biopsy

  1. Enucleation and curratage (20-50% reoccur)
  2. Resection
  3. If secondary to neoplasm then radiotherapy
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15
Q

What is cherubisum ?

A

Monocytic osteoclastic reactive lesion

Rare, national dominant 4p16. SHH, BP2 gene mutations. 2-7 years, usually halts at puberty. Multiple grades (not usually aggressive). If regresses resolves bony defect around 30yrs.

Plumb round bony cheeks with eyes slanted and eyes looking upwards. Asymptomatic unless growth impinging on foramen, airway.

16
Q

What is the radiographic presentation of cheribisum?

A

Bilateral widening of the ridges with soap bubble expansive radiolucency

May interfere with tooth development and eruption (hypodontia), delayed or ectopic eruption. Development of teeth may be interrupted.

17
Q

What are the histological features of cheribisum?

A

Vascular fibrous with variable multinucleated lesion. Small giant cells with focal aggregation. Esosinophillic cuffing around BV that starts with collagen cuffing then becomes fibrous or metaplastic bone as activity decreases.

18
Q

How is cheribusm diagnosed?

A

Normal blood biomarkers e.g. pth, ca, alp, calcitronin.

Has grading system:

  1. man with no root resoprtion
  2. max/mand no root resoprtion
  3. Aggressive man with root resorption
  4. Max and man with root resorption
  5. Aggressive spread max and man
  6. Includes orbits and is very aggressive
19
Q

What is the treatment for cheribusm?

A

Debunk as benign with possible resolution
Annual recalls, 2-5yr post puberty recalls
-orth surgery, nathic, exos of loose teeth, exposures.

20
Q

What is a brown tumour?

A

Monocytic osteoclastic reactive lesion to abnormal pth expression resulting in dysfunction of bone turnover. >60, female

Pth 45% (primary), secondary to adenoma, hyperplasia, carcinoma, low serum Ca due to renal disease

Asymptomatic swelling. Radiographocally well demarcated (uni or mult) in mand. RR abnormal.

21
Q

What’s the histological findings of brown tumours?

A

Osteoclasts burrow into trubecular bone forming tunnels

Hemosideran hemorrhage deposits.

22
Q

What is the management of Brown’s tumours?

A

GP, Serum check for Ca, PTH, renal panel.

Once fixed cause may regress. If large excision.

23
Q

What is a giant cell tumour

A

Benign bone tumour.
Can be aggressive and metastasis. 2%h and n tumours.
Well circumscribed lyric lesions with lattice or no sclerosis
Biopsy required
Giant cells usually regular and informed
Requires excision/resection

Oral pathology (11 decks)

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