Mast Cell Concentrations in Peripheral and Central Giant Cell Granulomas: Is there any Angiogenetic Role?

BACKGROUND: In the maxillofacial region, giant cell granulomas occur in 2 clinical forms, central and peripheral. Despite histopathological similarity between these 2 forms totally different clinical behaviors have been reported. The present study was undertaken to compare mast cell and vascular concentrations in these pathologic lesions. MATERIALS AND METHODS: In this cross-sectional descriptive study, 20 pathological samples of central giant cell granuloma (CGCG) and 20 samples of peripheral giant cell granuloma (PGCG) were selected and examined through toluidine blue staining for mast cell assessment and immunohistochemical staining by VEGEF antibody for comparing the number of mast cells. T-test, chi-squared test and backward multivariate linear regression were used for statistical analysis using SPSS 20. Statistical significance was set at P<0.05. RESULTS: This study showed significantly greater VEGF expression and mast cell concentrations in CGCG compared to PGCG cases. Also there was a significant correlation between VEGF expression and the concentration of mast cells. No relation was found between age, sex and site of the lesion and concentration of mast cells or VEGF expression. CONCLUSIONS: It is feasible that higher concentrations of mast cells in CGCG versus PGCG samples might lead to more aggressive clinical behavior via vascular proliferation and angiogenesis. However, other biologic mechanisms should be considered in this situation.

Giant cell lesions of the jaws: does the level of vascularity and angiogenesis correlate with behavior?

PURPOSE: To compare vascularity and angiogenic activity in aggressive and nonaggressive giant cell lesions (GCLs) of the jaws. MATERIALS AND METHODS: This is a retrospective study of 14 GCLs treated at the University of California, San Francisco. Immunohistochemistry was used to determine of the expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), CD34, and CD31. VEGF and bFGF expression in giant cells (GCs) and surrounding mononuclear stroma was classified into 1) high immunoreactivity (>50% staining) and 2) low immunoreactivity (<50% staining). CD31- and CD34-stained vessels were counted at 200× magnification. Clinical and radiographic records were reviewed to classify lesions as aggressive or nonaggressive. RESULTS: Of the lesions, 8 were aggressive and 6 were nonaggressive. High VEGF expression was found within the GCs in 4 of 8 aggressive lesions compared with 1 of 6 nonaggressive lesions. The stroma in both groups had low staining. High staining of the GCs for bFGF was found in 6 of 8 aggressive lesions compared with 3 of 6 nonaggressive lesions. The stroma of all aggressive cases showed high expression of bFGF compared with 3 of 6 nonaggressive cases. The aggressive group had a mean of 20.1 ± 5.4 vessels/high-powered field (hpf) stained for CD31 compared with 11.5 ± 5.6 vessels/hpf in the nonaggressive group. The aggressive group had 24.6 ± 7.0 vessels/hpf stained with CD34 compared with 18.5 ± 4.0 vessels/hpf in the nonaggressive group. CONCLUSIONS: The vascularity and level of angiogenesis within aggressive GCLs are higher than those in nonaggressive lesions.

Mutations in SH3BP2, the cherubism gene, were not detected in central or peripheral giant cell tumours of the jaw.

Giant cell granulomas of the jaw (GCGJ) are non-familial, generally unilateral osteoclast-rich lesions that are histopathologically indistinguishable from cherubism. Cherubism is an autosomal dominant disease that is characterised by bilateral radiolucencies of the jaw, and caused by mutations that occur in SH3BP2 exon 10. The aim of the study was to screen lesional GCGJ tissue for SH3BP2 mutations. Lesional mononuclear stromal or spindle cells were microdissected from paraffin-embedded tissue from GCGJ, and DNA was then extracted and sequenced for SH3BP2 mutations associated with cherubism. No mutations were detected in 26 GCGJ (15 central, 11 peripheral), which indicated that people with GCGJ do not harbour cherubism-related germline SH3BP2 mutations, and that GCGJ do not harbour somatic SH3BP2 mutations. This suggests that cherubism and GCGJ arise on a different genetic background, and therefore detection of SH3BP2 mutations can be a useful means of distinguishing between them.

Granuloma gingantocelular periférico: presentación de dos casos / Peripheral giant cell granuloma: report of two cases

Se estudiaron dos casos de granulomas periféricos de células gigantes, de gran tamaño, en adulto de 30 años y 50 años, comparando las características clínicas, radiográficas e histopatológicas; en este último aspecto se realizó inmunohistoquímica, utlizando el anticuerpo monoclonal MIB-1 (Ki 67 en parafina), el cual resultó de bajo índice de proliferacion celular, a pesar de no tener uno de los casos antecedente de recidiva, con un comportamiento agresivo.

Granuloma gingantocelular periférico: presentación de dos casos / Peripheral giant cell granuloma: report of two cases

Se estudiaron dos casos de granulomas periféricos de células gigantes, de gran tamaño, en adulto de 30 años y 50 años, comparando las características clínicas, radiográficas e histopatológicas; en este último aspecto se realizó inmunohistoquímica, utlizando el anticuerpo monoclonal MIB-1 (Ki 67 en parafina), el cual resultó de bajo índice de proliferacion celular, a pesar de no tener uno de los casos antecedente de recidiva, con un comportamiento agresivo. (AU)

The surgical treatment of central giant cell granuloma of the mandible.

PURPOSE: The objective of this study was to report and evaluate our experience in the surgical treatment of mandibular central giant cell granuloma by resection without continuity defect and peripheral ostectomy. METHODS: A retrospective analysis was conducted of patients with central giant cell granuloma of the mandible who were treated between 1991 and 2000, in the Oral and Maxillofacial Surgery Unit at Jordan University of Science and Technology. A uniform surgical technique was used in all cases. The compact bone composed of the lower border of the mandible and/or posterior border of the ascending ramus, together with the nutrient periosteum attached to it, was preserved. All soft tissues in contact with or overlying the lesion and a margin of cancellous bone related to the lesion were excised. All patients were reviewed annually for a follow-up period of 1 to 9 years (mean, 3.9 years). RESULTS: Eighteen patients with central giant cell granuloma were included, (9 males and 9 females). Their age ranged from 10 to 46 years, with 89% younger than 40 years. Five (28%) lesions were in the incisor-canine region, 2 (11%) were confined to the premolar region, 4 (22%) were in the premolar-molar region, and 7 (39%) were in the molar-ramus region. All patients had aggressive central giant cell granulomas with pain, tooth mobility, and rapidly enlarging swelling. The initial diameter of lesions ranged from 2.7 to 10 cm. During the follow-up period, there was 1 case of recurrence, 2 (11%) patients had permanent lower lip paraesthesia, and no patient had obvious facial deformity. CONCLUSION: Our results suggest that resection without a continuity defect and peripheral ostectomy is a satisfactory method in the treatment of central giant cell granuloma of the mandible, with no or a very low recurrence rate and favorable postoperative function.

Patología granulomatosa facial / Facial granulomatous pathology

En este trabajo se ralizauna revisión de aquellos preocesos-patológicos de localización facial que cursan con infiltrados granulomatosos. Se consideran los distintos tipos histológicos de granulomas. Se hace el comentario de las características clínicas distintivas que permiten hacer el diagnóstico diferencial entre las mismas

Patología granulomatosa facial / Facial granulomatous pathology

En este trabajo se ralizauna revisión de aquellos preocesos-patológicos de localización facial que cursan con infiltrados granulomatosos. Se consideran los distintos tipos histológicos de granulomas. Se hace el comentario de las características clínicas distintivas que permiten hacer el diagnóstico diferencial entre las mismas(AU)

[Reticular elastolytic giant cell granuloma. A variant of the annular elastolytic giant cell granuloma]. / Retikuläres elastolytisches Riesenzellgranulom. Eine Variante des anulären elastolytischen Riesenzellgranuloms.

The case report presented describes a new variant of annular elastolytic giant cell granuloma. Over a period of 10 years, a 40-year-old woman had developed reticular, brown to livid, partly atrophic skin lesions on the shoulders and decolletée. The patient had no subjective symptoms. Histology revealed a patchy lymphohistiocytic infiltrate in the dermis, with many giant cells. Elastic fibres were less frequently found in these infiltrates; in a few of the giant cells and macrophages fragments of elastic fibres were demonstrated within the cytoplasm. There were no deposits of mucin. For this new variant we propose the term "reticular elastolytic giant cell granuloma."

Los epulis: epulis fisurado - hiperplasia fibrosa inflamatoria - tumor por lesión protética - tejido redundante / Epulis: cleft epulis - inflammatory fibrous hyperplasia - prosthetic lesion tumor - remaining tissue

Se presenta un caso de epulis, de una mujer de 65 años de edad, la cual es portadora de prótesis total mal adpatada desde hace aproximadamente seis años. Al interrogatorio y al examen clínico se determina que la lesión es asintomática. En este artículo se analiza la definición, etiología, características tanto clínicas como histopatológicas, así como el diagnóstico diferencial, pronóstico y tratamiento que esta hiperplasia fibrosa inflamatoria tiene en los pacientes portadores de prótesis

Advanced giant cell granuloma: a twenty-year study.

Giant cell granuloma is a benign lesion that generally involves the mandible and maxilla. It may be locally aggressive and result in extensive tissue destruction in advanced cases. A retrospective analysis of giant cell granuloma during the interval 1970 to 1990 revealed 18 cases of advanced disease, as defined by bone destruction and a greatest dimension of 2.0 cm or more. Epidemiologic factors, physical findings, imaging studies, pathologic specimens, treatment modalities, and outcome were reviewed for each case. Eight lesions were treated by local excision and curettage, and 10 were treated by partial mandibulectomy. Five mandibular defects were reconstructed with iliac bone grafts and one with a free flap. Only one patient with maxillary giant cell granuloma who underwent curettage had regrowth of what is suspected to have been residual disease. Individualized treatment, tailoring the extent of resection to the extent of disease, provided excellent results.

[Epulides: the histopathological and epidemiological aspects]. / Epulide: aspetti istopatologici ed epidemiologici.

The authors examined 195 epulides in order to point out distribution of this pathology in relation to some clinical, epidemiological and histopathological parameters. The Authors have found that the epulis is more prevalent in the female sex and in the anterior sextants. The epulides were subdivided on the basis of histopathological findings into: pyogenic granuloma (GP), giant cell granuloma (GGC), fibrous hyperplasia (IF), peripheral fibroma with calcification (FPC) and variety lympho-plasma-cellular (LP). Furthermore investigating the correlation between sex and histopathological variety it was found a significant prevalence of the GGC in the male sex, whereas the correlations within the age's sets are the followings: the LP is more prevalent in the IV age set (46-60 years), whereas the GP is more prevalent in the III age set (31-45 years) and in the V age set (greater than 60 years). This finding revaluates the hormone's influence in the vascular proliferation of the GP. IF and FPC are, in percentage, less frequent than others histopathological variety regarding to the size, it was found that GGC is the bigger than the other types, whereas IF is the smaller.

Multifocal central giant cell lesions of the maxillofacial skeleton: a case report.

The classification of giant cell lesions of the maxillofacial skeleton is one that remains controversial. Classifying giant cell lesions of the jaw as granulomatous based solely on location seems inappropriate. The categories of benign or malignant are more realistic. Benign lesions may then be subdivided into aggressive and nonaggressive. Multifocal giant cell lesions strongly suggest the brown tumor of hyperparathyroidism. Serum chemistry tests including calcium, phosphorus, ionized calcium, and PTH levels should routinely be obtained when a giant cell lesion is suspected. A case of benign, aggressive, multifocal central giant cell lesions of the maxillofacial skeleton, in the absence of either primary or secondary hyperparathyroidism is presented. Whether this represents metastasis from the initial lesion, metabolic osteoclastic dysfunction, or a new entity, craniofacial giant cell dysplasia, is unknown.

Annular elastolytic giant cell granuloma.

We treated a 13-year-old girl who had annular erythematous lesions with central atrophic areas, which had been present on her trunk and limbs for 4 months. Histological examination revealed patchy dermal lymphohistocytic infiltration with multinucleated giant cells which were phagocytosing elastic fibers, causing them to disappear. The active border of the lesions regressed after intradermal injection of corticosteroids. The classification of the disease and its differential diagnosis from the usual granuloma annulare, inflammatory anetoderma, O'Brien's actinic granuloma, and Convit's disease are discussed.

Giant-cell granuloma of the jaw.

The giant-cell reparative granuloma of the jaw, although well represented in the oral surgical and pathology literature, has yet to be discussed in the plastic surgical literature. We hope that this report will make plastic surgeons aware of this rare jaw tumor, prompt them to perform early excisional biopsy of this lesion, and thus avoid displacement of teeth and facial disfigurement that occurs when the tumor is left untreated.