Granuloma Periférico de Células Gigantes e Hiperparatiroidismo. Presentación de un Caso / Peripheral Giant Cell Granuloma and Hyperparathyroidism. Case Report

RESUMEN: Se presenta el caso de un paciente sexo femenino 31 años, insuficienciente renal crónica en hemodiálisis, hipertensa secundaria, consulta por aumento de volumen oral en relación a encía marginal vestibular izquierda, 6 meses de evolución. Al examen se observa aumento de volumen de 15 mm en relación a piezas. 3.6 y 3.7. Radiografía muestra compromiso periodontal pieza 3.7. Se realiza biopsia excisional y exodoncia pieza 3.7. Histopatología informa granuloma periférico de células gigantes. Se solicitan exámenes de laboratorio para estudio de hiperparatiroidismo (PTH elevada, calcemia fosfatemia normales). Evoluciona favorablemente. Sin signos de recidiva a los 3 meses. El diagnóstico histopatológico de lesión de células gigantes debe ser complementado con la clínica, exámenes de laboratorio e imagenología, el objetivo final es definir si tal diagnóstico corresponde a un tumor pardo, a un granuloma central de células gigantes o a un granuloma periférico de células gigantes. En la literatura los reportes de asociación entre granuloma periférico de células gigantes e hiperparatiroidismo son escasos. Este caso corresponde a granuloma periférico células gigantes, asociado a hipersecreción de paratohormona.

ABSTRACT: A 31-year-old female patient with chronic renal insufficiency in hemodialysis and secondary hypertension consulted due to an enlarging intraoral lesion in relation to the left marginal vestibular gingival, with 6 months of evolution. A 15mm mass in relation to mandibular left molars was noted. Radiograph showed periodontal involvement of mandibular left second molar. Excisional biopsy and tooth 3.7 extraction were performed. Histopathology reported a peripheral giant cell granuloma. Laboratory tests were requested for suspected hyperparathyroidism (aiding in the diagnosis) (high PTH, normal phosphatemia and calcemia). Evolution was favorable, without signs of reappearance after 3 months. The histopathological diagnosis of giant cell lesions should be complemented with clinical, laboratory and imaging tests. The final objective is to make the differential diagnosis between brown tumor, central giant cell granuloma and peripheral giant cell granuloma because the treatment varies considerably. There are few reports in the literature about the association between peripheral giant cell granuloma and hyperparathyroidism. This case corresponds to peripheral giant cell granuloma, possibly associated with parathormone hypersecretion.

A comparative study of osteopontin and MMP-2 protein expression in peripheral and central giant cell granuloma of the jaw / Estudo comparativo da expressão das proteínas osteopontina e MMP-2 no granuloma central e periférico de células gigantes de mandíbula

Abstract Introduction: Oral peripheral and central giant cell granulomas are lesions with little-known etiology and pathogenesis. Objective: The aim of this study was to compare matrix metalloproteinases-2 and osteopontin protein expression in the multinucleated giant cells and mononuclear cells of the peripheral and central giant cell granuloma lesions. Methods: In this retrospective study, the presence of matrix metalloproteinases-2 and osteopontin in 37 cases of central giant cell granuloma and 37 cases of peripheral giant cell granuloma paraffin blocks were assessed by streptavidin-biotin immunohistochemistry. Independent sample t-test, Chi-square, Mann-Whitney tests and Spearman's rank correlation coefficient were used. Results: The osteopontin was expressed in both multinucleated giant cells and mononuclear cells in all cases of peripheral and central giant cells granulomas. However, the matrix metalloproteinases-2 expression was positive in 86.5% of giant cells and it was positive in all of mononuclear cells in peripheral giant cells granuloma. In central giant cells granulomas, 91.8% of giant cells and all mononuclear cells were positive for matrix metalloproteinases-2 marker. Percentage and Intensity of staining were significantly higher in central than peripheral giant cells lesions, for both markers (p ˂ 0.05). Conclusion: This study showed that the expression of osteopontin in giant cells supports the theory of osteolcastic nature of these cells. Also, the presence of osteopontin and matrix metalloproteinases-2 in mononuclear cells may indicate the monocyte-macrophage origin of these cells, as the differentiation of the precursors of the mononuclear stromal monocyte/macrophage to osteoclasts is possibly affected by the expression of osteolytic factors. Also, may be differences in biological behaviors of these lesions are associated with the level of osteopontin and matrix metalloproteinases-2 expression.

Resumo Introdução: Os granulomas periféricos e centrais de células gigantes são lesões com etiologia e patogênese pouco conhecidas. Objetivo: Comparar a expressão das proteínas metaloproteinases da matriz-2 e osteopontina nas células gigantes multinucleadas e células mononucleares no granuloma periférico e central de células gigantes. Método: Neste estudo retrospectivo, a presença de metaloproteinases da matriz-2 e osteopontina em 37 casos de granuloma central de células gigantes e 37 casos de granuloma periférico de células gigantes em blocos de parafina foi avaliada por imuno-histoquímica pela estreptavidina-biotina. Foram usados teste t para amostra independente, teste de qui-quadrado, Mann-Whitney e coeficiente de correlação de Spearman. Resultados: A osteopontina foi expressa em células gigantes multinucleadas e células mononucleares em todos os casos de granuloma periférico de células gigantes e granuloma central de células gigantes. No entanto, a expressão de metaloproteinases da matriz-2 foi positiva em 86,5% de células gigantes e foi positiva em todas as células mononucleares em granuloma periférico de células gigantes. Em granuloma central de células gigantes, 91,8% das células gigantes e todas as células mononucleares foram positivas para o marcador metaloproteinases da matriz-2. A porcentagem e intensidade de coloração em granuloma central de células gigantes foram significantemente maiores do que em granuloma periférico de células gigantes para ambos os marcadores (p ˂ 0,05). Conclusão: Este estudo mostrou que a expressão de osteopontina em células gigantes apoia a teoria da natureza osteoclástica dessas células. Além disso, a presença de osteopontina e metaloproteinases da matriz-2 em células mononucleares pode indicar a origem dos monócitos-macrófagos dessas células, uma vez que a diferenciação dos precursores do monócito/macrófago estromal mononuclear em osteoclastos é possivelmente afetada pela expressão de fatores osteolíticos. Além disso, as diferenças nos comportamentos biológicos dessas lesões estão associadas ao nível de expressão de osteopontina e metaloproteinases da matriz-2.

Fibroma de Células Gigantes en Lactante Mayor / Giant Cell Fibroma in Older Infant. A Case Report

RESUMEN: El fibroma de células gigantes es considerado un tumor benigno no neoplásico de la mucosa oral. Este aparece en las primeras tres décadas de la vida, siendo relativamente raro en pacientes pediátricos. Puede encontrarse principalmente en la encía mandibular, mostrando predilección por el sexo femenino. Clínicamente se presenta como un crecimiento indoloro, de base sésil o pediculado, que generalmente se confunde con otras lesiones de tipo fibrosas como los fibromas de irritación. Histológicamente, se distingue por presentar fibroblastos estrellados con la presencia de células gigantes multinucleadas cerca de la lámina del epitelio. Presentamos el caso de una paciente femenino de un año de edad la cual presenta crecimiento nodular indoloro en relación con una superficie del paladar de 51 y 61. Teniendo en cuenta el tamaño y la ubicación de la lesión, se realizó escisión, biopsia y se envió para análisis histopatológico que confirmó la lesión como fibroma de células gigantes.

ABSTRACT: The giant cell fibroma is a benign nonneoplastic fibrous tumor of the oral mucosa. It occurs in the first three decades of life and is relatively rare in pediatric patients. It can be found predominantly in the mandibular gingiva, showing predilection for females. Clinically it presents as a painless, sessile, or pedunculated growth which is usually mistaken for other fibrous lesions like irritation fibroids. Histologically it is distinguished by the presence of stellated fibroblasts along with multinucleated giant cells near the epithelial sheet. We present a case where a one-year-old female patient presented with a painless nodular growth in relation to a palatesurface of 51 and 61. Considering the size and location of the lesion, excision and biopsy were performed and sent for histopathological analysis which confirmed the lesion as giant cell fibroma.

Immunohistochemical expression of RANKL in oral giant cell lesions is predictive of aggressiveness

Abstract The aim of this study was to evaluate the immunohistochemical expression of receptor activator of nuclear factor kappa-B ligand (RANKL) and of osteoprotegerin (OPG), important proteins correlated with osteoclastogenesis, in central giant cell lesions (CGCL) and peripheral giant cell lesions (PGCL) and to compare their expression with the histological and clinical parameters for quantification of multinucleated giant cells (MGC) and their nuclei, lesion size, and recurrences. Twenty cases of each lesion type were selected to quantify the number of MGCs and nuclei/mm2 of connective tissue. The immunoreactivity of RANKL and OPG was expressed as a percentage of the marked area in the stroma. Clinical data were collected from pathoanatomical and medical reports. No statistical differences were found for the number of MGCs (p = 0.24) between PGCL and CGCL, but the number of nuclei within the MGCs was higher in CGCL (p = 0.01). RANKL expression was higher in CGCL than in PGCL (p = 0.04) and all recurrent lesions showed higher RANKL and OPG expressions than nonrecurrent lesions. We report higher RANKL expression and a greater number of nuclei in CGCL, which may explain the difference in clinical behaviour between these lesions and their pathogenesis.

Florid cemento-osseous dysplasia and peripheral giant cell granuloma in a patient with neurofibromatosis 1

Abstract: We report a 35-year-old mulatto female patient with neurofibromatosis Type 1 who presented with facial asymmetry. The patient had two lesions: florid cemento-osseous dysplasia associated with peripheral giant cell granuloma. She was referred for surgical treatment of the peripheral giant cell granuloma and the florid cemento-osseous dysplasia was treated conservatively by a multidisciplinary team. So far, no changes have been observed in the patient's clinical status. We observed no recurrence of peripheral giant cell granuloma. To the best of our knowledge, the present case is the first report of a patient with neurofibromatosis Type 1 associated with a giant cell lesion and florid cemento-osseous dysplasia.

Central giant cell granuloma in a child: case report / Granuloma central de células gigantes en un niño: reporte de un caso

This article describes a case of central giant cell granuloma in the right posterior region of the mandible in a 10- year-old boy. The lesion was removed by curettage and a histopathological examination was carried out.

En este artículo se describe un caso de granuloma central de células gigantes en la región posterior derecha de la mandíbula en un niño de 10 años de edad. La lesión se retiró por legrado y se realizó un examen histopatológico.

Granuloma periférico de células gigantes: revisión de 87 casos / Peripheral giant-cell granuloma: a review of 87 cases

El granuloma periférico de células gigantes (GPCG) es una hiperplasiareactiva que se presenta sólo en la encía como respuesta a una irritación local o trauma crónico, sin predilección de género y edad variable. Objetivo: Identifi car las características demográfi cas e histopatológicas de 87 casos de GPCG en un servicio privado de patología bucal. Metodología: Se obtuvieron los datos de edad, género y diagnóstico clínico de 87 casos de GPCG. Se analizó la distribución por género y edad. Los cortes histológicos fueron examinados para confirmar el diagnóstico en 84 casos, ya que tres no presentaron las características del GPCG. Las características histopatológicas que se evaluaron fueron la presencia de estroma hipercelular, infi ltrado infl amatorio crónico, hemorragia, hemosiderina, tejidos mineralizados y úlcera. Resultados: De los 87 casos, tres fueron descartados por no corresponder al diagnóstico. En un periodo de 10 años se recibieron 6,696 biopsias, de las cuales 84 (1.2 por ciento) correspondieron a GPCG. Se presentó en un rango de edad de cinco a 90 años, con una media de edad de 42 años (± 19.9), siendomás frecuente en la quinta década de la vida y mostró predilección por el género femenino (58.5 por ciento). En los cortes histológicos se observó un estroma hipercelular con células de forma ovoide o fusiforme y células gigantes multinucleadas tipo osteoclasto, infi ltrado inflamatorio(66 por ciento), hemorragia (85 por ciento), hemosiderina (20 por ciento), tejidos mineralizados (11.9 por ciento) y úlcera (25 por ciento). Conclusión: El GPCG es una lesión exofítica reactiva de la encía que presenta características demográficas variables y que al examen microscópico se distingue por tener células gigantes multinucleadas tipo osteoclasto, además de otros componentes como tejidos mineralizados.

The peripheral giant-cell granuloma (PGCG) is a reactive hyperplasiathat occurs only in the gum, in response to local irritation orchronic trauma, with no predilection for either age or sex. Objective:To identify the demographic and histopathological characteristics of87 cases of PGCG in a private oral pathology service. Methodology:Data on the age, gender, and clinical diagnosis of 87 cases of PGCGwere obtained, which were analyzed to determine the distributionby sex and age. Histological sections were examined to confirm thediagnosis in 84 of the cases (three did not present any characteristicsof PGCG). The histopathologic features were evaluated for the presence of hypercellular stroma, chronic infl ammatory infi ltrate,hemorrhaging, hemosiderin, mineralized tissues, and ulcers. Results: of the 87 cases, 3 were eliminated as they did not match the requireddiagnosis. Over a 10-year period, 6,696 biopsies were received bythe pathology service, of which 84 (1.2%) were of PGCG. This was presented in patients ranging from 5 to 90 years old, the mean agebeing 42 years (± 19.9); it occurred most frequently in the 5th decadeof life and showed a predilection for females (58.5%). In the histologicsections, a hypercellular stroma with ovoid or fusiform cellsand multinucleated osteoclast-like giant cells was observed, as wellas infl ammatory infi ltrate (66%), hemorrhaging (85%), hemosiderin(20%), mineralized tissues (11.9%), and ulcers (25%). Conclusion:The PGCG is a reactive exophytic lesion of the gingiva that presentsvariable demographic features and which, under microscopic examination, is distinguished by multinucleated osteoclast-like giant cells, and other components as mineralized tissues.

Lesión híbrida conformada por una lesión central de células gigantes y un fibroma osificante central: reporte de un caso y revisión de la literatura / Hybrid lesión composes by a central giant cell lesion and central ossifying fibroma: a case report and review of literature

Las lesiones híbridas son entidades poco frecuentes conformadas por elementos histopatológicos de distintas lesiones, la asociación de un Fibroma Osificante Central (FOC) con una Lesión Central de Células Gigantes (LCCG) es un ejemplo de ellas y representa el tipo más frecuentemente reportado en la literatura con diez casos hasta la fecha. A continuación presentamos el caso de una paciente de 24 años de edad, quien es referida al servicio de clínica estomatológica de la Facultad de Odontología, por presentar un aumento de volumen en la zona mandibular derecha que ocasiona asimetría facial, al examen intrabucal se observó una lesión tumoral de aproximadamente 2,5 cms. de diámetro y recubierta por mucosa bucal sana, que se extendía desde el canino inferior derecho hasta el segundo premolar del mismo lado (de 43 al 45). La paciente refiere una evolución de 3 meses y aparición posterior a un trauma. Se indican pruebas hematológicas y de vitalidad pulpar de los dientes involucrados, tomografía computarizada y biopsia Incisional, la cual concluye: LCCG asociada a FOC. Se trata con recesión quirúrgica total previo tratamiento endodóntico de los dientes involucrados y después de dos años la paciente se mantiene libre de recidiva. El reporte de este tipo de lesiones híbridas permitirá entender mejor en el futuro su comportamiento y a su vez brindar el tratamiento más adecuado a estos pacientes.

Hybrid lesions are rare entities formed by histopathological elements of different lesions, the association of a Central Ossifying Fibroma (COF) with a Central Giant Cell Lesion (CGCL) is an example of them and represents the most frequently reported type in the literature, only ten cases to date. We present the case of a 24 years female patient, who is referred to the dental clinic service to present a swelling in the right mandibular region causing facial asymmetry, the intra oral examination revealed a 2,5 cm lesion covered with healthy oral mucosa which extended from the distal aspect of lower right canine to the right second bicuspid, with 3 months evolution and associated to a trauma. Haematological tests, pulp vitality of involved teeth, CT scan and incisional biopsy were indicated, concluding a diagnosis of COF associated to CGCL. The decision was made to go for the surgical approach of the lesion with previous endodontic treatment of involved teeth and after two years the patient remains free of recurrence. The report of this type of hybrid lesions helps to understand their behavior and guides to the best treatment for these patients.

Análise comparativa da imunoexpressão de GLUT-1, GLUT-3 e M-CSF em lesão periférica e central de células gigantes / Comparative analysis of GLUT-1, GLUT-3 and M-CSF immunoexpression in peripheral and central giant cell lesions

A lesão periférica de células gigantes (LPCG) e a lesão central de células gigantes (LCCG) são patologias histologicamente semelhantes que acometem a região de cabeça e pescoço. O estudo objetivou analisar a expressão imuno-histoquímica dos marcadores GLUT-1, GLUT-3 e M-CSF em uma série de casos de LPCG e LCCG, na tentativa de compreender os diferentes comportamentos biológicos destas entidades patológicas. A amostra foi constituída por 20 espécimes teciduais de LPCG, 20 de lesão central de células gigantes não agressivas (LCCGNA) e 20 de lesão central de células gigantes agressivas (LCCGA), oriundos do Serviço de Anatomia Patológica da Disciplina de Patologia Oral do Departamento de Odontologia da UFRN. Foi realizada a análise semiquantitativa e qualitativa da expressão imuno-histoquímica dos marcadores nas células gigantes e nas células mononucleares. Em relação ao GLUT-1, verificou-se uma diferença estatisticamente significativa na quantidade de células mononucleares imunomarcadas entre a LPCG e a LCCGNA e entre a LPCG e a LCCGA. Em relação à intensidade da marcação também foi verificado uma diferença estatisticamente significativa tanto para as células mononucleares quanto para as células gigantes entre LPCG e LCCGNA e entre LPCG e LCCGA, nas células gigantes também ocorreu uma diferença estatisticamente significativa entre a LCCGNA e a LCCGA. Em relação ao GLUT-3, foi encontrada uma diferença estatisticamente significativa entre LPCG e LCCGA e entre LCCGNA e LCCGA na quantidade de células mononucleares imunomarcadas. No que concerne à intensidade de marcação para a referida proteína foi verificado uma diferença estatisticamente significativa nas células gigantes entre LPCG e LCCGA. Para o M-CSF foi observada apenas uma diferença estatisticamente significativa na intensidade de marcação nas células mononucleares entre LPCG e LCCGNA e entre LPCG e LCCGA. Com base nestes resultados, pode-se concluir a participação do GLUT-1, GLUT-3 e do M-CSF na patogênese das lesões estudadas. A maior imunomarcação destas proteínas nas células mononucleares evidenciam que tais células desempenham uma maior atividade metabólica e osteoclastogênica, principalmente nas LCCGA. Constatou-se que as células mononucleares estavam mais relacionadas à patogênese das lesões estudadas do que propriamente as células gigantes (AU).

The peripheral giant cell lesion (PGCL) and the central giant cell lesion (CGCL) are lesions histologically similar affecting the head and neck region. The study aimed to analyze the immunohistochemical expression of markers GLUT-1, GLUT-3 and MCSF in a series of cases of PGCL and CGCL, in trying to understand the different biological behavior of these pathologies. The sample consisted of 20 tissue specimens of PGCL 20 central lesion of not aggressive giant cell (CLNAGC) and 20 central lesion of aggressive giant cell (CLAGC), coming from the Pathology Unit of Oral Pathology of the Department of Dentistry of UFRN. Was performed the semi-quantitative and qualitative analysis of immunohistochemical expression of the markers in giant cells and mononuclear cells. In relation to the GLUT-1, it was found a statistically significant difference (p <0.05) in the number of mononuclear cells immunomarked between the PGCL and the CLNAGC and between the PGCL and CLAGC. Regarding the intensity of staining was also observed a statistically significant difference both at the mononuclear cells as in giant cells between PL and CLNAGC and between PGCL and CLAGC, at the giant cells there was also a statistically significant difference between the CLNAGC and CLAGC. In relation to GLUT-3, was found a statistically significant difference between PGCL and CLAGC and between CLAGC and CLNAGC in amount of mononuclear cells immunomarked. Regarding the intensity of labeling for such protein was found a statistically significant difference at the giant cells between PL and CLAGC. To the M-CSF was observed only a statistically significant difference in the intensity of labeling at the mononuclear cells between PGCL and CLNAGC and between PGCL and CLAGC. Based on these results, we can conclude the participation of GLUT-1, GLUT-3 and M-CSF in the pathogenesis of the lesions studied. The bigger immunostaining of these proteins in mononuclear cells show that these cells perform a higher metabolic activity and osteoclastogenic, especially in CLAGC. It was found that the mononuclear cells were more related to the pathogenesis of the studied lesions than properly the giants cells (AU).

Fine Needle Aspiration Cytology and Intralesional Steroid Injection in a Central Giant Cell Granuloma Affecting the Gingiva: A New Clinical Approach

Central giant cell granuloma (CGCG) is a benign jaw lesion predominantly found in the mandible of young female patients with a variable clinical behavior. Although surgical management is regarded as the main treatment modality for this lesion, the use of intralesional injections of steroids has been recently advocated for its treatment. In addition to this conservative management, the use of fine needle aspiration cytology (FNAC) for diagnosing CGCGs has been proven a safe and efficient approach, especially useful in cases with lesions located in esthetic regions. Herein, it is described a case of CGCG extending to the overlying gingiva of a 15-year-old male patient diagnosed by FNAC and subsequently treated with intralesional injections of a solution of triamcinolone acetonide and ethanolamine oleate that led to an important clinical remission, allowing a more conservative surgical procedure for preservation of gingival esthetics. Therefore, both procedures can be considered as management options for CGCG of the jaws.

O granuloma central de células gigantes (GCCG) é uma lesão benigna dos maxilares predominantemente encontrada na mandíbula de pacientes jovens do sexo feminino com um variado comportamento clínico. Apesar de o manejo cirúrgico representar a principal modalidade terapêutica para esta lesão, o uso de injeções intralesionais de esteróides tem sido recentemente proposto para seu tratamento. Além do manejo conservador, o uso da punção aspirativa por agulha fina (PAAF) para o diagnóstico do GCCG tem sido comprovado ser uma abordagem segura e eficiente, especialmente útil em casos de lesões localizadas em regiões estéticas. Descrevemos aqui um caso de GCCG estendendo-se para a gengiva adjacente em um paciente do sexo masculino, 15 anos de idade, diagnosticado por meio da PAAF e subsequentemente tratado com injeções intralesionais de uma solução de acetato de triancinolona e oleato de etanolamina que levou a uma importante remissão clínica, permitindo a realização de uma abordagem cirúrgica conservadora preservando a estética periodontal. Por este motivo, ambos os procedimentos podem ser considerados opções de manejo para o GCCG dos maxilares.

Clinical and imagiological findings of central giant cell lesion and cherubism

Cone beam computed tomography (CBCT) is the best examination for bone lesions of the maxilla, allowing the dentist to evaluate precisely the behavior and components of the lesion and their relationship to the surrounding structures. Central giant cell lesion and cherubism are histologically very similar lesions. Therefore clinical and radiological examinations are fundamentally important for the diagnosis. The aim of this paper is to report two cases diagnosed as central giant cell lesions and cherubism using CBCT. This imaging modality was very important for the diagnosis of the lesions presented in the current study. It also allowed observing precisely the limits of the lesions, the components, the behavior and the exact relationship to adjacent structures.

A tomografia computadorizada de feixe cônico (TCFC) é o melhor exame para lesões ósseas da maxila, permitindo que o dentista possa avaliar com mais confiabilidade o comportamento, os componentes da lesão, e sua relação com estruturas adjacentes. A Lesão central de células gigantes e o querubismo são patologias muito semelhantes histologicamente, portanto, exames clínicos e radiológicos são de fundamental importância para o diagnóstico. O objetivo deste trabalho é relatar dois casos diagnosticados usando TCFC, um de lesões centrais de células gigantes e um de querubismo. Esta modalidade de imagem foi muito importante para o diagnóstico das patologias apresentadas neste estudo. Também permitiu observar com mais confiabilidade os limites das lesões, os componentes, o comportamento e a relação exata com as estruturas adjacentes.

Lesão central de células gigantes: relato de um caso clínico / Case report: central giont cell granulamo

A lesão central de células gigantes (LCCG) é própria dos ossos gnáticos, sendo um tumor benigno não odontogênico. É uma lesão de crescimento predominantemente lento, bem circunscrito e assintomático, geralmente diagnosticado através de algum exame de rotina ou em casos mais avançados quando se começa a visualizar alguma alteração estético-anatômica ou a paciente se queixando de algum desconforto localizado na região. Este trabalho apresenta um caso clínico de lesão central de células gigantes em um paciente do sexo feminino de 36 anos de idade com uma lesão na região de pré-molares inferior direita. Após avaliação radiográfica, da tomografia, exames sanguíneos e biópsia incisional, foi realizada a curetagem da lesão sob anestesia geral, sem sinais de recidiva após dois anos de proservação

The Central Giant Cell Granuloma (CGCG) is a typical lesion of the gnathic bones, being a benign non odontogenic tumor. It is a lesion of predominantly slow growth, well circumscribed and asymptomatic, usually diagnosed through a routine examination or in more advanced cases when the patient feels some kind of discomfort and when the patient's aesthetics are affected. This paper presents a clinical case of central giant cell granuloma on a 36 year old patient with the lesion on the right lower pre-molars region. After radiography, tomography, blood tests and incisional biopsy, the curettage of the lesion was performed under general anaesthesia with no signs of the tumor after 2 years of follow-up

Granuloma anular elastolítico gigantocelular: relato de caso / Annular elastolytic giant cell granuloma: case report

O granuloma anular elastolítico gigantocelular é dermatose granulomatosa rara, caracterizada, histologicamente, por fagocitose das fibras elásticas por células gigantes multinucleadas e, clinicamente, por placas anulares com bordas elevadas e centro atrófico, com preferência por áreas expostas. A patogênese é controversa. Descreve-se um caso de mulher de 44 anos, com achados clínicos e histológicos clássicos, que apresentou boa resposta à hidroxicloroquina, após o período de 1 mês.

Annular elastolytic giant cell granuloma is a rare granulomatous skin disease characterized histologically by phagocytosis of elastic fibers by multinucleated giant cells and clinically by annular patches with elevated borders and atrophic centers found mainly on sun-exposed skin. The pathogenesis of the disease is controversial. We report the case of a 44-year-old woman with classical clinical and histological findings of the disease whose condition improved when hydroxychloroquine was administered over a four-week period.

Granuloma actínico / Actinic granuloma

El granuloma actínico es una rara afección de la piel que se desarrolla en general en áreas expuestas al sol. Su patogénesis no es clara.La teoría más aceptada es la implicancia de la radiación solar como factor disparador. Típicamente la enfermedad se presenta en individuos mayores de 30 años con historia de exposición solar. Se manifiesta con lesiones anulares de bordes elevados y atrofia central,asintomáticas, con poca tendencia a la involución. Se han probado múltiples terapéuticas con éxito variado. Esta entidad poco frecuente fue descripta por primera vez en 1975 por O`Brien. Presentamos dos pacientes con granuloma actínico. El primero correspondió a una mujer de 83 años de edad con una lesión en pómulo izquierdo. El segundo a un varón de 70 años con una gran lesión que se extendía desde el epigastrio hasta las clavículas.

Actinic granuloma is a rare skin disorder usually developing uponsun-exposed areas. While its pathogenesis is unclear, the acceptedhypothesis maintains that solar radiation is the triggering factor.Typically the disease develops in individuals over 30 years of age witha history of sun exposure, showing annular lesions with raised bordersand central atrophy, asymptomatic, with little tendency to regression.Multiple therapies have been tested with variable response. Thisuncommon entity was described for the first time in 1975 by O’Brien.We present two patients with actinic granuloma. The first onecorresponded to an 83 years-old woman with a lesion on the leftcheek. The second one was a 70 years-old male with a large lesion thatextended from the epigastrium to the collar bones.

Unilateral mandibular central giant cell granuloma in a child: a case report

A 10 year old female child was seen in the Department of Pedondontics of Rama Dental College and Hospital [India] with a diffuse swelling about 2 into 3 cm in size on the left side of her face. It was firm but not tender. Left sub-mandibular lymph nodes were palpable, mobile, soft and tender. Intra oraly a growth about 3 into 4 cm was present in the lower left vestibule. CT 3D reconstruction image showed destructive lesion in 33-37 region. Histopathology of incisional biopsy revealed predominantly sheets of spindle to ovoid fibroblastic cells with interspersed osteoclast like giant cells. Enucleation was done under GA and tissue subjected to histopathology which confirmed the diagnosis

Estudo microscópico morfométrico e genotípico de pacientes portadores de lesão central de células gigantes / Microscopic morphometric and genotypic assessment of patients with central giant cell lesions

A lesão central de células gigantes (LCCG) é uma afecção benigna dos maxilares, de comportamento biológico incerto, variando de discreta tumefação assintomática e de crescimento lento à uma forma agressiva, associada a dor, reabsorção radicular e óssea, com destruição cortical. Sua etiologia permanece desconhecida, havendo controvérsias entre processo reacional, neoplásico ou genético. Mutações no gene SH3BP2 foram identificadas em pacientes com querubismo, condição que compartilha várias características clínicas, radiográficas e histopatológicas com a LCCG. Para testar a hipótese de que tais mutações seriam responsáveis por, ou estariam associadas a LCCG e na tentativa de melhor entender a diferenciação microscópica/morfométrica das lesões agressivas e não agressivas, vinte e cinco pacientes portadores de LCCG foram selecionados para o estudo. O DNA foi obtido através do sangue e de espécimes em blocos de parafina, oriundos de biópsias e tratamento cirúrgico. Um estudo microscópico morfométrico foi paralelamente realizado, para avaliar o número de células gigantes e densidade de volume das mesmas nas lesões agressivas e não agressivas. O sequenciamento genético dos treze exons do gene SH3BP2 nos vinte e cinco pacientes estudados evidenciou uma alteração no códon do exon 4 em 10 pacientes. A densidade de volume de células gigantes foi maior nas lesões agressivas quando comparadas às não agressivas (p=0,013). Não houve diferença significante quanto ao número de células gigantes/mm2 em lesões agressivas e não agressivas (p =0,245).

Central giant cell lesion (CGCL) is a benign disease of the jaws, with uncertain behavior, ranging from mild asymptomatic slow-growing swelling to an aggressive form, with pain, radicular and bone resorption and cortical destruction. Its aetiology is still unknown and there is discussion whether it is a reactive, neoplastic or genetic disease. Mutations on gene SH3BP3 were identified in patients with cherubism, which shares several clinical, radiographic and histopathological features with CGCL. In order to test the hypothesis that such mutations would be responsible for or would be related to CGCL and also in order to better understand microscopic morphometric differentiation of the aggressive and non-aggressive lesions, 25 patients with CGCL were selected to this study. DNA was extracted from blood samples and from tissue samples, obtained by biopsy or surgical treatment. Microscopic morphometric assessment was also performed, in order to evaluate the number and the volume density of the giant cells in aggressive and in non-aggressive lesions. Gene sequencing of all 13 exons in gene SH3BP3, performed on each of the 25 patients, showed an alteration in one codon from exon 4, in ten patients. Volume density of giant cells was greater in aggressive lesions than in non-aggressive ones (p=0,013). There was no significant difference on the number of giant cells per mm2 when comparing aggressive and non-aggressive lesions.

Granuloma reparativo periférico de células gigantes: a propósito de un caso / Peripheral giant cell reparative granuloma: a case report

El granuloma reparativo periférico de células gigantes es una lesión tumoral benigna que aparece como respuesta exuberante de los tejidos ante una agresión local. Presentamos el caso de una mujer de la raza negra de 34 años de edad que acude a la consulta de cirugía máxilo-facial con un aumento de volumen en el reborde alveolar superior derecho. Se realizan exámenes de laboratorio y radiográficos. La paciente es operada bajo anestesia general donde se realiza la excéresis de la lesión y examen histopatológico de la pieza. El informe del departamento de anatomía patológica corrobora el diagnóstico presuntivo de granuloma reparativo periférico de células gigantes. La evolución de la paciente fue satisfactoria.

The peripheral giant cell reparative granuloma is a benign tumor that appears as an exuberant response of tissue in the face of a local aggression. A case of a black woman of 34 years of age that goes to the maxillofacial doctor’s office with an increase of volume in the right superior alveolar rim is presented. X-ray examinations of laboratory are carried out. The patient is operated under general anaesthesia. The exeresis of the injury and histopathologic exam of the piece are done. The report of the department of pathological anatomy corroborates the presumptive diagnosis of peripheral giant cell reparative granuloma. The evolution of the patient was satisfactory.

Granuloma periférico de células gigantes: reporte de dos casos y revisión de la literatura / Peripheral giant cell granuloma: report of two cases and review of literature

El Granuloma Periférico de Células Gigantes (GPCG), es una lesión reactiva que se origina a partir del periostio o de la membrana periodontal tras una irritación o trauma crónico local.  Aparece a cualquier edad con una importante predilección por el sexo femenino. Generalmente se manifiesta como una lesión de naturaleza tumoral, de color rojo-púrpura y localizado en el tejido gingival. Radiográficamente podría mostrar erosión superficial del hueso subyacente. Al estudio microscópico se observa tejido de granulación hiperplásico y las características células gigantes multinucleadas. A continuación se presentan  2 casos clínicos en mujeres (62 y 20 años de edad) ambos en maxilar inferior,  zona premolar con un aspecto clínico similar, que consistió en lesiones tumorales, color rojo, sangrantes con presencia de irritantes locales tipo cálculo y placa dental. Al estudio radiográfico se evidenció lesión ósea asociada a la patología en uno de los casos. Se decide terapia periodontal previa a extirpación quirúrgica de ambas lesiones y  respectivo estudio histopatológico, reportando como diagnóstico definitivo GPCG. El diagnóstico precoz y preciso de estas lesiones permitió efectuar un tratamiento conservador sin riesgo para los dientes vecinos ni para el hueso adyacente. Se destaca la importancia de estos casos, por evidenciar que esta patología no muestra predilección por edad y además confirman su predilección por el sexo femenino

The Peripheral Giant Cell Granuloma (PGCG) is a reactive lesion that originates from periosteum or the periodontal membrane after irritation or chronic local trauma. It appears at any age with important prevalence for female gender. It usually appears as a tumor like lesion, its color ranges from red to purple and it is located on the gingiva. Its radiographic pattern could show surface erosion of the underlying bone. Under microscope analysis it shows hyperplasic granulation tissue and characters of giant multinucleated cells. In this article are present two cases of PGCG in 2 women (62 and 20 years old) both of them in mandible bone, bicuspids zone, both with similar clinical appearance. These cases were tumor like lesions, red color, bleeding aspect with presence of local irritants the type of calculus and plaque. Under radiographic analysis in one of the cases it was determined a bony lesion associated to the pathology of study.  Periodontal therapy was selected as treatment before surgical removal of both lesions and respective histopathological study, reporting PGCG as final diagnosis. The early and precise diagnosis of these lesions leads to conservative treatment avoiding risk to neighboring teeth and underlying bone. It is to emphasize the importance of these cases because they state that this pathology does not show prevalence for age range as well as reaffirms its prevalence for female gender

Central giant cell granuloma of the anterior maxilla.

Central giant cell granuloma (CGCG) formerly called giant cell reparative granuloma is a non-neoplastic proliferative lesion of unknown etiology. 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 examination but was histopathologically diagnosed as CGCG. We describe a case of central giant cell granuloma arising from the anterior maxilla to highlight to the general dental practitioner the importance of histopathology in the diagnosis of this enigmatic lesion.

Granuloma gigantocelular central del maxilar inferior: Presentación de un caso pediátrico / Giant cell granuloma of the lower jaw: Description of a pediatric case

El granuloma gigantocelular central (GGCC), es una lesión tumoral o seudotumoral, infrecuente de los huesos de la cabeza y cuello, que afecta más frecuentemente los maxilares. Su etiología y patogenia son poco conocidas, sus características histológicas son benignas y su comportamiento biológico puede ser agresivo localmente. Presentamos el caso de un niño de 6 años con esta afección y realizamos una revisión de la entidad y sus diagnósticos diferenciales con otras lesiones de los maxilares.

Giant Cell Granuloma (GCG) is an uncommon condition affecting the bones of the head and neck. The ethiology and pathophysiology are not completely understood. The histlogic characteristics of GCG are benign, but its biologic behavior could locally aggressive. We describe the case of a 6 year-old boy with GCG and performed a review of the entity ant their differential diagnosis with other lesions of the maxillary bones.