Multiple Synchronous Central Giant Cell Granulomas of the Maxillofacial Region: A Case Report

Abstract

Central giant cell granulomas (CGCG) of the jaws usually present as a painless lesion and a solitary radiolucent expansion is seen on the simple radiographs. This disease is most commonly diagnosed in the third decade of life, and females are twice as likely to be affected as males (1). The gnathic cases of giant cell granuloma have accounted for 1-7% of all the benign lesions in several previously reported oral surgical series. Jaw lesions affect women more frequently than men (2:1 ratio) (2). The presence of multiple CGCGs in the maxillofacial region is suggestive of hyperparathyroidism or a number of syndromes (3, 4). To the best of our knowledge, only 5 cases of multifocal CGCGs without any concomitant systemic disease have currently been reported (4, 5). We report here on a case of multifocal CGCGs in the maxillofacial region of a 17-year-old male and the patient was without any concomitant systemic disease. Case ReportA 17-year-old man presented with right nasal obstruction and rhinorrhea that he had suffered with for the previous five months. There was no history of prior trauma or surgery to the mandible. The clinical examination revealed a mass in the right posterior nasal cavity. We then performed computed tomography (CT) and magnetic resonance imaging (MRI) of the paranasal sinuses and nasal cavity.The CT scan of the right maxilla with the bone window setting showed a relatively well defined, heterogeneous isodense mass with mineralized septa, expansile boney remodeling with cortical thinning of the medial and lateral walls of the antrum and opacification of the antrum and the posterior nasal cavity. The mass had eroded the adjacent bony structures, such as the anterior wall of the sphenoid sinus, and it extended to the surrounding spaces, such as the right maxillary sinus and the posterior nasal cavity. There were also bilateral oste- J Korean Soc Radiol 2010;62:11-15 ─ 11 ─

Aggressive Multiple Central Giant Cell Granulomas of the Jaws

“…Synchronous involvement is generally associated with syndromes or systemic disorders like brown tumor in hyperparathyroidism, Noonan syndrome, cherubism, fibrous dysplasia, ossifying fibroma, Paget's disease, or fibroosseous lesions. The simultaneous occurrence of multiple CGCGs without systemic disease or familial history is extremely rare [4,[16][17][18][19]. Multifocal CGCGs could be associated with the brown tumor of hyperparathyroidism.…”

“…Paget disease may be associated with malignant tumors, including osteosarcoma, fibrosarcoma, and benign tumors, such as CGCG. Radiographically, a cotton wool appearance and an elevated level of serum alkaline phosphatase and hydroxyproline in urine are noted [ 17 , 23 , 25 – 27 ]. Therefore, Paget disease is also ruled out in our case.…”

Multifocal Central Giant Cell Granuloma of the Jaws: Case Report and Review of Literature

“…2,23,25 The mean age of the 15 previously reported multifocal CGCG cases was 29.46 years. Eight cases occurred in patients under the age of 30 years, 5,10,[26][27][28][29][30] and seven of them occurred in patients above the age of 30 years (Table 1). 5,[31][32][33][34][35][36] The age of the present case was 62 years.…”

Multicentric Synchronous Giant Cell Granulomas of the Mandible

“…However, there have been rare reports of multiple synchronous giant cell granulomas for which other causes have been excluded. 3,4 There is a familial tendency to multiple lesions of this nature in some cases. 5…”

“…However, there have been rare reports of multiple synchronous giant cell granulomas for which other causes have been excluded. 3,4 There is a familial tendency to multiple lesions of this nature in some cases. 5 Giant cell granuloma of the jaws tends to occur in younger patients, most frequently before the age of 20 years, and it affects twice as many females as males.…”