Other bone diseases.

(Central giant cell granuloma, Aneurysmal bone cyst)

Chapter 23/part 3.
By :Minas Salah

Other lesions of the bone.

Central giant cell granuloma (CGCG):
Synonyms: giant cell reparative granuloma, giant cell
lesion, giant cell tumor.
Mechanism: reactive lesion to an unknown yet stimulus
or a neoplastic lesion (debate).
Imaging characteristics: similar to that of benign tumors,
maxillary lesions have some aggressive malignant type
characteristics (ill-defined borders)

Clinical features:
common lesion in the jaws
mostly affecting adolescents & young adults
(60% of cases occur < 20 years)
most common sign is painless swelling
may elicit tenderness on palpation
overlying mucosa purple
sometimes no symptoms
usually slow growth.

Imaging features:
1-location:
Mx : Mn 1:2
in first 2 decades epicenter anterior to first molar
in Mn and anterior to cuspids in Mx
older individual greater frequency in posterior
aspect.
2-Periphery:
well-defined in Mn
no cortication
ill-defined in Mx (almost malignant appearing
boarders).

3-Internal structure:
some show no evidence of internal structure
(especially small lesions),

 Others show subtle granular pattern of

calcification organized into ill-defined wispy
septa.

 Septa are characteristic of the lesion especially

if they are at right angles from the periphery
and if a small indentation of the expanded
cortical margin is seen at the point where the
right angled septa originated this becomes a
stronger characteristic of CGCG.

4-effect on surrounding structure:

displaces and resorbs teeth
missing lamina dura
ID canal displaced inferiorly
strong propensity to expand the cortical
boundaries of Mx & Mn.

 Differential diagnosis:
1- if internal structure contains septa then DD includes
Ameloblastoma
odontogenic myxoma
aneurysmal bone cyst (ABC)
Simple bone cyst
Brown tumors of hyperparathyroidism
Cherubism.
2- if granular internal structure present then DD
includes
ossifying fibroma.

disease

differentiating feature

ameloblastoma

Older age group

Posterior Mn
Coarse curved, well defined trabeculae.

Odontogenic myxoma

Older age group

Sharper straight septa
Dont have the same propensity to expand.

Aneurysmal bone cyst

Rare lesion
More often in the posterior aspect
Usually cause profound expansion.

Cherubisum

Lesions are multiple

Epicenters located most posterior of Mx
and Mn.

 Management: CT scan (establish extent and

involvement), if in second decade of life
hyperparathyroidism should be considered
and test for elevated calcium level.
Treatment: may include enucleation,
curettage, resection of the jaw in some cases.
recurrence is rare, but if occurs it is more
likely in Mx

Aneurysmal bone cyst (ABC)

Considered a reactive lesion of bone, however
there have been several chromosomal
translocations described that give some
credence to a neoplastic nature of the lesion.

Clinical features:
90%of jaw lesions in individuals younger than 30
years old
have a predilection for females
fairly rapid bony swelling usually buccal or labial
pain (occasional complaint)
tender to palpation.
Imaging features:
1-location:
Mn:Mx 3:2
molar and ramous region more involved than
anterior region.

2-periphery and shape:

well-defined periphery
circular or hydraulic shape.
3-internal structure:
small initial lesion shows no evidence of
internal structure
often the internal aspect has a multilocular
appearance
wispy ill-defined septa and at right angle to
the outer expanded border (as in CGCG).

4-effect on surrounding structure: can

displace and resorb teeth.

 Differential diagnosis:
CGCG
Amelobastoma
Cherubism
Diagnosis is based on biopsy, a hemorrhagic
aspirate favors diagnosis of ABC. CT scan will
determine the extent of the lesion.

disease

Feature similar to ABC

Differentiating feature

CGCG

Internal granular septa

Expand to a lesser degree

Ameloblastoma

Expansion to the same

degree in posterior
mandible

Older age

cherubism

Giant cell like feature

Multifocal bilateral

 Management: surgical curettage and partial

resection.
Recurrence rate is from 19% to about 50%
after curettage and approximately 11% after
resection.

 reference: oral radiology principles and

interpretations 7th edition by Stuart C. White
and Michael J. Pharoah.

THE END.