Central giant-cell granuloma

A benign intraosseous lesion of the jaw

Central giant-cell granuloma (CGCG) is a benign intraosseous lesion that occurs predominantly in the jaws. It is characterized by the presence of multinucleated giant cells within a background of spindle-shaped stromal cells. CGCG is considered a non-neoplastic lesion, although it can exhibit aggressive behavior in some cases.

Clinical Presentation

CGCG typically presents as a painless swelling in the jaw, most commonly affecting the mandible more than the maxilla. It is often discovered incidentally on radiographic imaging or when it causes noticeable facial asymmetry. The lesion can cause tooth displacement and root resorption in adjacent teeth.

Radiographic Features

On radiographs, CGCG appears as a unilocular or multilocular radiolucency. The borders of the lesion can be well-defined or ill-defined, depending on the aggressiveness of the lesion. Panoramic radiography and cone beam computed tomography (CBCT) are commonly used to assess the extent of the lesion.

Histopathology

Central giant-cell granuloma

Histologically, CGCG is characterized by the presence of numerous multinucleated giant cells scattered within a fibrous stroma. The stroma contains spindle-shaped fibroblasts and capillaries. The giant cells are similar to those seen in other giant cell lesions, such as giant cell tumor of bone.

Pathogenesis

The exact pathogenesis of CGCG is not fully understood. It is thought to arise from a reactive process, possibly in response to local trauma or inflammation. Some studies suggest a possible genetic component, with mutations in the SH3BP2 gene being implicated in some cases.

Treatment

The treatment of CGCG depends on the size and behavior of the lesion. Small, non-aggressive lesions may be managed with curettage alone. More aggressive lesions may require en bloc resection. Adjunctive therapies, such as corticosteroid injections, calcitonin, or interferon therapy, have been used to reduce the size of the lesion before surgical intervention.

Prognosis

The prognosis for CGCG is generally good, with a low recurrence rate following complete surgical removal. However, aggressive lesions have a higher risk of recurrence and may require more extensive surgical management.

Related Pages

• Giant cell tumor of bone
• Jaw tumors
• Fibro-osseous lesions