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Other Lesions of Bone.Central Giant Cell Granuloma.-Giant Cell
Reparative Grauloma, Giant Cell Lesion, Giant Cell Tumor.
Mechanism:Neoplasm consisting of osteoblast-like cells. Imaging
characteristic same like benign tumor.Relationship to Giant Cell
Tumor is unclear.
Clinical Features:Common lesion in jaws..60% < 20 years
old.Painless swelling, usually grows slowly, overlying mucosa has
purple colour.Palpation of suspected bone are ellicit
tenderness.Imaging Features:LocationMandible 2x more often.First 2
decades epicenter lesion anterior to first molar in mandible and
anterior to cuspid in maxilla. Older people posterior aspect of
jaws.PeripheryWell defined margin in mandible.Most cases, periphery
shows no evidence of cortication.
Internal StructureSome shows no evidence.Subtle granular pattern
of calcification.Granular bone organized into ill-defined, wispy
septa (right angle).Small indentations of expanded cortical
margin.
Effects on Surrounding Structure:Displaces and resorbs
teeth.Lamina dura missing. Inferior Alveolar Canal displaced
inferiorly.Strong tendency to expand cortical boundaries of
mandible & maxilla.Border of expanded mandible often a granular
texture.
Differential Diagnosis:Ameloblastoma Odontogenic Myxoma.ABC.
4. Ossifying Fibroma5. Cyst6. Brown Tumor of
Hyperparathyroidism7. Cherubism.
Management : CT scan for maxilla and large lesions.If lesion
occur after 2 decade, serum testing or full body technetium bone
scan to rule out hyperparathyroidism.
Treatment : Enucleation, curettage , resection of jaw.Follow
up.Recurrence rare .Aneurysmal bone cystMechanism: Reactive bone
lesion.Proliferation of vascular spaces, fibroblast, osteoclast
like cells, reactive poorly calcified woven bone.Develop in
association with other primary lesion.
Clinical Features :>90% , < 30 years old.Females Rapid
bone swelling. (buccal / labial)Involved area tender on
palpation..
Imaging Features LOCATION:Mandible more often (3:2)Molar and
ramus.PERIPHERY:Well definedCircular / hydraulicINTERNAL
STRUCTURE:Small lesions no internal structure.Multilocular
appearance, wispy, ill defined septa (right angle)CT image, more
radiolucent region,roughly circular shape large vascular
spaces.Effect on Surrounding:EXTREME expansion of outer cortical
plates.Displace and resorb teeth.
Differential Diagnosis CGCG AmeloblastomaCherubismDiagnosis
based on biopsy.Hemorragic aspirates.CT scan recommended.
Management Surgical curretagePartial resectionFollow up.
CHERUBISMMechanismFamilial Fibrous DysplasiaRare, inherited
autosomal dominant.Bilateral enlargement of jaw.Reactive
boneRegress with age.
Clinical Features2 6 years Painless, firm, bilateral enlargement
of lower face.No systemic abnormalities.eye raised to heaven
appearance.
Imaging Features.Location :Bilateral, affects both
jaws.Epicenter in posterior aspect of jaws.Lesion grows in anterior
direction.Severe cases extend almost to midline.Periphery:Well
defined, sometimes corticated.Internal Structure:Resembles CGCG
Effects on Surrounding.Severe enlargement of jaws.Maxillary lesions
enlarge into maxillary sinuses.Teeth displaced anteriorly.
Differential Diagnosis.Giant Cell GranulomaFibrous
DysplasiaMultiple Odontogenic Keratocyst in Basal Nevus
Syndrome.
Management.Diagnosis rely on radiograph alone.Treatment
delayedConservative surgicalSurgery Orthodontic.
By: Nurul Liyana Rashid
