Langerhans, Paget's, and Giant Cell Lesions

Question 1

A chronic, painful bone remodeling disorder affecting one or multiple bones in older adults

Characterized by osteoclast hyperactivity and compensatory osteoblastic activity that results in expansion and poor quality bone at affected sites

Rx - “cotton wool” lucent-opaque. Teeth may exhibit hypercementosis

during active disease serum alkaline phosphatase is elevated

Answer 1

Paget’s Disease of Bone

Question 2

Proliferation of cells resembling langerhans cells of the skin and mucosa

Lesions may appear over a wide age range

Lytic bone lesions may be found in jaws and/or extragnathic sites; may mimic periapical or periodontal lesions

Answer 2

Langerhans Cell Disease

Question 3

Rare in the US

May be a tumor or Vit. D deficiency

Stones, bones and groans

Dental x rays, loss of lamina dura and radiolucencies representing giant cell lesions

Answer 3

Hyperparathyroidism

Question 4

Uncommon

Children are often affected, but adults

Swelling, radiolucency, tooth resorption

Clinically and radiographically classified as aggressive or nonagressive

consider hyperparathyroidism

Answer 4

Central Giant Cell Lesion

Question 5

Fairly Common; younger patients mainly affected

usually in mandible

Asymptomatic lucency, may “scallop” around roots of nearby teeth

Empty cavity in bone, lacking epithelial lining

Answer 5

Simple Bone Cyst

Question 6

Uncommon
young adults; mandible>maxilla

“bloody sponge”

Histo: variably sized blood filled spaces, foci of giant cells and reactive woven bone

Answer 6

Aneurismal Bone Cyst