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Abstract Background Magnetic resonance imaging (MRI) of the brain is frequently performed on patients with neurofibromatosis type 1 (NF1), to detect and follow-up intracranial findings. In addition, NF1-related pathologies can appear in the jaws. This case study investigates if it is advantageous to assess the depicted parts of the jaws in the imaging of NF1 patients with intracranial findings, thereby detecting jaw pathologies in their initial stages. Case presentation We report on the 3-year management with clinical and radiological follow-ups of a central giant cell granuloma and a neurofibroma in the mandible of a patient with NF1 who underwent examinations with brain MRIs. A review of the mandible in the patient’s MRIs disclosed lesions with clear differences in progression rates. Conclusion NF1-related jaw pathologies may be detected in the early stages if the depicted parts of the jaws are included in the assessment of the imaging of NF1 patients with intracranial findings. This could impact the treatment of eventual pathologies before lesion progression and further damage to the vicinity.

Introduction: Giant cell-rich lesions are a diverse group of lesions that usually occur in bone and contain varying numbers of reactive osteoclastic-type multinucleate giant cells. These lesions present a challenge in pathologic diagnosis, often requiring a combination of clinical, radiographic, and histopathological assessments. The present retrospective observational study aims to provide a concise diagnostic criterion by combining all these parameters, which will aid in effective diagnosis and targeted treatment planning in the future. Material and Method: Previously diagnosed cases of these lesions were taken from the archives and categorized as Central Giant Cell Granuloma (CGCG), CGCG with secondary Aneurysmal Bone Cyst (ABC), primary ABC, and Brown's Tumour. Their demographic characteristics along with clinical, radiological, and histological data were retrieved and compiled into the table. The data was then analyzed and classified into aggressive and non-aggressive CGCG according to the criteria set in the study. Result: 10 reported cases were of isolated CGCG, 5 were CGCG with secondary ABC, 5 of Brown's tumor and 3 were that of conventional ABC. Out of these, the lesions showing extensive size along with an increased number of giant cells were categorized under aggressive CGCG, whereas those with less aggressive characteristics were categorized under non-aggressive CGCG. The aggressive category comprised 5 cases of isolated CGCG, 2 cases of CGCG with secondary ABC, 3 cases of primary ABC, and 5 of brown tumor, whilst the rest of the cases were categorized under non-aggressive CGCG. Conclusion: Since all these share overlapping features, thereby this type of concise categorization is the dire need so that the lesions can have a precise diagnosis with treatment and follow-up intervals for aggressive lesions. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Magnetic resonance imaging (MRI) of the brain is frequently performed on patients with neurofibromatosis type 1 (NF1), to detect and follow-up intracranial findings. In addition, NF1-related pathologies can appear in the jaws. This case study investigates if it is advantageous to assess the depicted parts of the jaws in the imaging of NF1 patients with intracranial findings, thereby detecting jaw pathologies in their initial stages. Case presentation: We report on the 3-year management with clinical and radiological follow-ups of a central giant cell granuloma and a neurofibroma in the mandible of a patient with NF1 who underwent examinations with brain MRIs. A review of the mandible in the patient's MRIs disclosed lesions with clear differences in progression rates. Conclusion: NF1-related jaw pathologies may be detected in the early stages if the depicted parts of the jaws are included in the assessment of the imaging of NF1 patients with intracranial findings. This could impact the treatment of eventual pathologies before lesion progression and further damage to the vicinity. [ABSTRACT FROM AUTHOR]

Peripheral giant cell granuloma (PGCG) is a non-neoplastic, tumour-like reactive lesion that exclusively involves the gingiva and/or the alveolar crest. The surgical approach with a scalpel has been the golden standard of treatment for PGCG, but the scientific literature reports a high rate of lesion recurrence. Hence, this unique case report aimed to evaluate the efficacy of λ 10,600 nm high-level laser therapy (HLLT) in eradicating persistent, aggressive, and recurrent PGCG that failed to respond to standard surgical treatment. A fit and healthy thirty-four-year-old Caucasian male presented with a two-month history of recurrent episodes of an oral mucosal lesion involving the buccal and lingual interdental papillae between the lower right second premolar (LR5) and lower right first molar (LR6), which was surgically excised with a scalpel three times previously. A λ 10,600 nm-induced HLLT was chosen as a treatment modality at a lower peak power of 1.62 W, measured with a power metre, emitted in gated emission mode (50% duty cycle), whereby the average output power reaching the target tissue was 0.81 W. The spot size was 0.8 mm. Ninety seconds was the total treatment duration, and the total energy density was 7934.78 J/cm2. Patient self-reporting outcomes revealed minimal to no post-operative complications. Initial healing was observed on the 4th day of the post-laser treatment, and a complete healing occurred at two-weeks post-operatively. The histological analysis revealed PGCG. This unique case report study demonstrated the efficacy of λ 10,600 nm-induced HLLT and its superiority to eradicate persistent aggressive PGCG over the standard surgical approach with minimal to no post-operative complications, accelerating wound healing beyond the physiological healing time associated with no evidence of PGCG recurrence at the six-month follow-up timepoint. Based on the significant findings of this unique study and the results of our previous clinical studies, we can confirm the validity and effectiveness of our standardised λ 10,600 nm laser dosimetry-induced HLLT and treatment protocol in achieving optimal outcomes. Randomised controlled clinical trials with large data comparing λ 10,600 nm with our dosimetry protocol to the standard surgical treatment modality at long follow-up timepoints are warranted. [ABSTRACT FROM AUTHOR]

Background: Since giant cell tumors of bone (GCTB) and other giant cell rich tumors of bone (GCRTB) share the histological presence of osteoclastic giant cells and expression of RANK/RANKL, we hypothesized that GCRTB will respond similarly to denosumab as GCTB. The primary objective of this study was to determine the efficacy of denosumab in patients with GCRTB that have recurred or require morbid surgery. Methods: In this open-label, multicenter, phase II trial, patients with GCRTB were included (June 2018-March 2020). Recruitment was stopped because of low accrual. Patients received denosumab (120 mg) subcutaneously (SC) on day 1 of every 4-week cycle with a loading dose of 120 mg SC on days 8 and 15. Results: Three patients were enrolled. One withdrew consent before start of study. The remaining patients had central giant cell granuloma of the jawbone (CGCG). Median treatment duration was 15 cycles (range 12-18). In both subjects, improvement in ossification of lesions was seen. Median follow-up was 28.5 months (range 20-37). One patient developed a recurrence for which surgery was performed. Conclusion: Due to critical emerging real-world data of denosumab in GCRTBs, the study was prematurely stopped and not supportive of use of denosumab for this indication. (ClinicalTrials.gov Identifier: NCT03605199). Giant cell tumors of bone (GCTB) and other giant cell rich tumors of bone (GCRTB) share the histological presence of osteoclastic giant cells and expression of RANK/RANKL, and so it was hypothesized that GCRTB would respond similarly to denosumab as GCTB. This article reports on the efficacy of denosumab in patients with GCRTB that have recurred or require morbid surgery. [ABSTRACT FROM AUTHOR]

Background: Different giant cell‐rich tumors may occur in the jaws. Recently, a new condition known as keratin‐positive giant‐cell rich tumor harboring recurrent HMGA2::NCOR2 fusions has been described. Interestingly, the mononuclear cells of this tumor are immunoreactive with the AE1/AE3 keratin. Considering the similarities of central and peripheral giant cell granuloma of the jaws with the keratin‐positive giant cell‐rich tumor of the soft tissue and bone, we hypothesized whether the keratin‐positive tumors could also occur in the maxillary bones. Methods and Results: An immunohistochemical investigation of AE1/AE3 in a cohort of 16 cases of peripheral and central giant cell granuloma of the jaws was carried out. None of the cases was keratin‐positive. Conclusions: Although no immunopositivity for keratin was observed in the present giant cell granulomas cohort, we cannot completely exclude the possibility of keratin‐positive giant cell‐rich tumors occurring in the jaws. Therefore, oral pathologists should be aware about this condition and further studies using cohorts from different laboratories are necessary. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Peripheral giant cell granuloma (PGCG) is a benign reactive exophytic oral lesion that originates from the periosteum or the periodontal ligament. It exclusively develops on the gingiva or alveolar mucosa. Hyperparathyroidism (HPT) is a possible etiology for its development. HPT is an endocrine disorder characterized by increased secretion of the parathyroid hormone (PTH). This case report describes a case of recurring PGCG in a patient diagnosed with secondary HPT after paraclinical assessment. [ABSTRACT FROM AUTHOR]

Gingival overgrowth is one of the most undesirable consequences that often lead to impaired esthetics and masticatory functions, compromised oral hygiene maintenance often requiring surgical excision of the excessive tissue. Gingival overgrowth belongs to a common group of lesions designated as focal reactive overgrowths. These growths are reactive in nature. A definitive diagnosis will then enable an appropriate management strategy. Peripheral giant-cell granuloma (PGCG) is a reactive focal overgrowth, ordinarily presents as an epulis-like growth. This is of a reactive rather than neoplastic nature and its pathogenesis is uncertain. It is widely considered to originate from the cells of the periodontal ligament, occurring as a response to irritants such as dental calculus, plaque, microorganisms, dental appliances, and restorations. The purpose of this article is to report the clinical, histopathological features and treatment of a case with PGCG arising from mandibular posterior alveolus in a 34-year-old female. The overgrowth was well defined along with the bone defect, involving the buccal aspect of the mandibular gingiva. The tooth was endodontically treated, the lesion was completely excised, and the osseous defect was filled with regenerative material. The 12-month follow-up radiograph revealed successful healing with no more recurrence.

Key Clinical Message Peripheral giant cell granuloma (PGCG) is a benign reactive exophytic oral lesion that originates from the periosteum or the periodontal ligament. It exclusively develops on the gingiva or alveolar mucosa. Hyperparathyroidism (HPT) is a possible etiology for its development. HPT is an endocrine disorder characterized by increased secretion of the parathyroid hormone (PTH). This case report describes a case of recurring PGCG in a patient diagnosed with secondary HPT after paraclinical assessment.

Introduction: The present study aimed to evaluate vascular density in giant cell lesions with different biologic behavior. Therefore, CD34 expression in central and peripheral giant cell granulomas and the aneurysmal bone cyst was evaluated by immunohistochemistry.Materials and Methods: A total of 15, 15, and 8 samples of PGCG, CGCG, and ABC were selected from the archives of the Dentistry School of Mashhad University and Ghaem Hospital, Mashhad, Iran, respectively. Immunohistochemical evaluation of CD34 expression was performed according to the manufacturer's instructions to assess microvessel density (MVD). MVD was calculated in five microscopic fields and the mean MVD of samples was evaluated. Findings were analyzed using t-test, ANOVA, and Pearson’s correlation coefficient.Results: CD34 expression was 31.53, 31, and 26.40 in CGCG, ABC, and PGCG samples, respectively. Although the highest MVD was in CGCGs, no statistical difference was observed between the studied groups (0.270).Conclusions: According to the findings of the present study, evaluation of microvessel density with CD34 expression indicates no pathogenesis and different biological behavior of the studied groups. Therefore, further research seems necessary.

Gingival overgrowth is one of the most undesirable consequences that often lead to impaired esthetics and masticatory functions, compromised oral hygiene maintenance often requiring surgical excision of the excessive tissue. Gingival overgrowth belongs to a common group of lesions designated as focal reactive overgrowths. These growths are reactive in nature. A definitive diagnosis will then enable an appropriate management strategy. Peripheral giant-cell granuloma (PGCG) is a reactive focal overgrowth, ordinarily presents as an epulis-like growth. This is of a reactive rather than neoplastic nature and its pathogenesis is uncertain. It is widely considered to originate from the cells of the periodontal ligament, occurring as a response to irritants such as dental calculus, plaque, microorganisms, dental appliances, and restorations. The purpose of this article is to report the clinical, histopathological features and treatment of a case with PGCG arising from mandibular posterior alveolus in a 34-year-old female. The overgrowth was well defined along with the bone defect, involving the buccal aspect of the mandibular gingiva. The tooth was endodontically treated, the lesion was completely excised, and the osseous defect was filled with regenerative material. The 12-month follow-up radiograph revealed successful healing with no more recurrence. [ABSTRACT FROM AUTHOR]

Dermoid cysts are uncommon congenital or acquired developmental cystic malformations that are usually seen in the midline of frontal region and the anterior fontanel. It contains structures such as hair fluid, teeth, or skin glands that can be found on or in the skin. Superficial orbital dermoid cysts present early in life where as deep dermoid cysts remain clinically occult until adolescence or adulthood. We here are presenting a rare case of exophthalmos in an elderly male, from Southern Odisha, caused by dermoid cyst with giant cell granuloma in the extra conal space of orbit. This non-pulsatile, painless swelling extended to the lateral border of lower orbital rim gradually increasing over a period of 10 months. A histopathology study can be done by Fine needle aspiration biopsy (FNAC) to rule out any malignancy. So, for prompt management and prevention of complication in such cases, enucleation of the cyst should be done by modified Weber-Ferguson incision, without hampering the eyesight. [ABSTRACT FROM AUTHOR]

Introduction: The distinction between giant cell tumors and giant cell granulomas is challenging, as both entities have overlapping diagnostic criteria, especially in oral locations. The two entities have similar clinical and radiological presentations, but they differ in their prognoses. Objective: The main objective of this study was to list the clinical, radiological, histological, and prognostic features of maxillomandibular giant cell tumors and giant cell granulomas cases n order to assess their value as a diagnostic referral factor that may allow the distinction between maxillo-mandibular giant cell granuloma and giant cell tumor. Study design: Data of maxillomandibular giant cell granulomas and giant cell tumors were assessed through a scoping review and a pre-existing systematic review of literature. We have also realized a bicentric retrospective study. Results: Various criteria facilitate the differential diagnosis like age, size, locularity and presence of necrosis zone but not the gender. The most discriminating factors was symptomatology (reported in 72% of GCTs while only 15% of GCGs) and the distribution pattern of giant cells in the stroma (homogeneously dispersed in 80% of GCTs versus grouped in clusters in 86.7% of GCGs). Recurrences were most described for giant cell tumors than giant cell granulomas. Malignant transformation and pulmonary metastasis were exclusively reported for giant cell tumors. Conclusion: As clinical and radiological elements are not sufficient to distinguish between these two entities, immunohistochemistry and molecular genetics can be represent diagnostic biomarkers to distinguish giant cell granulomas and giant cell tumors in oral cavity. We have attempted to define the main criteria for the differentiation of giant cell tumor and giant cell granuloma and propose a decision tree for the management of single maxillomandibular giant cell lesions.

Introduction and Significance: Peripheral giant cell granuloma (PGCG) is a benign reactive lesion commonly found in the mandible but rarely in the maxillary sinus and extending to the infratemporal fossa, which poses a major challenge in excision in this case. It can occasionally lead to bone erosion. Complete surgical excision is the primary treatment., Case Presentation: We present a rare case of PGCG in the maxillary sinus of a male patient following the extraction of the maxillary second molar, resulting in destruction of the bony margins. The patient underwent complete endoscopic resection with a flap to repair the bone loss in the maxilla., Clinical Discussion: Clinicians should be aware of this uncommon location of PGCG to ensure accurate diagnosis and appropriate treatment with minimal patient trauma and excellent outcomes., Conclusion: Endoscopy is a highly effective method for removing PGCG located in the maxillary sinus and extending to the infratemporal fossa, even in cases of large size. It offers excellent results and provides good visualization of the maxillary sinus., Competing Interests: Conflict of interest statement The authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Cherubism is a rare hereditary disease that was first described by Jones in 1933. The disease is characterized by painless jaw enlargement in early childhood. We encountered a very rare case of familial cherubism in monozygotic twins, as reported here for the first time. On the first examination at age 7, the twins' facial features were characterized by painless swelling of the left side of the face. Panoramic radiographs revealed multilocular cystic radiolucency giving soap-bubble appearance in the mandible and unilocular radiolucency in the maxilla. Later, the mandibular diseases gradually progressed, and facial asymmetry was apparent additionally. Therefore, at age 11, they underwent conservative curettage and debulking of the left mandibular molar region under general anesthesia. The specimens were compatible with giant cell granulomas. Consequently, the twins were diagnosed with cherubism. Orthodontic treatment starting at age 12 has resulted in almost normal dental arches. The maxillary diseases disappeared completely without surgical treatment at 14 years of age. [ABSTRACT FROM AUTHOR]

Central giant cell granulomas (CGCG) are not common in the mandibular condyle. In teenagers, the problem is more complex because of difficulties in diagnosis and treatment involving the potential growth of the mandibular process and development of the face. In this short communication a case is presented of an eleven-year-old female under diagnosis of central giant cell granuloma affecting the mandibular condyle treated surgically in two steps using a condylectomy and vertical ramus osteotomy at the first time and later orthognathic surgery, showing the clinical evolution after 13 years of follow-up. In addition, we performed a review of the scientific reports related to CGCG in the mandibular condyle to compare this treatment with others, in terms of follow-up and results. We concluded that the CGCG affecting the mandibular head can be properly treated with low condilectomy, vertical mandibular ramus sliding osteotomy, and discopexy. [ABSTRACT FROM AUTHOR]

Objectives Intraosseous pathological lesions of the jaw include a wide range of benign to aggressive or malignant lesions with different clinical and histopathological characteristics and require various treatments. This study was designed to assess the frequency and characteristics of primary jaw lesions in a defined group of an Iranian population. Methods In this retrospective study, 6676 biopsy reports from the Oral and Maxillofacial Pathology Department, Shahid Beheshti University of Medical Sciences, were assessed. In cases with primary jaw lesions, other variables such as age, gender, location of lesions, and microscopic diagnosis were recorded. The lesions were categorized into “benign /malignant” and “inflammatory” /“non-inflammatory” groups. Chi-square, Kruskal-Wallis, and Fisher exact were used for statistical analysis. Results In total, 395 (5.91%) cases (63.70% female, 36.29% male) with a mean age of 32.37±16.94 had a primary osseous lesion. About 74% of the lesions were found in the mandible with posterior predilection. Fibro-osseous lesions (28.72%), central giant cell granuloma (22.45%), and osteomyelitis (9.13%) were the most common histopathologic diagnoses. The most common malignant tumor was osteosarcoma (8.61%). Of the total lesions, 10.2% were inflammatory lesions. The most common lesions in children and adolescents were fibro-osseous lesions (24.7%), central giant cell granuloma (24.7%), and simple bone cysts (18.8%). Conclusion The main findings of this study were similar to those of most previous studies in different countries. Fibro-osseous lesions and central giant cell granuloma were the most common primary osseous lesions of the jaw in older adults and children with a female predilection. Malignancies included about 9% of all lesions. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to evaluate the Fibronectin expression in peripheral and central giant cell granulomas (PGCG and CGCG) of jaws and giant cell tumor (GCT) of bone using immunohistochemistry. Materials and Methods: In this retrospective study, PGCG (n=15), CGCG (n=15), and GCT (n=10) samples were selected from the archives of Dental School and Ghaem Hospital, Mashhad, Iran. Distribution pattern, staining pattern, and intensity of Fibronectin expression in extracellular matrix were investigated using the immunohistochemistry method according to the manufacturer's instructions. Results: Regarding the intensity of expression, 26 (65%) samples showed strong expression. On the other hand, 64.3 % of the PGCG samples demonstrated weak expression, whereas 46.3% of the CGCG samples showed strong immunoreactivity. There was a statistically significant difference between PGCG and GCT in terms of strong and weak expression. Furthermore, the Reticulate-Fibrillar staining pattern was observed in 19 samples. The Reticulate-Fibrillar and Fibrillar in CGCG lesions and Reticular patternin PGCG lesions were the most prevalent patterns. A statistically significant correlation was reported between the staining pattern and the type of the lesion. The uniform distribution pattern was observed in 33 samples; in addition, it showed the most distribution in CGCG, and most cases of the focal distribution pattern were observed in the PGCG lesions. The distribution pattern was not related to the type of lesion. Conclusions: The findings of the present study showed more similarity between CGCG and GCT lesions regarding Fibronectin immunoreactivity. Therefore, further studies are required to evaluate the similar pathogenesis of these lesions.

Introduction: Central giant cell granuloma (CGCG) is a benign bone tumor that occurs more in young females and anterior of the mandible. It can be unilocular or multilocular with wispy-septation, undulating borders, cortical expansion, and perforation. Central giant cell granuloma in association with other benign lesions of the jaws is named hybrid lesion. An aneurysmal bone cyst (ABC) is a rare, rapidly growing benign tumor that is commonly developed in young females and the mandible molar and ramus regions. It is usually a well-defined cyst-like expansile lesion with an internal structure similar to CGC lesions in radiographic features. Case Report: A 17-year-old girl was referred to the radiology department for panoramic radiography at the end of orthodontic treatment. The complete opacification of the right maxillary sinus, root resorption, and periodontal ligament widening was evident in panoramic radiography. Cone-beam computed tomography revealed a soft-tissue mass and displacement of the lateral nasal wall. The lesion was multilocular with wispy septation and ground glass in some parts. On T2-weighted magnetic resonance imaging, a heterogeneous mass with low to intermediate signals and fluid-fluid levels were observed. The patient underwent surgical curettage, and the histopathological diagnosis was the coexistence of CGCG and ABC. Conclusion: An unusual view of the coexistence of CGCG and ABC could be a lesion with ground glass pattern calcification. Hybrid lesions with the coexistence of CGCG and ABC are rare, and only six cases are reported in the literature in this regard.

Ameloblastic fibro-odontomas (AFOs), cemento-ossifying fibromas (COFs), and giant cell granulomas (GCGs) represent mixed radiolucent/radiopaque lesions found most often in the mandible [1,2,3,4,6,7]. Though there have been reported cases documenting associations of hybrid COFs and GCGs, there have been no reported cases documenting hybrid AFOs and cemento-ossifying fibromas. The following report presents a unique case of the development of an AFO in combination with a COF and a GCG in the mandible of an 8-year-old male. This combination has not yet been described in the literature, and the purpose of this case report is to highlight the presentation of and review the clinical features and treatment recommendations for this combined lesion.

Copyright of Revista Española de Cirugía Oral y Maxilofacial is the property of Sociedad Espanola de Cirugia Oral y Maxilofacial (SECOM) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To evaluate the effectiveness of non-surgical treatment as an alternative in the management of central giant cell granuloma (CGCG). Material and methods: A literature search was carried out in accordance with the PRISMA statement in order to answer the question "Are non-surgical treatments effective as an alternative in the treatment of CGCG?". Two examiners independently assessed eligibility, risk of bias, and extracted data, which included therapeutic protocol, side effects, and need for surgical supplementation. Results: Among 1712 studies, 15 were included, totaling 145 patients. Calcitonin, intralesional corticosteroids, and denosumab were the medications used. For calcitonin (n = 61), complete remission was found in 30 cases. For intralesional triamcinolone (n = 68), reduction in size was observed in most cases (n = 39). Four cases received subcutaneous denosumab and showed absence of active bone metabolism in the region, of which three presented ossification. Combination of drug therapies (n = 29) was reported in one study and included subcutaneous interferon and oral imatinib. More and less side effects were found for interferon and corticosteroids, respectively. Forty percent of patients required additional surgical treatment. Conclusion: Despite the side effects presented and the need for additional surgery in some patients, in general, all non-surgical treatments could provide positive results as an alternative for the management of CGCG, especially with regard to reducing the size of the lesion. Clinical relevance: CGCG is a benign bone lesion that mainly affects young individuals. Although the most common therapy is surgery, its contraindication in some patients, the large extension, and high recurrence rate of the aggressive variant have led the search for non-surgical therapies. [ABSTRACT FROM AUTHOR]

Central giant cell granuloma (CGCG) is a rare tumour. The aetiology remains controversial with immunohistological features suggestive of inflammatory, vascular and proliferative markers. It is most often diagnosed in children and young adults under the age of 30 years with a predilection for the mandible. We herein present a case in a paediatric age group of a maxillary lesion of CGCG with a novel genetic translocation. A combination of surgical intervention including enucleation and embolization produced a good result. The importance of long term follow up for facial growth and recurrence is terribly important for the child. [ABSTRACT FROM AUTHOR]

Central giant cell granuloma (GCCG) is a benign osteolytic lesion of the maxillary bones, with a destructive characteristic and has its osteoclastic origin. Clinically, it presents as a painless, slow-growing lesion with expansion of the cortical bone. In rare cases, it is associated with bone perforation, evolving with paresthesia and local pain. Surgical treatment with aggressive curettage is the traditionally used method of GCCG. Curettage can be defined as the direct approach to the lesion. The paper reports a case of aggressive GCCG in the anterior region of the mandible, which exhibited tooth displacement, root resorption, cortical expansion that was initially treated conservatively, by intralesional corticosteroid injection, evolving with a rare complication of amaurosis, followed by curettage with peripheral osteotomy, preserving bone continuity, associated with immediate reconstruction with xenograft. [ABSTRACT FROM AUTHOR]

Background and Objectives: Peri-implantitis is a common finding among patients with dental implants. There is no consensus regarding the treatment of this disease, but in many cases, surgical treatment is common practice. A histopathological analysis is not an integral part of suggested protocols. The present study investigated the clinical and histopathological parameters of lesions mimicking peri-implantitis and correlated them with the outcome and follow-up data. Materials and Methods: The study included 65 consecutive biopsies taken from peri-implantitis patients between 2008–2019. Results: The three common diagnoses were fibro-epithelial hyperplasia 20 (30.7%), pyogenic granuloma 16 (24.6%), and peripheral giant cell granuloma 15 (23%). There were 18 cases of recurrent lesions in the study group (27.7%). The recurrence rate was the highest in peripheral giant cell granuloma (8, 12.3%), versus 6% in pyogenic granuloma and fibro-epithelial hyperplasia. These differences in the recurrence rate were statistically significant (p = 0.014). Conclusions: This study emphasizes the necessity of submitting tissue of peri-implantitis cases for histopathological analysis since the more locally aggressive lesions (peripheral giant cell granuloma and pyogenic granuloma), which comprise nearly half of the cases in this study, do not differ in clinical or radiographic characteristics from other peri-implant lesions. [ABSTRACT FROM AUTHOR]

Introduction: Central giant cell granuloma (CGCG) is a benign bone tumor that occurs more in young females and anterior of the mandible. It can be unilocular or multilocular with wispy-septation, undulating borders, cortical expansion, and perforation. Central giant cell granuloma in association with other benign lesions of the jaws is named hybrid lesion. An aneurysmal bone cyst (ABC) is a rare, rapidly growing benign tumor that is commonly developed in young females and the mandible molar and ramus regions. It is usually a well-defined cyst-like expansile lesion with an internal structure similar to CGC lesions in radiographic features. Case Report: A 17-year-old girl was referred to the radiology department for panoramic radiography at the end of orthodontic treatment. The complete opacification of the right maxillary sinus, root resorption, and periodontal ligament widening was evident in panoramic radiography. Cone-beam computed tomography revealed a soft-tissue mass and displacement of the lateral nasal wall. The lesion was multilocular with wispy septation and ground glass in some parts. On T2-weighted magnetic resonance imaging, a heterogeneous mass with low to intermediate signals and fluid-fluid levels were observed. The patient underwent surgical curettage, and the histopathological diagnosis was the coexistence of CGCG and ABC. Conclusion: An unusual view of the coexistence of CGCG and ABC could be a lesion with ground glass pattern calcification. Hybrid lesions with the coexistence of CGCG and ABC are rare, and only six cases are reported in the literature in this regard. [ABSTRACT FROM AUTHOR]

Background: Denosumab is a nonsurgical treatment option for central giant cell granulomas (CGCG), especially in aggressive lesions. Case report: We describe a 9‐year‐old girl with an aggressive maxillary CGCG successfully treated with denosumab, avoiding a mutilating surgery after intralesional corticosteroid injections failed, and the lesion continued to rapidly grow. During denosumab treatment, she developed a self‐limiting area of osteonecrosis in the maxillary alveolar bone, which rapidly resolved after antibiotic therapy. Six months after denosumab discontinuation, a maxillary surgical recontour was performed. Two weeks after surgery, the patient presented vomiting, pallor, dehydration, but no fever. Blood tests revealed severe hypercalcemia and acute renal dysfunction. After discarding thyroid, parathyroid, and adrenal alterations, a diagnosis of severe rebound hypercalcemia after denosumab treatment was made. Treatment consisted of hyperhydration, calcium pamidronate, and methylprednisolone, restoring calcium levels to normal. Conclusion: After 2 years of follow‐up, she remains on orthodontic treatment, with no recurrences or other episodes of hypercalcemia. [ABSTRACT FROM AUTHOR]

Central giant cell granuloma is a non-neoplastic proliferative lesion of unknown aetiology, and may cause severe local destruction. It occurs mostly in the mandible, but can also be found in the maxilla. Surgical excision is the mainstay of treatment. We managed this case by curettage via intranasal incision without producing external scar in a young woman.

Dental implants are highly recommended to improve retention, stability, and support of prostheses in edentulous patients with large surgical defects. Depending on the size of the defect a bone graft procedure might be necessary. However, due to limitations of bone grafts some complications might negatively affect the prosthetic rehabilitation of the patient. This case presents some of these prosthetic problems following surgical resection and autogenous bone graft procedures.

Background: Central giant cell granuloma (CGCG) is one of the most intriguing lesions of the jaws and its nature has not yet been fully elucidated. Clinically, some CGCG behave more aggressively, while others have an indolent course. In cases of aggressive CGCG of the maxilla, effective personalized therapies are worth understanding. Case report: We report here a challenging case of aggressive CGCG in a 15‐year‐old girl which was misdiagnosed as an endodontic lesion. Radiographically, a large osteolytic lesion involving the hard palate from the central incisor to the second premolar, extending into the nasal cavity, with loss of the lamina dura and cortical resorption was observed. The lesion expanded aggressively after extensive curettage. With possible mutilation and defects due to a more radical approach to the lesion, treatment with systemic prednisone and intralesional triamcinolone hexacetonide associated with a calcitonin nasal spray was instituted. The decision in favor of this therapeutic strategy was made after careful immunohistochemical analysis of calcitonin and glucocorticoid receptors. The H‐score for the staining of glucocorticoid and calcitonin receptors in multinucleated giant cells was 222 and 153.6, respectively. The lesion reduced in size, and no adverse effects associated with medications were observed. Another curettage was performed, and only fibrous connective tissue was found. The patient is in follow‐up for 11 years without evidence of recurrence. Conclusion: Pharmacological agents hold clinical promise in cases of aggressive CGCG affecting the maxilla of pediatric patients. Investigating the expression of calcitonin and glucocorticoid receptors in order to plan treatment is very helpful in the decision to manage aggressive CGCG. [ABSTRACT FROM AUTHOR]

Central odontogenic fibroma is a rare benign odontogenic tumor that relies on clinical–radiographic–histological correlation to reach its diagnosis, especially its rare variants. Of these rare types is the coexistence of giant cell granuloma-like lesion, with the characteristic odontogenic epithelial rests. The presented case is a 33 years old female complaining of asymptomatic mandibular bony swelling. Radiographically, the lesion is unilocular radiolucent, without root resorption. Histological examination revealed the presence of multinucleated giant cells within the diagnosed central odontogenic fibroma. Immunohistochemical staining highlighted the presence of both components. [ABSTRACT FROM AUTHOR]

The aim of this case report was to detail diagnosis and therapy in a case of implant-associated peripheral giant cell granuloma (IA-PGCG) of the jaw. Case Report: The 41-year-old female attended the outpatient clinic for treatment of recurrent mandibular IA-PGCG. The lesion was excised and the defect was closed with a connective tissue graft of the palate. Healing of oral defects was uneventful, and no local recurrence has occurred during a follow-up of 7 months. Genetic examination of the lesion identified a somatic mutation in KRAS. Conclusion: The lesions are assessed as reactive-inflammatory changes in the mucous membrane of the oral cavity. The cause of the lesion is unknown. KRAS mutations are commonly found in various cancer tissues, but also in germline and mosaic RASopathies. Recently, KRAS mutations have been identified in several IAPGCG. The clinical course of a frequently locally recurring lesion gives rise to the assumption that lesions of this type show characteristics known in benign neoplasms. [ABSTRACT FROM AUTHOR]

Objective: Central giant cell granuloma and peripheral giant cell granuloma of the jaw and oral cavity are identical in histopathologic features, although they are different in pathogenesis and clinical behavior. The aim of present study was to compare CD 68 and factor VIII related antigen (VIII-RA ) immunoreactivity in central giant cell granuloma and peripheral giant cell granuloma to determine the biologic nature and clinical behavior of these lesions which may lead to a better or new treatment modality. Material and Method: CD68 and factor VIII-RA expression were examined immunohistochemically in 22 cases of central giant cell granuloma (10 aggressive and 12 non- aggressive ) and 19 cases of peripheral giant cell granuloma. The Kruskal-Wallis test followed by the Dunn test was used for data analysis. Results: CD68 expression was observed in approximately 100% of multinucleated giant cells and 50% of mononuclear cells. Overexpression of factor VIII-RA in the endothelial cells of capillary like vessels in the periphery of the lesions was prominent. A statistical significant difference for CD68 intensity score in mononuclear cells among three groups (P=0.016) was observed. Indeed, factor VIII-RA intensity score in the endothelial cells of central giant cell granuloma and peripheral giant cell granuloma showed significant difference (P=0.004). Conclusion: These findings support the histiocyte/macrophage nature of multinucleated giant cells and mononuclear cells. Overexpression and high intensity score of CD68 in mononuclear cells and the high intensity score of factor VIII-RA in endothelial cells represent less aggressive behavior in central giant cell granuloma.

Objectives: To investigate the molecular pathogenesis of implant‐associated peripheral giant cell granuloma (IA‐PGCG). Methods: A convenience sample of 15 IA‐PGCG cases was selected. Hotspot mutations of KRAS, FGFR1, and TRPV4 genes, previously reported in conventional giant cell lesions of the jaws, were investigated by Sanger sequencing. As these mutations could activate MAPK/ERK pathway, the expression of phospho‐ERK1/2 was also evaluated by immunohistochemistry. Results: KRAS mutations were detected in 8/15 (53.4%) samples. Similar to conventional peripheral giant cell granuloma, the KRAS mutations most frequently occurred in codon 146 (p.A146V, n = 3), followed by codon 12 (p.G12A and p.G12D, n = 1 each) and codon 14 (p.V14L, n = 1). Variants of unknown significance (VUS) were also detected in two cases, affecting codons 37 (p.E37K) and 127 (p.T127I). All samples showed wild‐type (WT) sequences for FGFR1 and TRPV4 genes. Consistent with MAPK/ERK pathway activation, all mononuclear cells of the lesion showed strong staining for phospho‐ERK1/2 protein in the immunohistochemical analysis. Conclusions: KRAS mutations and activation of the MAPK‐ERK signaling pathway occur in IA‐PGCG. This is the first study to demonstrate cancer‐associated gene mutations in a non‐neoplastic reactive condition associated with dental implants. [ABSTRACT FROM AUTHOR]

Next‐generation sequencing has revealed mutations in several bone‐related lesions and was recently used to uncover the genetic basis of giant cell lesions of the jaws (GCLJ). Consistent with their benign nature, GCLJ show a low tumor mutation burden. They also harbor somatic, heterozygous, mutually exclusive mutations in TRPV4, KRAS, or FGFR1. These signature mutations occur only in a subset of lesional cells, suggesting the existence of a 'landscaping effect', with mutant cells inducing abnormal accumulation of non‐mutant cells that form the tumor mass. Osteoclast‐rich lesions with histological similarities to GCLJ can occur in the jaws sporadically or in association with genetically inherited syndromes. Based on recent results, the pathogenesis of a subgroup of sporadic GCLJ seems closely related to non‐ossifying fibroma of long bones, with both lesions sharing MAPK pathway‐activating mutations. In this review, we extrapolate from these recent findings to contextualize GCLJ genetics and we highlight the therapeutic implications of this new information. © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]