Child patient presented with swelling in the buccal and palatal maxillary anterior area tow days ago, the pathology of the lesion there is a giant cell, what is the diagnosis:
1. Giant granuloma.***
2. Hemangioma.
3. ...
Giant cell central granuloma:
This lesion is considered a non-neoplastic lesion. In the past, it was called giant cell repair granuloma due to a weak evidence of restorative response. Nowadays, most maxillofacial pathologists have abandoned the term "repairer" and instead opt for the term "giant cell granuloma".
Clinical presentation:
It affects an age group between 2 to 80 years old with 60% of subjects under 30 years old. It affects mostly women. In 70% of cases, she is met in the mandible. It especially affects the anterior region of the jaws, then, in the mandible, it is frequent that it crosses the median line. Most of the time, they are asymptomatic and discovered on a routine x-ray or they may look like small, non-painful bone expansions. However, a minority of cases may be symptomatic and may be associated with pain, paresthesia, or perforation of the cortical bone with ulceration of the mucosa.
Based on clinical and radiographic features, giant cell granuloma is divided into 2 groups:
Non-aggressive lesions that are characterized by an absence or few symptoms, slow growth, no root resorption and no perforation of the cortex.
Aggressive lesions characterized by pain, rapid growth, cortical perforations, root resorptions and a tendency to recur following treatment.
Radiological aspect:
It corresponds to a unilocular or multilocular radiocidal defect well delimited and uncorrected. The radiological aspect is not very specific. Unilocular lesions may be confused with an apical granuloma or an apical cyst, whereas multilocular lesions are difficult to distinguish from an ameloblastoma. In addition, bilateral multifocal lesions in a young child should be suggestive of cherubism and warrant further investigation.
histopathology:
Presence of multinucleated giant cells, with mesenchymal fusiform cells and monocytic or macrophagic round cells. There is evidence that these giant multinucleated cells originate from osteoblasts. In addition, their distribution may be focal or diffuse within the lesion. Spindle-shaped cells are thought to be of fibroblastic origin. The stroma of the lesion may be loose and edematous or cellular and fibrous, depending on the level of evolution. Also, it is possible to find haemorrhagic zones and hemosiderin deposits.
Treatment and prognosis:
Despite extensive curettage, most studies indicate a recurrence rate of 15% to 20%. These recurrences are more frequent in patients of young ages. Although the less aggressive and recurrent lesions disappear after a few successive curetages, more aggressive lesions require more radical successive treatments. Indeed, with these aggressive tumors, there are 3 alternatives: (1) Corticosteroids (2) Calcitonin (3) Interferon alfa-2a. (1) The use of intramuscular injection of Triamcinolone acetonide (synthetic corticosteroid) for 6 weeks had a good therapeutic success. (2) The daily injection of Calcitonin for 12 months is done intradermally or by nasal spray. (3) Interferon alfa-2a alone or in combination with surgery also results in resolution of large lesions. However, its use can have many side effects, including flu symptoms and in rare cases pancreatitis or drug-induced lupus erythematosus. The advantage of using these alternative methods for large lesions is to avoid extensive surgery that would be too deforming for the patient. Generally the prognosis is good and the risks of metastases are non-existent.
1. Giant granuloma.***
2. Hemangioma.
3. ...
Giant cell central granuloma:
This lesion is considered a non-neoplastic lesion. In the past, it was called giant cell repair granuloma due to a weak evidence of restorative response. Nowadays, most maxillofacial pathologists have abandoned the term "repairer" and instead opt for the term "giant cell granuloma".
Clinical presentation:
It affects an age group between 2 to 80 years old with 60% of subjects under 30 years old. It affects mostly women. In 70% of cases, she is met in the mandible. It especially affects the anterior region of the jaws, then, in the mandible, it is frequent that it crosses the median line. Most of the time, they are asymptomatic and discovered on a routine x-ray or they may look like small, non-painful bone expansions. However, a minority of cases may be symptomatic and may be associated with pain, paresthesia, or perforation of the cortical bone with ulceration of the mucosa.
Based on clinical and radiographic features, giant cell granuloma is divided into 2 groups:
Non-aggressive lesions that are characterized by an absence or few symptoms, slow growth, no root resorption and no perforation of the cortex.
Aggressive lesions characterized by pain, rapid growth, cortical perforations, root resorptions and a tendency to recur following treatment.
Radiological aspect:
It corresponds to a unilocular or multilocular radiocidal defect well delimited and uncorrected. The radiological aspect is not very specific. Unilocular lesions may be confused with an apical granuloma or an apical cyst, whereas multilocular lesions are difficult to distinguish from an ameloblastoma. In addition, bilateral multifocal lesions in a young child should be suggestive of cherubism and warrant further investigation.
histopathology:
Presence of multinucleated giant cells, with mesenchymal fusiform cells and monocytic or macrophagic round cells. There is evidence that these giant multinucleated cells originate from osteoblasts. In addition, their distribution may be focal or diffuse within the lesion. Spindle-shaped cells are thought to be of fibroblastic origin. The stroma of the lesion may be loose and edematous or cellular and fibrous, depending on the level of evolution. Also, it is possible to find haemorrhagic zones and hemosiderin deposits.
Treatment and prognosis:
Despite extensive curettage, most studies indicate a recurrence rate of 15% to 20%. These recurrences are more frequent in patients of young ages. Although the less aggressive and recurrent lesions disappear after a few successive curetages, more aggressive lesions require more radical successive treatments. Indeed, with these aggressive tumors, there are 3 alternatives: (1) Corticosteroids (2) Calcitonin (3) Interferon alfa-2a. (1) The use of intramuscular injection of Triamcinolone acetonide (synthetic corticosteroid) for 6 weeks had a good therapeutic success. (2) The daily injection of Calcitonin for 12 months is done intradermally or by nasal spray. (3) Interferon alfa-2a alone or in combination with surgery also results in resolution of large lesions. However, its use can have many side effects, including flu symptoms and in rare cases pancreatitis or drug-induced lupus erythematosus. The advantage of using these alternative methods for large lesions is to avoid extensive surgery that would be too deforming for the patient. Generally the prognosis is good and the risks of metastases are non-existent.
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