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We present an uncommon diagnosis in a 34-year-old female with a non-healing extraction socket. Incisional biopsy revealed multi-nucleated giant cells suggestive of central giant cell granuloma (CGCG). The computed tomography (CT) report made incidental note of a parathyroid mass. The parathyroid hormone (PTH) level was checked and found to be abnormally high. A diagnosis of brown tumour of the mandible was made. The patient was referred to a head and neck surgeon and the parathyroid mass was removed. The mandibular lesion was managed conservatively and continues to regress post-normalisation of PTH levels. The inclusion of the parathyroid region on the CT scan in this case was fortuitous. There are a range of pathologies containing multinucleated giant cells that can arise from the maxillofacial region; PTH level should, nevertheless, be checked in all such jaw lesions. This allows the clinician to exclude brown tumour from the diagnostic sieve.

Several case reports describing the coexistence of sarcoidosis and malignancy have been published. Therefore, sarcoidosis should always be considered as a differential diagnosis when a cancer patient develops lymphadenopathy. Positron-emission tomography (PET) 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) combined with computed tomography (CT) is widely used for cancer staging and surveillance because it permits localization of metabolically active malignant tissue. PET/CT or CT findings in patients with suspected cancer recurrence can be used to guide early and aggressive therapy. However, benign hypermetabolic lymphadenopathy can mimic malignant lymphadenopathy, both on a conventional CT scan and on PET/CT. Thus, it is important to obtain a histological diagnosis before initiating antineoplastic therapy based on imaging findings. Four cases of patients affected by gynaecological malignancies and coexisting sarcoidosis are reported in this study. Furthermore, the clinical relevance of making a differential diagnosis between gynaecological cancer recurrence and granulomatous disorder is given specific mention., (Copyright © 2012 Elsevier España, S.L. and SEMNIM. All rights reserved.)

Central giant cell granuloma (CGCG), formerly called giant cell reparative granuloma, is a non-neoplastic proliferative lesion of an unknown aetiology. It occurs most commonly in the mandible. The case reported here resembled a wide variety of conditions that led to a misdiagnosis both on clinical and radiographic examinations but was histopathologically diagnosed as CGCG. We managed this case by endoscopic excision and curettage via nasal route without producing external scar and avoiding damage to the un-erupted tooth.

We aim to review the imaging appearance of granulomatous lesions of the head and neck. Granulomatous lesions are seen in different regions of the head and neck and a difficult diagnostic challenge for the radiologist. Infective granulomas may be due to bacterial or fungal agents. Non-infective granulomas are Wegener's granulomatosis, sarcoidosis, amyloidosis, chemical granuloma and reparative giant cell granuloma. Familiarity with the clinical presentation and imaging features of these lesions can suggest diagnosis in some cases. CT and MR imaging demonstrate the exact location, extension and effect on surrounding structures. A thorough knowledge of age, gender, common location, clinical features and imaging appearance of granulomatous lesions are important for diagnosis., (Copyright © 2009. Published by Elsevier Ireland Ltd.)

Objective: The objective was to investigate the clinical and radiological characteristics of central giant cell granulomas (CGCGs) of the jaws., Methods: A retrospective analysis of a 20-year database was performed regarding both clinical and radiological features of 22 patients affected with CGCGs of the jaws., Results: Fourteen women and 8 men were included with the age range of 7-81 years (mean 31.7 years). Among the 22 lesions, 16 were located in the mandible and 6 in the maxilla. Painless swelling was the most common clinical feature in 18 of all cases. Limited mouth opening was noted in 2 patients where the lesions involved the condyle. Radiographically, 13 lesions were homogeneously osteolytic and 9 lesions were trabeculated. Fifteen lesions were unilocular and 14 lesions presented with well-defined but not sclerotic margins. CT images in 5 patients clearly showed the trabeculation within the lesions. The follow-up ranged from 1.5 to 11 years with a mean period of 5 years. Three out of 9 aggressive and 1 out of 13 nonaggressive lesions developed recurrence., Conclusions: Diagnosis of CGCGs of the jaws depends on both correct interpretation of clinical, radiographic and pathological data. Differentiation between aggressive and nonaggressive CGCGs should be considered to improve individual treatment planning.

Central giant cell lesion (CGCL) is a benign disease involving the mandible (70%) more than the maxilla; it tends to be more common in women. Clinically, the lesion may be associated with pain, tooth displacement, facial asymmetry, paraesthesia and ulceration of the mucosa. The radiographic aspect of CGCL is highly variable since it may appear as a unilocular or multilocular radiolucent area with expansion and perforation of the cortical bone. Few previous reports have dealt with the usefulness of CT in the evaluation of this lesion. The purpose of this study is to report the clinical and imaging features of a case, including CT, treated by a conservative method.

In this paper we present the aspect of a mandibular giant cell granuloma in spiral computed tomography-based three-dimensional (3D-CT) reconstructed images using computer graphics, and demonstrate the importance of the vascular protocol in permitting better diagnosis, visualization and determination of the dimensions of the lesion. We analyzed 21 patients with maxillofacial lesions of neoplastic and proliferative origins. Two oral and maxillofacial radiologists analyzed the images. The usefulness of interactive 3D images reconstructed by means of computer graphics, especially using a vascular setting protocol for qualitative and quantitative analyses for the diagnosis, determination of the extent of lesions, treatment planning and follow-up, was demonstrated. The technique is an important adjunct to the evaluation of lesions in relation to axial CT slices and 3D-CT bone images.

Fibro-osseous and cartilaginous lesions of the orbit and facial region share overlapping clinical, radiologic, and pathologic features that may lead to diagnostic confusion and possible misdiagnosis. The value of imaging studies in the histopathologic diagnosis of these lesions cannot be overemphasized. The histopathologic diagnosis of such lesions should not be rendered in the absence of radiographic correlation.

The use of computed tomography (C.T.) in the diagnosis and management of developmental and pathological conditions of the jaws in children was evaluated. CT was found to be superior to plain film radiography in estimation of the three-dimensional morphology of the abnormality in the jaws, in determining spatial relationship and proximity to vital structures. It is valuable by allowing accurate planning of the surgical procedure, estimation of the extent of the surgery and prediction of outcome as well as complications and prognosis. CT in the appropriate circumstances, is a very useful diagnostic tool in pediatric maxillofacial surgery. Tissue preservation and precision are of utmost importance, especially in children where many structures have not reached their final dimensions. Careful consideration should be given to risk benefit ratios due to higher exposure to radiation.

The radiographic features of ten pediatric cases of central giant cell granuloma of the jaws were studied, using plain film radiography (PFR), computed tomography (CT), and a dental CT software program (DS). The radiologic features varied from ill-defined destructive lesions to a well-defined, multilocular appearance. Teeth or root displacement was found as the most consistent feature. Root resorption was rare. The features seen on CT were clearer than those seen on PFR. DS, by its visualization of the jaw in three plans - axial, panoramic, and buccolingual - provided useful information for determining the topography of the lesion in its structure (uni- or multilocular) and proximity to adjacent anatomic structures, such as teeth, nerves, or maxillary sinus. CT and, ideally, CT with DS should be used for diagnosis and surgical management of central giant cell granuloma of the jaws in children.

A case of a rare giant cell lesion of a tarsal bone, giant cell reparative granuloma, is presented with CT correlation. CT is useful in pre-operative management both in defining the extent of involvement of adjacent structures and demonstrating soft tissue abnormality.