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Tuesday, July 12, 2016

Central Giant-Cell Granuloma


Central Giant-Cell Granuloma
Giant cell lesions of the jaws are more frequent in first two decade of life and are more prevalent in female patients 2:1  

Although other lesions containing giant cells do occur in other bones of the body, they are much less frequent and are generally felt to be variants of other tumors, most often a low-grade osteosarcoma.

Diagnosis of central giant cell granuloma is made histologically from an incisional biopsy.

Similar histological appearances are seen in the following lesions, which must often be differentiated:
  1. The brown tumor of hyperparathyroidism.

  2. The aneurysmal bone cyst.

  3. Cherubism.
Conventional management is surgical and consists of:
1. Enucleation and curettage. Despite this, a recurrence rate of 15-20% is often quoted, and in these cases treatment may need to be more aggressive and may need to consist of an “en bloc” resection.

2. Intralesional steroid injections protocol is a 50/50 mixture of 2% lidocaine with 1:100,000 epinephrine with triamcinolone (Kenalog®)

Experience with this technique is limited. In the hands of those who use this technique on a regular basis, it appears that it is successful in around 50% of cases
3. Calcitonin injections
In the United States only salmon calcitonin is available, and although it is more potent than human calcitonin, antibody formation can limit its effectiveness. Results from the use of calcitonin have shown fairly high success rates.
Treatment with alpha interferon
Based on the assumption that this lesion may be vascular in origin, subcutaneous alpha interferon has been used in the treatment of this lesion. It is given for its anti-angiogenic effects, though there is little evidence that the lesion is vascular in origin. The treatment has shown some success, but its use is limited by its side effects.
Below see a case treated with both Intralesional steroid injections and Calcitonin on a 12 year old with a 5 year follow up with no recurrence.
At presentation 

6 months post treatment
 
1 year post treatment

4 year post treatment

5 year post treatment
 

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