Giant Cell Reparative Granuloma of Paget's Disease of Bone: A Unique Clinical Entity

Abstract

Giant cell tumor of bone is a rare, but well-recognized complication of Paget's disease of bone. In contrast, giant cell reparative granuloma (a benign tumor of the jaws occurring primarily in young adults) has never been described in association with Paget's disease. Five patients had giant cell lesions complicating Paget's disease. In each instance, the lesion histologically more closely resembled reparative granuloma than true giant cell tumor. The location of these lesions and their sensitivity to irradiation were consistent with reparative granuloma. Unique features included the frequency of polyostotic distribution, the occurrence only in bones affected by Paget's disease, and an apparent familial or geographic clustering of the patients. We also reviewed the histologic findings of three patients from another institution and compared the cases of all eight patients with others we believe were incorrectly diagnosed as having benign giant cell tumors in Paget's disease. We suggest that giant cell reparative granuloma of Paget's disease is a unique clinical entity with specific prognostic and therapeutic implications.

Imaging of Giant Cell Tumor and Giant Cell Reparative Granuloma of Bone: Radiologic-Pathologic Correlation

“…As in gnathic lesions, clinical symptoms are nonspecific, with pain and swelling that may be present for months to years. GCRG has also been described in association with enchondromatosis, Goltz syndrome, fibrous dysplasia, and Paget disease (117)(118)(119)(120). Involvement at other sites including the sinuses, temporal bone, skull, spine, clavicle, tibia, humerus, ribs, and femur is rare (114 -116).…”

Clinically aggressive central giant cell granulomas in two patients with neurofibromatosis 1

“…11 Proposed etiologies include intraosseous hemorrhage 12 , trauma 13 , faulty bone development and abnormal repair of bone. Arguing in favor of a reactive process is the occasional association of CGCGs with other pre-existing bone lesions, such as fibrous dysplasia, 14 Pagets disease of bone 15 , central odontogenic fibroma 16,17 , traumatic bone cyst 18 and ossifying fibroma 19,20 . However, the possibilities that some subtypes of CGCG of the jaws (e.g.…”

Clinically aggressive central giant cell granulomas in two patients with neurofibromatosis 1

“…11 Proposed etiologies include intraosseous hemorrhage 12 , trauma 13 , faulty bone development and abnormal repair of bone. Arguing in favor of a reactive process is the occasional association of CGCGs with other pre-existing bone lesions, such as fibrous dysplasia, 14 Pagets disease of bone 15 , central odontogenic fibroma 16,17 , traumatic bone cyst 18 and ossifying fibroma 19,20 . However, the possibilities that some subtypes of CGCG of the jaws (e.g.…”