Central Giant Cell Granuloma of the Mandible and Maxilla; A Clinicopathological Study of 21 cases

Abstract

Background: Central giant cell granuloma (CGCG) presents as a locally invasive, intraosseous anomaly characterized by the accumulation of multinucleated giant cells amidst a matrix of hemorrhage and reactive fibrous tissue, which infiltrate the bone trabeculae. This idiopathic non-neoplastic proliferative lesion primarily affects the mandible, typically appearing as either unilocular or multilocular radiolucencies on X-rays. Although trauma or intraosseous hemorrhages are plausible triggers, the precise histogenesis and etiology remain elusive. CGCG predominantly occurs in children and young adults, with a slight predilection for females. Methods and Materials: A retrospective analysis of 21 cases of central giant cell granuloma (CGCG) diagnosed at the oral pathology/pathology department of Temple University Hospital between 2015 and 2022 was conducted. Each case was evaluated based on various parameters including age, gender, presenting symptoms, radiographic findings, clinical differential diagnosis, and histological confirmation. The primary radiographic technique employed for diagnosis was X-ray imaging of the mandible and maxilla. Histological examination involved the cutting of paraffin-embedded tissue into 5-micrometer-thick sections, which were then stained using routine hematoxylin and eosin (H&E) stain. Notably, no specialized histochemical or immunohistochemical stains were utilized in the evaluation process. Results:Of the total of 21 cases, nine were males and eleven were females, while a single case was of unknown gender. Age range was 15- 76 years, with a mean of 50 years. The mandible was the most common location of involvement (17; 81%), and maxilla was affected less commonly (4 cases; 19%). Many of the CGCG lesions were asymptomatic (13; 62%); eight cases (38%) were symptomatic, and the main manifestations were pain, and fullness of the affected dental region. In a minority of cases, brown tumor (severe hyperparathyroidism) and odontogenic neoplasms, such as ameloblastoma, were suspected clinically and radiographically. The diagnosis of central giant cell granuloma with associated acute and chronic inflammation was confirmed in all the cases. Histological evaluation of the H&E-stained sections was the main diagnostic tool utilized. No special stains or molecular studies were required to establish the final diagnosis. Discussion: Our investigation has determined that CGCG exhibits a non-neoplastic nature, displaying a spectrum of behaviors ranging from aggressive to non-aggressive tendencies. Predominantly observed in the mandible, rare instances of CGCG involvement in the maxilla have also been documented. Importantly, no confirmed association with neoplastic lesions was identified during our analysis. The clinical course of CGCG tends to be indolent, with some cases presenting in association with impacted teeth. It's noteworthy that CGCG can present with features mimicking neoplastic conditions such as ameloblastoma or localized lesions linked to systemic disorders, such as hyperparathyroidism (brown tumor). We have concluded that CGCG is non-neoplastic, with aggressive or non-aggressive behavior, predominantly involving the mandible, with rare cases involving the maxilla. No confirmed association with neoplastic lesions was recognized. The lesions followed an indolent clinical course, and some were associated with impacted teeth. CGCG can mimic neoplastic conditions such as ameloblastoma or a localized lesion associated with systemic disorders, for instance hyperparathyroidism (brown tumor).