Granuloma de células gigantes mandibular. Tratamiento de una recidiva y rehabilitación dental: presentación de un caso / Giant cell granuloma of the jaw. Treatment of a recurrence and dental rehabilitation: a case report

El granuloma de células gigantes (GCG) es una patología de etiología no esclarecida que aparece tras traumatismos o procesos inflamatorios. Puede ser asintomático, debutar como una masa de comportamiento inflamatorio o comportarse de forma localmente agresiva. El diagnóstico resulta de la combinación de datos clínicos, radiológicos e histológicos. El tratamiento puede ser quirúrgico, mediante cirugías más o menos extensas, así como médico con diferentes fármacos.Se presenta el caso de un paciente intervenido de un GCG mandibular que acudió a nuestra consulta con una recidiva de la lesión, manejada quirúrgicamente mediante resección segmentaria y reconstrucción con colgajo libre de peroné, añadiendo al tratamiento la rehabilitación dental para realizar un manejo global del caso. (AU)

Giant cell granuloma (GCG) is a pathology of unclear aetiology that appears after trauma or inflammatory processes. It may be asymptomatic, have an early presentation as a mass with inflammatory reaction, or behave in a locally aggressive manner. Diagnosis results from a combination of clinical, radiological and histological data. Treatment can be surgical, with more or less extensive surgery, as well as medical with different drugs.We present the case of a patient who underwent surgery for a mandibular GCG who came to our hospital with a recurrence of the lesion, which was managed surgically by segmental resection and reconstruction with a fibula free flap, adding dental rehabilitation to the treatment for a global management of the case. (AU)

Granuloma central a células gigantes agresivo, de presentación atípica: reporte de un caso / Aggressive central giant cell granuloma: report of an atypical case

El granuloma central a células gigantes (GCCG) es una lesión osteólitica poco frecuente, no odontogénica, benigna, localizada y potencialmente agresiva, caracterizada por la presencia de células gigantes en un estroma vascular. Se presenta mayoritariamente en mujeres, más frecuentemente en las dos primeras décadas de vida. Radiográficamente el GCCG se puede observar desde una imagen radiolúcida de aspecto quístico, a una imagen multilocular extensa de límites pocos definidos. De acuerdo a la presentación clínica, radiográfica e histológica del GCCG, se ha propuesto un tipo agresivo caracterizado por crecimiento rápido, dolor, parestesia, expansión y perforación de corticales, rizalisis y alta tasa de recidiva. Existe controversia respecto a la etiología. Si bien está descrito como una lesión de carácter reparativo asociada a trauma, se observan características potencialmente destructivas, expansivas e infiltrativas. Se presenta un caso de GCCG agresivo, de presentación atípica en relación con la edad, sexo del paciente y ubicación de la lesión. (AU)

Central giant cell granuloma (CGCG) is an infrequent benign, localized, potentially aggressive, non-odontogenic osteolytic lesion, characterized by the presence of giant cells in a vascular stroma. CGCG is seen mainly in women, more frequently in the first two decades of life. Radiographically, CGCG can be seen from a cystic-like radiolucent image, to an extensive multilocular image, with less defined margins. According to clinical, radiographic and histological aspects of CGCG, an aggressive type has been proposed, which is characterized by rapid growing, pain, paresthesia, expansion/perforation of cortical bone, rizalisis, and high rates of recurrence. Of controversial etiology, CGCG has been described as a reparative lesion, associated to trauma. However, potentially destructive, expansive and infiltrative characteristics have been observed in CGCG. An atypical case of an aggressive CGCG is presented. (AU)

Épulis congénito gigante: importancia del diagnóstico prenatal / Congenital giant cell epulis: Importance of the prenatal diagnosis

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Intubación con el videolaringoscopio Insighters en paciente con épulis gigante / Intubation with the video laryngoscope Insighters in a patient with giant epulis

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An unusually large peripheral giant cell granuloma: a case report / Granuloma periférico de células gigantes inusualmente grande: reporte de un caso

Peripheral giant cell granuloma (PGCG) is a benign reactive lesion of the oral cavity. Although PGCG is classified as a tumor-like lesion, it does not represent a true neoplasm, however it is often associated with a response of local irritation and trauma. Clinically, it appears as an exophytic growth with either sessile or pedunculated base, it can be located in gingiva or edentulous alveolar mucosa and usually does not exceed two cm in diameter. The following report describes the case of a 64-year-old female diagnosed with a PGCG of a particularly large size and rapidly evolving, located in the upper jaw area. The lesion was completely excised, and the diagnosis was confirmed by histopathology, there is no apparent recurrence in the area after 12 months of follow-up. A few cases of PGCG greater than 5 cm in diameter have been reported. Furthermore, exceptional cases might present an abnormal rapid growth as well. An opportune diagnosis based on clinical examination, radiographic and histopathological study are fundamental for a prompt and efficient treatment

El granuloma periférico de células gigantes (GPCG) es una lesión reactiva benigna de la cavidad oral en respuesta a una irritación local o a un traumatismo crónico. Si bien es una lesión de aspecto tumoral, no constituye una verdadera neoplasia. Se manifiesta como un crecimiento exofítico de base sésil o pediculada, localizado en encía o procesos alveolares edéntulos y no suele sobrepasar los 2 cm de diámetro. El presente reporte describe el caso de un GPCG de tamaño anormalmente grande y rápida evolución localizado en la zona del maxilar superior en un paciente femenino de 64 años. La biopsia escisional de la lesión confirmó el diagnóstico de GPCG y a 12 meses de seguimiento no se ha presentado recidiva. Se han reportado algunos casos de GPCG de más de 5 cm de diámetro. Además, casos excepcionales también pueden presentar un crecimiento rápido anormal. Un diagnóstico oportuno basado en el examen clínico, radiográfico e histopatológico es fundamental para un tratamiento rápido y eficaz

Comunicaciones Orales: I Encuentro científico virtual de la SCCALP / Oral CommuniCations: 1st Virtual scientific meeting of SCCALP

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Peri-implant peripheral giant cell lesions: report of 13 new cases and comparative histological and immunohistochemical analysis with peripheral and central giant cell lesions

BACKGROUND: Few cases or periimplant peripheral giant cell lesions (PGCL) have been reported in the literature. The aim of this study was to report 13 new cases of peri-implant PGCL and compare the expression of smooth muscle actin, Bcl-2 protein, GLUT-1, CD68, osteoprotegerin, receptor activator of nuclear factor kappa-B, Ki-67 and CD34 in these cases with PGCL and central giant cell lesions (CGCL). MATERIAL AND METHODS: Clinical data were retrieved from the laboratory records and histological analysis was performed using HE-stained slides. Immunohistochemical reactions for the above mentioned antibodies were performed and digitally scored. RESULTS: Peri-implant PGCL mostly affected the posterior mandible of adult females. CD68 and Bcl-2 expressions were higher in conventional PGCL and CGCL than in peri-implant PGCL (p = 0.033 for CD68 and p < 0.0001 for Bcl-2). Microvessel density was higher in conventional peripheral than in central and peri-implant PGCL (p = 0.002). Proliferative index of the mononuclear cells showed no statistically significant differences comparing the three groups but it was higher in peri-implant PGCL. CONCLUSIONS: The current study demonstrated that peri-implant PGCL is more common in the posterior mandible of adult females. There were some differences in microvessel density, proliferative activity and expression of CD68 and Bcl-2 among conventional PGCL, peri-implant and CGCL. Further studies are encouraged to better understand these early findings

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Granuloma periférico de células gigantes como lesión reactiva asociada a un implante dental. A propósito de un caso y revisión de la literatura / Giant cell peripheric granuloma as a reactive lesion associated to a dental implant. A clinical case study and review of the literature

Introducción: El Granuloma periférico de células gigantes (GPCG) es una lesión exofítica poco frecuente de la cavidad oral, cuya aparición se encuentra generalmente asociada al diente natural y cuya etiología se relaciona, entre otros factores, con el efecto crónico en el tiempo de diversos irritantes locales. Con el creciente uso de los implantes dentales, se ha observado la aparición de este tipo de lesiones en la mucosa periimplantaria, lo que obliga a estudiar y comprender su etiología y evolución en función de garantizar la longevidad de este tipo de rehabilitaciones. Caso clínico: Se presenta el caso de una paciente mujer de 41 años de edad, sin antecedentes médicos de interés, remitida al servicio de Cirugía Bucal del Hospital Virgen de la Paloma, la cual presenta una tumoración de base sésil asociada a un implante en posición de 47, de 1,2x0,6 cm, indolora, de consistencia firme y no desplazable con coloración congestiva. Se llevo a cabo un tratamiento de exéresis total de la lesión, remitiendo la pieza a estudio histopatológico, tras el cual se obtuvo el diagnóstico de GPCG. Conclusiones: Es de vital importancia mantener un control exhaustivo de los diversos factores locales que pueden identificarse como irritantes para los tejidos periimplantarios, como es el caso de una higiene oral deficiente, entre otros, con el fin de prevenir la aparición de lesiones que pudieran comprometer la supervivencia y éxito de los implantes a largo plazo

Introduction: The peripheral giant cell granuloma (GPCG) is a rare exophytic lesion of the oral cavity, whose appearance is usually associated with the natural tooth and whose etiology is related, among other factors, to the chronic effect over time of various local irritants. With the increasing use of dental implants, the appearance of this type of lesions in the peri-implant mucosa has been observed, which requires studying and understanding its etiology and evolution in order to guarantee the longevity of this type of rehabilitation. Clinical case: We present the case of a 41-year-old female patient, with no medical history of interest, referred to the Oral Surgery Department of the Hospital Virgen de la Paloma, which presents a sessile base tumor associated with an implant in position 47, of 1.2x0.6 cm, painless, firm consistency and nondisplaceable with congestive coloring. A total exeresis treatment of the lesion was carried out, sending the piece to histopathological study, after which the diagnosis of GPCG was obtained. Conclusions: It is vital to maintain an exhaustive control of the various local factors that can be identified as irritants for peri-implant tissues, such as poor oral hygiene, among others, in order to prevent the appearance of injuries that could compromise survival and success of long-term implants

Placas anulares bilaterales en manos y antebrazos / Bilateral Annular Plaques on the Hands and Forearms

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IL-4 induces the formation of multinucleated giant cells and expression of Beta5 integrin in central giant cell lesion

BACKGROUND: It is now well established that IL-4 has a central role in the development of monocytes to multinucleated giant cells (MGCs) by inducing the expression of integrins on the surface of monocytes. The aim of this study was to investigate the potential role of IL-4 in induction of β5 integrin expression in the peripheral blood samples of patients with giant cell granuloma. MATERIAL AND METHODS: Monocytes were isolated from peripheral blood samples of patients with central giant cell granuloma (CGCG) and healthy controls using human Monocyte Isolation Kit II. Isolated monocytes were then cultured in the absence or presence of IL-4 (10 and 20 ng/mL), and following RNA extraction and cDNA synthesis, Real-time PCR was performed to determine the level of β5 integrin expression. The formation of CGCGs and morphological analyses were done under light microscopy. For confirmation of CGCGs, immunocytochemistry technique was also carried out by anti-RANK (receptor-activator of NF-κB ligand) antibody. RESULTS: In both patient and control groups, β5 levels were significantly enhanced by increasing the IL-4 dose from 10 to 20 ng/mL. In addition, these differences were significant between patient and control groups without IL-4 treatment. On the other hand, the number of cells which expressed RANK and therefore the number of giant cells were significantly higher in the patient group in comparison to controls, as assessed by immunohistochemistry evaluations. CONCLUSIONS: In this study, we showed an elevation in the expression levels of β5 integrin when stimulated by IL-4. It is strongly indicated that this integrin acts as an important mediator during macrophage to macrophage fusion and development of giant cells

Granuloma elastolítico anular de células gigantes en área no fotoexpuesta con respuesta a dapsona / Annular Elastolytic Giant Cell Granuloma in Sun-Protected Sites Responds to Dapsone

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Granulomatous Variant of Pigmented Purpura / Variante granulomatosa de púrpura pigmentada

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Chronic intradiploic hematomas of the skull without coagulopathy: report of two cases / Hematoma crónico intradiploico sin coagulopatía: informe de 2 casos

Background: Chronic intradiploic hematoma was first described by Chorbski and Davis in 1934. To date, only twelve cases have been reported in the literature. Chronic intradiploic hematomas have also been described as non-neoplastic cysts of the diploe, traumatic cysts, and giant cell repetitive granulomas. The term chronic intradiploic hematoma was coined by Sato et al. in 1994. Case description: Case 1: a 16-year-old male presented with a non-tender scalp swelling on the right fronto-orbital region. Computed tomography (CT) scans showed an intraosseous isodense lesion with surrounding sclerosis. Magnetic resonance imaging (MRI) results revealed an intradiploic mass with homogeneous cystic and abnormal signal intensities. Case 2: a 64-year-old male presented with a 6-month history of headaches and visual disturbances. CT scans showed an isodense lesion with surrounding sclerosis in the posterolateral left orbit. MRI results revealed a hypointense lesion on both the T1weighted and T2-weighted images of the posterolateral left orbit. Conclusion: Although rarely seen, the presence of a benign chronic hematoma should be considered as part of the differential diagnosis for each intradiploic mass lesion. When taking the medical history, all patients with such mass lesions should be asked about previous minor or major head traumas. Due to the possibility of progressive growth, surgical excision of an intradiploic hematoma is recommended after radiological diagnosis of the condition

Antecedentes: El hematoma crónico intradiploico fue descrito por primera vez por Chorbski y Davis en 1934. Hasta la actualidad solo se han publicado 12 casos en la literatura. Los hematomas crónicos intradiploicos también se han descrito como quistes no neoplásicos del diploe, quistes traumáticos y granulomas repetitivos de células gigantes. El término hematoma crónico intradiploico fue acuñado por Sato et al. en 1994. Descripción de los casos: Caso 1: Varón de 16años que consultó por hinchazón no dolorosa en región frontoorbitaria derecha. La tomografía computarizada mostró una lesión intraósea isodensa con esclerosis circundante. La resonancia magnética (RM) reveló una masa intradiploica con quiste homogéneo de señal anormal. Caso 2: Varón de 64años que consultó por historia de 6meses de dolor de cabeza y alteraciones visuales. La tomografía computarizada craneal mostró una lesión isodensa con esclerosis circundante en la región posterolateral de la órbita izquierda. La RM mostró una lesión hipointensa tanto en las secuencias TI como T2 de la porción posterolateral de la órbita izquierda. Conclusión: A pesar de su rareza, la presencia de un hematoma crónico benigno debe considerarse en el diagnóstico diferencial de cada lesión masiva intradiploica. A los pacientes con este tipo de lesiones de masa se les debe interrogar sobre el antecedente de trauma craneal previo mayor o menor. Debido a la posibilidad de crecimiento progresivo, se recomienda la extirpación quirúrgica del hematoma intradiploico una vez realizado el diagnóstico radiológico de la enfermedad

Nódulos asépticos y alopécicos del cuero cabelludo / Aseptic and Alopecic Nodules of the Scalp

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Granuloma central de células gigantes. Diagnóstico y opciones terapéuticas. A propósito de un caso / Central giant-cell granuloma. Diagnosis and therapeutic options. A case report

El granuloma central de células gigantes es una patología poco común que constituye el7% de las lesiones benignas de los maxilares. Se trata de un proceso osteolítico localizado, de naturaleza variablemente agresiva, que aparece con mayor frecuencia en los sectores anteriores de los maxilares en niños y adolescentes jóvenes. Su etiología es aún un tema de gran controversia y constituye el 1% de las lesiones óseas tumorales. Se presenta el caso de un paciente varón de48 años de edad con una lesión indolora en la región hemimaxilar superior derecha, que engloba las piezas 16, 17 y 18 con movilidad en el 16. En la ortopantomografía, se advierte una gran lesión osteolítica, y se realiza un primer diagnóstico de presunción de quiste de origen odontogénico, por lo que se (..) (AU)

The central giant-cell granuloma is an uncommon pathology that constitutes 7% of the benign lesions of the maxilla. It deals with a localised osteolytic process, of a variably aggressive nature, that appears with greater frequency in the anterior sectors of the maxilla in children and young adolescents. Its aetiology is still a subject of great controversy and it constitutes 1% of the osseous tumour lesions. The case is presented of a male patient of48 years of age with a painless lesion in the upper right hemimaxilla region, which includes the pieces 16, 17 and 18 with mobility in the 16. The orthopantomograph warned of a large osteolytic lesion, and a primary diagnosis was made of the presumption of a cyst ofodontogenic origin, for which reason it was removed. During the surgery, a mass was observed not compatible with a cyst and an (..) (AU)

Quiste óseo aneurismático mandibular de tipo sólido / Mandibular solid aneurysmal bone cyst

El quiste óseo aneurismático sólido es una lesión ósea benigna muy infrecuente de la que no existe consenso en relación a su origen etiopatogénico. Presenta características clínicas, radiológicas e histológicas inespecíficas, por lo que los estudios ultraestructurales son fundamentales para su diagnóstico y clasificación. El diagnóstico diferencial es extenso e incluye múltiples lesiones óseas como el granuloma reparativo de células gigantes e incluso tumores malignos como el osteosarcoma. El tratamiento de elección es la cirugía conservadora. La recidiva se debe fundamentalmente a la extirpación incompleta(AU)

Solid aneurysmal bone cyst is a rare benign bone lesion for which no consensus exists regarding its origin. It has nonspecific clinical, radiological and histological features so ultrastructural studies are essential for diagnosis and classification. The differential diagnosis is extensive and includes a variety of bone lesions, such as giant cell reparative granuloma, and even malignant tumors like osteosarcoma. The treatment of choice is conservative surgery. Recurrence is due mainly to incomplete resection(AU)

Increased TNF-Alpha, IL-6 and decreased IL-1â immunohistochemical expression by the stromal spindle-shaped cells in the centralgiant cell granuloma of the jaws

Objectives: the exp ress ion of the osteoclastogenic cytokines TNF-Alpha, IL-6 and IL-1Beta were immunohistochemically evaluated in peripheral (PGCG) and central (CGCG) giant cell granulomas of the jaws in order to determine differences between these two lesions and between the two distinct tumor cell populations (multinucleated giant cells, MGCs and stromal spindle-shaped cells).Study Design: Paraffin-embedded tissue sections from 40 PGCG and 40 CGCG were immunohistochemically stained using antibodies against TNF-Alpha, IL-6 and IL-1Beta. The percentage of positively stained cells and the staining intensity were assessed to provide a combined immunoreactivity score value. Results: TNF-Alpha, IL-6 and IL-1Beta were expressed in all lesions. The CGCG compared to the PGCG showed significantly increased expression of TNF-Alpha and IL-6 and decreased expression of IL-1Beta by the spindle-shaped cells and increased express ion of IL-1Beta by the MGCs. The MGCs demonstrated in comparison to the stromal spindle shaped cells significantly increased expression of all three cytokines in both PGCG and CGCG. Conclusions: The proinflammatory cytokines TNF-Alpha, IL-6 and IL-1Beta seem to be involved in the growth process of PGCG and CGCG of the jaws. A possible alteration in the synthesis or/and activity of these cytokines by the stromal spindle cells in the CGCGs may enhance osteolysis through the stimulation of osteoclast progenitor cells, given the fact that the intraosseous lesions cause bone resorption (AU)

Problemas diagnósticos en tumores del nervio periférico (II) / Diagnostic problems of peripheral nerve tumours (II)

En esta segunda parte se revisan los criterios diferenciales entre mixomas de vainas neurales y neurotekeomas, neuromas mucosos y neuromas traumáticos y las lesiones neurales pigmentadas (neurofibroma pigmentado y schwannoma pigmentado). Asimismo, se describen los criterios de malignidad en las lesiones precursoras del tumor maligno de vaina neural periférica, los distintos tipos de lesiones de células granulares y los hallazgos diferenciales más significativos de las lesiones neurales de células fusiformes que asientan en piel y tubo digestivo(AU)

In the second part of this study, the criteria for the differentiation between neural sheath myxomas and neurothekeomas, mucous neuromas and traumatic neuromas and pigmented neural lesions (pigmented neurofibroma and pigmented schwannoma) are discussed. Furthermore, the criteria for malignancy in precursor lesions of malignant peripheral nerve sheath tumours, the various types of granular cell lesions and the most significant differential findings in neural lesions with fusiform cells occurring in the skin and digestive tract are examined(AU)