Oral giant cell tumor or giant cell granuloma: How to know?

Introduction: The distinction between giant cell tumors and giant cell granulomas is challenging, as both entities have overlapping diagnostic criteria, especially in oral locations. The two entities have similar clinical and radiological presentations, but they differ in their prognoses. Objective: The main objective of this study was to list the clinical, radiological, histological, and prognostic features of maxillomandibular giant cell tumors and giant cell granulomas cases n order to assess their value as a diagnostic referral factor that may allow the distinction between maxillo-mandibular giant cell granuloma and giant cell tumor. Study design: Data of maxillomandibular giant cell granulomas and giant cell tumors were assessed through a scoping review and a pre-existing systematic review of literature. We have also realized a bicentric retrospective study. Results: Various criteria facilitate the differential diagnosis like age, size, locularity and presence of necrosis zone but not the gender. The most discriminating factors was symptomatology (reported in 72% of GCTs while only 15% of GCGs) and the distribution pattern of giant cells in the stroma (homogeneously dispersed in 80% of GCTs versus grouped in clusters in 86.7% of GCGs). Recurrences were most described for giant cell tumors than giant cell granulomas. Malignant transformation and pulmonary metastasis were exclusively reported for giant cell tumors. Conclusion: As clinical and radiological elements are not sufficient to distinguish between these two entities, immunohistochemistry and molecular genetics can be represent diagnostic biomarkers to distinguish giant cell granulomas and giant cell tumors in oral cavity. We have attempted to define the main criteria for the differentiation of giant cell tumor and giant cell granuloma and propose a decision tree for the management of single maxillomandibular giant cell lesions.

Bony Canal Method of Dexamethasone Injections in Aggressive Form of Central Giant Cell Granuloma-Case Series.

Central Giant Cell Granuloma constitutes approximately 7% of benign tumors of the jaws. The aggressive form of CGCG clinically behaves like a classic semi-malignant neoplasm. In the literature, the suggested method of treatment of aggressive forms of CGCG is curettage or resection with the margin of 0.5 cm. Surgical treatment, especially in the developmental age, entails disturbances in the growth and differentiation of tissues and deforms and disturbs the functioning of the stomatognathic system. Alternative treatment methods of the CGCG presented in this article lead to the patient avoiding a mutilating procedure and improve their quality of life. The aim was to present alternative method of treatment of aggressive forms of Central Giant Cell Lesion of the jaws-injections of dexamethasone into the tumor mass through drilled bony canals. Here, we present the three cases of aggressive forms of CGCG of jaws treated with dexamethasone injections into the tumor mass. Two cases resulted in regression of the tumor, which was confirmed in histologic evaluation after remodeling surgery. Those two patients were uneventful and showed no signs of tumor recurrence at 8 and 9 years of thorough follow-up, respectively. The third patient was qualified for the mandible resection due to the enlargement of the lesion and destruction of the cortical bone. According to our observations, if the proper patient discipline, and thorough, careful clinical and radiological examinations are provided, the dexamethasone injections could be a recommended method of treatment of intraosseous giant cell granuloma. The indication is restricted to the cases with preserved bony borders despite deformation. Additionally, leaving vital teeth in the lesion is also possible.

Primary hyperparathyroidism presenting as a brown tumor in the mandible: A case report.

A brown tumor is a non-neoplastic lesion resulting from an abnormality of bone metabolism in the context of hyperparathyroidism. We report the case of a 51-year-old woman who initially consulted for edentulism and a growing mandibular mass. She benefited from a radiological and biological assessment which made the diagnosis of primary hyperparathyroidism combined with a parathyroid adenoma. We remind through this observation the difficulty to establish a correct diagnosis in patients with an osteolytic process of the maxilla and the necessity to look for hyperparathyroidism in front of a giant cell lesion given the insidious character of this endocrinopathy.

Brown tumor of hyperparathyroidism with multiple lesions.

Brown tumors are rare focal giant-cell lesions that arise as a direct result of the effect of parathyroid hormone (PTH) on bone tissue in some patients with hyperparathyroidism. Browns tumor is a syndrome associated with an increase in PTH levels by parathyroid glands resulting in hypercalcemia. In the present case report, a 44-year-old female patient presented with a rare case of brown tumor with multiple lesions in the head-and-neck region. The recent advance in various diagnostic and biochemical tests helps in early diagnosis of hyperparathyroidism cases. The dentist should be aware of oral manifestations associated with this type of systemic disease.

Neurofibromatosis Type 1 With Cherubism-like Phenotype, Multiple Osteolytic Bone Lesions of Lower Extremities, and Alagille-syndrome: Case Report With Literature Survey.

BACKGROUND/AIM: Neurofibromatosis type 1 (NF) is an autosomal dominant hereditary disease. The cardinal clinical findings include characteristic skeletal alterations. Difficulties in diagnosis and therapy can arise if an individual has further illnesses. CASE REPORT: This is a case report of a 16-year-old patient affected by NF1. She also suffered from Alagille syndrome and the consequences of fetal alcohol exposure. The patient's facial phenotype showed findings that could be assigned to one or more of the known diseases. The patient was referred for treating a cherubism-like recurrent central giant cell granuloma (CGCG) of the jaw. The patient developed bilateral, multilocular non-ossifying fibromas (NOF) of the long bones of the lower extremity. Treatment of the skeletal lesions consisted of local curettage. While NOF regressed after surgery, the CGCG of the jaw remained largely unchanged. Extensive genetic tests confirmed a previously unknown germline mutation in the JAG1 gene, the germline mutation of the NF1 gene, and the somatic mutation in the NF1 gene in the diffuse plexiform neurofibroma, but not in the CGCG. CONCLUSION: Assigning facial findings to a defined syndrome is ambiguous in many cases and especially difficult in patients who have multiple diseases that can affect the facial phenotype. Surgical therapy should be adapted to the individual findings.

Treatment of a central giant cell lesion in the mandible.

Central giant cell lesion (CGCL) is a benign intraosseous lesion that usually accompany the gnathic bones in the anterior region, mostly crossing the midline. Its clinical features involve cortical expansion, tooth displacement, and root resorption. Pain may occur in 20% of cases. Histopathological characteristics are like other pathological entities, being necessary discarding them. In this case, a 53-year-old female presented an expansive legion in the anterior mandible with tooth displacement and pain. After incisional biopsy, the result was CGCL. Surgical planning involved manufacturing a biomodel, bending the reconstruction plate to give the correct mandibular arch perimeter. After that, it was performed a segmental resection and installation of a reconstruction plate using a cervical approach. The patient is under follow-up with no signs of recurrence or complications.

A systematic review of the clinical and radiographic features of hybrid central giant cell granuloma lesions of the jaws.

OBJECTIVE: Central giant cell granuloma (CGCG) can coexist with other benign lesions of the jaw. These hybrid lesions are diagnostically challenging to both oral pathologists and radiologists. This work systematically reviews the clinical and radiographic features of hybrid-CGCG lesions in the jaws. MATERIALS AND METHODS: Three reviewers conducted an electronic search of five databases for histologically diagnosed hybrid-CGCG lesions in human jaws. RESULTS: Thirty-four of 1224 articles met the inclusion criteria. Of 39 hybrid-CGCG lesions, 14 (35.9%) were central odontogenic fibroma, 11 (28.2%) were central ossifying fibroma, seven (17.9%) were fibrous dysplasia, and seven (17.9%) were other bone conditions. There were 22 females and 17 males with a mean age of 30.5 ± 19.9 years. 89.5% of hybrid-CGCG lesions were well defined, 57.9% were non-corticated, 60.5% were radiolucent, and 66.7% were in the posterior mandible. Most hybrid lesions affected the cortical plates by thinning, expansion, or perforation (93.1%), displaced, or resorbed teeth (60%). CONCLUSION: The radiographic features of hybrid-CGCG lesions vary according to the concurrent bony lesion. Hybrid-CGCG lesions altered the radiographic appearance with the following entities: fibrous dysplasia, melorheostosis, and Paget's disease. Optimal imaging modalities are crucial to detail radiographic features and direct representative biopsy of suspicious sites that may host a CGCG hybridisation.

Intralesional injection of triamcinolone hexacetonide as an alternative treatment for central giant cell lesions: a prospective study.

The aim of this prospective study was to report on the response to treatment of central giant cell lesions (CGCL) with intralesional corticosteroid injections. Consecutive cases of CGCL were treated with a biweekly intralesional injection of 20mg/ml triamcinolone hexacetonide diluted in an anaesthetic solution of 2% lidocaine/epinephrine 1:200 000 at the proportion 1:1. All patients were monitored using cone beam computed tomography. Eleven patients were treated; their ages ranged from 15-34 (mean 22 years); and eight lesions were in the mandible, and three in the maxilla. Three cases were diagnosed as non-aggressive, and eight as aggressive. Six cases presented good results (four aggressive and two non-aggressive); three cases presented a moderate response (two aggressive and one non-aggressive); and two had a poor response to treatment (both aggressive). In four cases with a good response, osteoplasty was done. In all cases with a moderate response, the remaining lesion was curetted. Cases with a poor response were submitted to either curettage or denosumab injections. Corticotherapy, as main or neoadjuvant therapy, may be an option for treatment of CGCL.

Cytomorphological spectrum of hand, wrist, and foot lesions at tertiary care center in central India.

BACKGROUND: Fine-needle aspiration cytology (FNAC) being a fast technique is used as a primary investigation to diagnose wide spectrum of hand, wrist, and foot lesions. These sites are prone to trauma, reparative, and infectious process, which forms mass lesions mimicking neoplasia. Our study highlighted the importance of FNAC with the chance of reduction in biopsy or excision. AIMS AND OBJECTIVES: To report the prevalence and cytomorphological spectrum of hand and foot lesions with the aim of consolidating the diagnostic potential and also correlate the cytological evaluation with histopathology. MATERIALS AND METHODS: This retrospective observational study was done in central India for the period of 5.5 years. The archive cytology slides of patients with palpable lesions at these sites are reviewed and analyzed. RESULTS: Of the total 6512 FNAC cases, 115 cases presented as swelling in the hand, wrist, and foot are reviewed. Age ranged from 4 months to 80 years with M:F = 1.25:1. Of the 111 satisfactory smears (96.7%), 21 cases (18.9%) diagnosed as inflammatory lesion, including synovitis, tuberculosis, gout, and fat necrosis. Sixty cases as benign non-neoplastic (tumor-like) lesions with the most common being ganglion (29). Of the 30 neoplastic lesions, 26 were benign tumor with the most common being mesenchymal neoplasms (19), followed by giant cell tumor of tendon sheath. Malignant tumors included malignant melanoma, small round cell tumor, and squamous-cell carcinoma. CONCLUSION: FNAC is useful investigation for early diagnosis of hand and foot lesions. These lesions are benign mostly with less malignancy occurrence (<2%), compared with other soft tissue lesions.

Multifocal osteolytic lesions of jaw as a road map to diagnosis of brown tumor of hyperparathyroidism: A rare case report with review of literature.

Brown tumor is unifocal or multifocal bone disease which represents terminal stage of hyperparathyroidism (HPT)-dependent bone pathology. It is recognized as a component of metabolic bone disease called osteitis fibrosa cystica generalisata or Von Recklinghausen disease of bone. HPT was first described by Von Recklinghausen in 1891. Brown tumor diagnosis nowadays is less frequently encountered because of early stage detection of HPT. This early detection is possible due to routine blood screening in asymptomatic adults or during evaluation of osteoporosis. Histologically, it may resemble any other giant cell lesion of the jaw that imposes diagnostic challenge and delay in treatment. We are introducing a case report of a 30-year-old female patient presented with multifocal osteolytic lesions in mandible with histopathology depictive of giant cell granuloma. Further biochemical investigations and X-ray skeletal changes raised the suspicion of primary HPT which was confirmed by parathyroid scintigraphy revealing parathyroid adenoma. The main purpose of this case report is to reinforce the role of oral examination in diagnosis of systemic diseases and to propose a diagnostic layout/algorithm when giant cells are present in biopsy specimen. Review of literature showing brown tumor of oral cavity associated with PHPT is discussed.

Central giant cell granulomas of the jaws: retrospective radiographic analysis of 13 patients.

OBJECTIVE: This study was performed to retrospectively analyse the imaging features of 13 patients with central giant cell granulomas (CGCGs) examined at a single institution. METHODS: The orthopantomography and cone beam computed tomography images of 13 patients histopathologically diagnosed with CGCGs were retrospectively analysed. Patients aged > 30 years underwent measurement of their calcium and parathyroid hormone levels. No cases of hyperparathyroidism were identified in the study group. RESULTS: Thirteen lesions of 13 patients (7 female, 6 male) were included in this study. The patients' ages ranged from 8 to 79 years at the time of presentation. Among the 13 lesions, 2 (15.4%) were in the maxilla and 11 (84.6%) were in the mandible. Eight lesions (61.5%) were unilocular and 5 lesions (38.5%) were multilocular with a soap bubble appearance. Three of the lesions were > 5 cm, and the remaining ten lesions were < 5 cm; five of these smaller lesions met at least three of the aggressiveness criteria. Therefore, according to these criteria, eight aggressive and five non-aggressive CGCGs were examined in this series. CONCLUSION: The distinction between aggressive and non-aggressive CGCGs is extremely important because it leads to changes in the individual treatment protocol that is applied. It may be possible to minimise recurrence after treatment by detecting findings such as cortical perforation or thinning, cortical bone expansion, and the presence of root resorption.

Adjunctive Strategies for Benign Maxillofacial Pathology.

Benign cysts and neoplasms of the maxillofacial region can vary in behavior, with some growing rapidly and resulting in destruction of surrounding structures. Despite their benign histology, many require often-morbid treatment to prevent recurrence of these lesions. Several less invasive and adjunctive medical treatments have been developed to lessen the morbidity of surgical treatment. As the molecular and genomic pathogenesis of these lesions is better understood, more directed treatments may lessen the burden for patients.

Clinical factors associated with the recurrence of central giant cell lesions.

Central giant cell lesion of the jaws (CGCLJ) is a destructive condition that shows a varied and unpredictable biological behaviour. In the present study, we aimed to evaluate factors associated with the recurrence of CGCLJ. Based on the data of a previous systematic review of 2270 cases of CGCLJ, we used the multiple imputation to deal with the missing data. The dependent variable was the recurrence after the first treatment (yes/no). The dichotomic covariates were sex, upper or lower jaw location, size (up to or larger than 4 cm), pain, cortical bone perforation (yes/no), locularity (uni-/multilocular), tooth displacement (yes/no), treatment type (curettage or enucleation) and root resorption (yes/no). The final logistic model indicated that the tumours associated with tooth displacement, root resorption and treated with curettage had a more significant chance of recurrence. In conclusion, our study suggests that tooth displacement, root resorption and the type of treatment are potentially useful in the future construction of an algorithm for patient's treatment.

Expresión Inmunohistoquímica de Ki-67 en Lesión Central de Células Gigantes / Immunohistochemical Expression of Ki-67 in Central Giant Cell Lesion

RESUMEN: La lesión central de células gigantes (LCCG) es una lesión osteolítica benigna que en algunos casos presenta un comportamiento agresivo, con recidiva y mal pronóstico. Ki-67 es una proteína nuclear cuya función general es la regulación de la proliferación celular. Este marcador es utilizado para el reconocimiento de células en proliferación y como herramienta de pronóstico en el diagnóstico de neoplasias. El objetivo de este estudio fue cuantificar la inmunoexpresión de Ki-67 en las diferentes poblaciones celulares de las LCCG y analizar su asociación con las características clínicas, demográficas y radiográficas. Se evaluó la inmunoexpresión de Ki-67 de 17 casos de LCCG en dos poblaciones celulares: células gigantes multinucleadas (CGM) y células mesenquimatosas estromales (CME). El análisis estadístico se efectuó con el programa SAS 9.0 y SPSS versión 23.0, con un nivel alfa impuesto de P<0,05. Las CME mostraron inmunoexpresión promedio de 9,4 % y las CGM de 0,65 %. No se encontró relación estadísticamente significativa entre las características clínicas, demográficas y radiográficas de las LCCG y la inmunoexpresión de Ki-67. La expresión de Ki-67 en CME sugiere que esta población se encuentra en constante actividad celular y que las LCCG son lesiones dinámicas y en constante proceso de diferenciación.

ABSTRACT: The central giant cell lesion (CGCL) is a benign osteolytic lesion which in some cases presents an aggressive behavior with recurrence and poor prognosis. Ki67 is a nuclear protein whose general function is the regulation of cell proliferation. This marker is used to identify proliferating cells and as a prognostic tool in the diagnosis of neoplasms. The aim of this study was to quantify the immune expression of Ki-67 in the different cell populations of CGCL and analyze its association with clinical, demographic and radiographic characteristics. The Ki-67 immune expression of 17 cases of LCCG was evaluated in two cell populations: multinucleated giant cells (CGM) and stromal mesenchymal cells (SMC). The statistical analysis was carried out with SAS 9.0 and SPSS version 23.0, with an alpha tax level of P <0.05. The CME showed average immune expression of 9.4 % and the CGM of 0.65 %. No statistically significant relationship was found between the clinical, demographic and radiographic characteristics of the CGCL and the immune expression of Ki-67. The expression of Ki-67 in CME suggests that this population is in constant cellular activity, and that the CGCL are dynamic lesions in a continuous differentiation process.

Non-ossifying fibroma: A RAS-MAPK driven benign bone neoplasm.

Non-ossifying fibroma (NOF) has been an intriguing entity since its first description. It is the most common bone tumour, is usually asymptomatic affecting children and adolescents, is composed of a heterogeneous cell population, and undergoes spontaneous regression after puberty. In a recent article in The Journal of Pathology, Baumhoer and colleagues demonstrate mutations activating the RAS-MAPK pathway (KRAS, FGFR1 and NF1) in ∼80% of the tumours. Activation of the RAS-MAPK pathway by somatic mutations is found in a plethora of tumour types, both benign and malignant, while germline mutations cause a wide range of syndromes collectively termed the RASopathies. Their findings indicate that NOF, for long thought to be reactive, should be considered a true neoplasm. Moreover, their data suggest that only a subset of cells in the lesion contain the mutation. A second cell population consisting of histiocytes and osteoclast-like giant cells appears to be reactive. This intimate relation between WT and mutant cells is also frequently encountered in other benign and locally aggressive bone tumours and seems essential for tumourigenesis. The spontaneous regression remains enigmatic and it is tempting to speculate that pubertal hormonal signalling, especially increased oestrogen levels, affect the balance between mutant and WT cells. © 2019 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.

Peripheral giant cell granuloma associated with dental implants: a systematic review.

The purpose of the present review was to integrate the available published data on peripheral giant cell granuloma (PGCG) associated with dental implants into a comprehensive analysis of its clinical/radiologic features. An electronic search was undertaken in February/2018 in three databases, looking for publications reporting cases of PGCGs associated with dental implants. Nineteen publications were included, reporting 37 implant-associated PGCG. These lesions are more prevalent in women, in mandible, and in posterior regions of the jaws. Both 'excision alone' and 'excision + curettage' presented high recurrence rates (40% and 31.3%, respectively). The etiology of implant-associated PGCG has not yet been determined. Despite the small number of cases reported, implant-associated PGCG shows a high recurrence rate (1/3) for a benign non-neoplastic lesion and sometimes it requires the removal of the associated implant in order to prevent further recurrences. This recurrence rate is not affected by curettage after excision.

Primary aneurysmal bone cyst of the mandibular condyle with USP6-CDH11 fusion.

Primary aneurysmal bone cyst (ABC) is a cystic bone neoplasm characterized by disease-defining gene fusions involving the USP6/Tre2 gene. The literature describing gnathic ABC is limited. This case report describes a 27-year-old man presenting with a long-standing left-sided facial asymmetry. Multi-detector computed tomography imaging demonstrated a large expansile lesion positioned within the left condylar head. The lesion was biopsied and resected. The specimen showed a giant cell-rich cystic neoplasm, with fibrous tissue lined by multinucleated giant cells. Next-generation sequencing confirmed the presence of a USP6-CDH11 fusion gene, consistent with classification as a primary ABC, the first reported to be translocation-positive in the head of the mandibular condyle.

Mutações KRAS e ativação da via de sinalização MAPK/ERK em lesões periféricas de células gigantes associadas ao implante dentário / KRAS mutations and activation of the MAPK/ERK pathway in peripheral giant cell lesion associated with dental implant

As lesões de células gigantes (LCG) compõem um grupo de doenças que acometem os maxilares e que compartilham do mesmo quadro histopatológico. Existem dois subtipos de LCG, a periférica e a central. A lesão central de células gigantes (LCCG) é uma lesão intraóssea, usualmente assintomática, que afeta com maior frequência a região anterior da mandíbula de indivíduos jovens. A lesão periférica de células gigantes (LPCG) se manifesta clinicamente como um nódulo usualmente de coloração vermelha-arroxeada, que afeta com frequência a gengiva ou mucosa alveolar de indivíduos entre a quarta e quinta décadas de vida. Em alguns casos, a LPCG pode se desenvolver adjacente ao implante dentário, apresentando características clínicas e histopatológicas muito semelhantes a forma convencional não associada ao implante. Recentemente, nosso grupo de pesquisa reportou mutações recorrentes, mutuamente exclusivas e com ganho de função nos genes TRPV4, KRAS e FGFR1, com consequente ativação constitutiva da via de sinalização intracelular MAPK/ERK nas LCG dos maxilares. No entanto, o perfil molecular da LPCG associada aos implantes dentários é ainda desconhecido. Assim, o objetivo deste estudo foi avaliar o perfil de alterações moleculares na LPCG associada aos implantes dentários, investigando mutações nos genes KRAS, FGFR1 e TRPV4 previamente descritas na lesão convencional. Além disso, a ativação da via MAPK por meio da reação imuno-histoquímica para a forma fosforilada das proteínas ERK1/2 (fosfo-ERK1/2) foi também avaliada. Para isso, foram utilizadas 15 amostras de LPCG associada ao implante dentário incluídas em blocos de parafina. Mutações ativadoras no gene KRAS foram encontradas em 8 das 15 amostras analisadas, afetando os códons 12 (p.G12A/D), 14 (p.V14L), 37 (p.E37K), 127 (p.T127I) e 146 (p.A146V). Não foram detectadas mutações afetando os genes FGFR1 e TRPV4. As células mononucleares mostraram uma forte marcação nuclear e citoplasmática para a proteína fosfo-ERK1/2 na análise imuno-histoquímica, o que sugere ativação da via MAPK/ERK na LPCG associada ao implante dentário. Concluindo, este estudo mostra ativação da via MAPK/ERK na LPCG associada aos implantes. Nossos achados também demonstram que as lesões relacionadas aos implantes apresentam perfil molecular semelhante a LPCG convencional.

Giant cell lesions (GLC) are a group of jaw diseases that share the same histopathological features. The GCL of the jaws have two distinct clinical subtypes: central and peripheral. The central giant cell lesion (CGCL) is an intraosseous disease, often asymptomatic that most commonly affects young individuals in the anterior region of the jaw. Peripheral giant cell lesion (PGCL) is clinically characterized by nodule with a reddish-purple color, mainly presented in the gingiva or alveolar mucosa of female individuals between the fourth and fifth decades of life. In some cases, PGCL may develop adjacent to a dental implant. The clinical and histopathological features of these lesions are very similar to those of non-implant-associated lesions. Recently, our research group reported recurrent, mutually exclusive and activating mutations in the TRPV4, KRAS and FGFR1 genes and a consequent constitutive activation of the MAPK/ERK intracellular signaling pathway in the GCL of the jaws. However, the molecular profile of PGCL associated with dental implants has not been determined. Thus, the objective of this study was to evaluate the molecular profile of the PGCL associated with dental implants by the investigation of KRAS, FGFR1 and TRPV4 mutations previously reported in the conventional lesions. MAPK activation was also evaluated through the immunohistochemical expression of the phosphorylated form of ERK1/2 proteins (phosphoERK1/2). For this purpose, 15 samples of PGCL associated with dental implant were used. Activating mutations in the KRAS gene were found in 7 of the 15 samples analyzed, affecting codons 12 (p.G12A / D), 14 (p.V14L), 37 (p.E37K) and 146 (p.A146V). Mutations in FGFR1 and TRPV4 genes were not detected. Mononuclear cells were strong staining by phospho-ERK1/2 protein in the immunohistochemical analysis, which confirmed the activation of the MAPK/ERK pathway in the PGCL associated with dental implants. In conclusion, the present study shows MAPK/ERK pathway activation in PGCL associated with dental implants. Our findings also demonstrate that the lesions associated with dental implants present a similar molecular profile with the conventional PGCL

Comparación de inmunoexpresión de receptores CD68 en células gigantes y mononucleadas en lesiones central y periférica de células gigantes de los maxilares / A comparison of immunoexpression of CD68 receptors in giant cell and mononuclear cells of central and peripheral giant cell lesions of the jaws

Introducción: La lesión central (LCCG) y periférica (LPCG) de células gigantes de los maxilares, son lesiones reactivas con comportamiento clínico diferente. Objetivo: Comparar la inmunoexpresión de CD68 en células gigantes (CGm) mononucleares (CMn) en lesiones central y periférica de los maxilares. Material y métodos: Se evaluaron 35 casos de LCCG y 24 de LPCG en bloques de parafi na que podían ser procesadas para la expresión del anticuerpo CD68. La inmunoexpresión se valoró en el citoplasma de ambas poblaciones celulares, obteniendo proporciones; la inmunoexpresión se categorizó en intensa, moderada, leve. Las proporciones se compararon con χ2, siendo signifi cativo p ≤ 0.05. Resultados: Para las CGm de LCCG, CD68 se expresó en una proporción de 96 versus 84.2% LPCG (p < 0.005). La proporción de la tinción de la expresión intensa y moderada fue más frecuente en las LCCG (p = 0.032). Las proporciones entre las CMn 59.3% LCCG versus 18.6% en la LPCG (p < 0.001). Hubo diferencia en intensidad de CD68, en las CMn de LCCG fue mayor (p = 0.002). Conclusiones: La alta expresión de CD68 en las CGM y CMn en la lesión central y periférica confi rma su fenotipo de macrófago. Las diferencias entre las proporciones y la tinción a CD68 refl eja mayor actividad fagocítica posiblemente relacionada con el comportamiento clínico (AU)

Introduction: Central (CGCL) and Peripheral (PGCL) giant cell lesions of jaws are reactive lesions displaying diff erent behavior patterns. Objective: To compare CD68 immunoexpression between CGCL and PCGL in giant multinucleated and mononuclear cells. Material and methods: 35 CGCL and 24 PGCL were retrieved from paraffi n-embedded biopsy, as well as the feasibility to analyze CD68 immunoexpression. The immunoexpression was analyzed in cytoplasm both cell populations cellular, for and staining intensity was categorized as intense, moderate or faint. Proportions were compared by χ2, making a p ≤ 0.05 value signifi cate. Results: In 96% of CGCL's in GMCs displayed CD68, as compared to 84.2% in PGCL, (p < 0.005). The proportion of stained cells, intense to moderate staining was more frequent in CGCL (p = 0.032). The proportion CD68 was expressed in 59.3% or CGCL mononuclear cells, as compared to 18.6% in PGCL, (p < 0.001). There was diff erence in staining CD68 intensity between mononuclear cells in CGCL, (p = 0.002). Conclusions: The high CD68 expression frequency in GMCs and mononuclear cells in central and peripheral GCL confi rm a macrophage phenotype; a more intense staining in CGML and GMCs suggests a more active phagocytic activity, and possibility underline the diff erent clinical behavior (AU)

Central xanthoma of the jaw in association with Noonan syndrome.

Xanthomas are histiocytic lesions of the skin, soft tissue, and bone and are generally considered to be reactive in nature. When they arise in the bones of the jaw, they are referred to as central xanthomas. New evidence supports the hypothesis that central xanthomas are a separate and distinct entity from their extragnathic counterparts. Noonan syndrome (NS) is an autosomal dominant disorder that has been associated with giant cell lesions, which also commonly occur in the jaw. We present a case of a 15-year-old boy with NS who presented with a radiolucent lesion of the mandible that on excision was found to be a central xanthoma. Although giant cell lesions have been well described in NS, xanthomas of the jaw have not been reported. We will also discuss the entities that must be excluded before making a diagnosis of central xanthoma, as this can affect both treatment and follow-up.