Goint cell

• Giant cell lesions


  Lesions that contain many multinucleated giant cells
• Giant cell lesions of the jaw


  • Giant cell granuloma (central-peripheral)
  • Cherubism
  • Brown tumor of hyperparathyroidism
  • Aneurysmal bone cyst
• Central giant cell granuloma (CGCG)


  A non-neoplastic lesion, formerly called "giant cell reparative granuloma"
• Some CGCG lesions demonstrate aggressive behavior similar to that of a neoplasm
• Giant cell granuloma


  Also called "giant cell lesion", the term "reparative" has been dropped
• Whether true giant cell tumors occur in the jaws is uncertain and controversial
• Central giant cell granulomas

  • Occur in patients ranging from 2 to 80 years of age, with over 60% before age 30
  • More common in females
  • Approximately 70% arise in the mandible
  • More common in the anterior portions of the jaws
  • Mandibular lesions frequently cross the midline
• Nonaggressive central giant cell lesions


  Exhibit few or no symptoms, demonstrate slow growth, and do not show cortical perforation or root resorption
• Aggressive central giant cell lesions


  • Characterized by pain, rapid growth, cortical perforation and root resorption
  • Show a marked tendency to recur after treatment
• Radiographic appearance of central giant cell granulomas

  • Appear as radiolucent defects, which may be unilocular or multilocular
  • The defect is usually well delineated, but the margins are generally non corticated
  • May vary from a 5 X 5 mm incidental finding to a destructive lesion greater than 10 cm in size
  • Small unilocular lesions may be confused with periapical granulomas or cysts
• Histopathologic features of giant cell lesions

  • Presence of few-many multinucleated giant cells in a background of ovoid to spindle shaped mesenchymal cells
  • Giant cells may be aggregated focally or present diffusely
  • Giant cells vary in size and shape from case to case
• Treatment of central giant cell lesions


  • Usually treated by thorough curettage
  • Recurrence rates range from 2% to 50% or greater
  • Recurrent lesions often respond to further curettage, although some aggressive lesions require more radical surgery
• Prognosis of giant cell granulomas

  Long term prognosis is good and metastases do not develop
• Cherubism


  A rare developmental jaw condition that is generally inherited as an autosomal dominant trait
• Clinical and radiographic features of cherubism


  • Usually occurs between ages 2 and 5, may not be diagnosed until 10-12 years old
  • Produces angelic chubby cheeks from bilateral involvement of the posterior mandible
  • Radiographically appears as multilocular expansile radiolucencies, typically bilateral
• Histopathologic features of cherubism

  • Similar to isolated giant cell granulomas
  • May show eosinophilic, cuff-like deposits surrounding small blood vessels, but this is not always present
• Prognosis of cherubism


  • Lesions tend to show varying degrees of remission and involution after puberty, with facial features approaching normalcy by the fourth decade
  • Prognosis is unpredictable, with some patients having very mild alterations and others having grotesque changes that are slow to resolve
• Hyperparathyroidism


  Excess production of parathyroid hormone (PTH), can be primary, secondary or hereditary
• Radiographic features of hyperparathyroidism in the jaws

  • Osteoporotic appearance of the mandible and maxilla showing well-demarcated unilocular or multilocular radiolucencies
  • Generalized resorption and cortical thinning
  • Loss of the lamina dura surrounding tooth roots
  • Longstanding lesions may produce significant cortical expansion
• Brown tumor of hyperparathyroidism


  A lesion derived from the abundant hemorrhage and hemosiderin deposition within the tumor, histologically identical to central giant cell granuloma
• Diagnosis of brown tumor of hyperparathyroidism requires bone chemistry profiling to reveal elevated PTH, serum calcium and alkaline phosphatase, with decreased phosphorus
• Treatment of hyperparathyroidism


  Patient should be referred to a surgeon for excision of the parathyroid gland or for kidney function evaluation, as the jaw lesion should resolve after treatment
• Aneurysmal bone cyst


  An intraosseous accumulation of variable-sized blood filled spaces surrounded by cellular fibrous connective tissue and reactive woven bone
• The cause and pathogenesis of aneurysmal bone cyst are poorly understood, but it may arise from a traumatic event or as a result of disrupted vascular dynamics in a preexisting intraosseous lesion
• Clinical and radiographic features of aneurysmal bone cyst


  • Uncommon in the jaws, with a wide age range but most cases in children and young adults
  • Mandibular predominance, usually in the posterior segments
  • Radiographically appears as a unilocular or multilocular radiolucent lesion with marked cortical expansion and thinning
• Histopathologic features of aneurysmal bone cyst

  • Characterized by blood-filled spaces of varying size, surrounded by cellular fibroblastic tissue containing multinucleated giant cells and trabeculae of osteoid and woven bone
  • The blood-filled spaces are not lined by endothelium
• Treatment of aneurysmal bone cyst


  • Usually treated by curettage or enucleation, sometimes supplemented with cryosurgery
  • Recurrence rates are 8%-60%, mostly from inadequate initial removal
• Despite recurrences, the long-term prognosis of aneurysmal bone cyst appears favorable