Management of CGCG using subcutaneous Denosumab therapy

1. Management of Central Giant Cell Granuloma with
Subcutaneous Denosumab therapy
Dr. Anish Kamat
2nd YEAR PG
OMFS
GUIDED BY
Dr.Geetanjali Mandlik

19. • An incisional biopsy was performed of the right mandible and submitted for histopathologic evaluation, resulting in a
diagnosis of central giant cell granuloma
• Subsequent serum testing showed that serum calcium, alkaline phosphatase, phosphorus, and parathyroid hormone
levels were within normal ranges.
• According to protocol byThomas et al
Subcutaneous injections of denosumab 120 mg monthly (every 28 days), with additional loading doses on days 8 and 15 of
1st month.
Pt was also started on daily supplement of calcium and vitamin D.

20. After 6 months subcutaneous denosumab therapy After 6 months of subcutaneous denosumab therapy.
18 months of denosumab therapy After 24 months of the initial diagnosis

21. Patient photograph 28 months after initial diagnosis

25. 3DCT 6 months of treatment 3DCT at cessation of Denosumab therapy 1 year post cessation of Rx

26. Before treatment (volume 35848 mm3) Three months after cessation of therapy( volume 18114 mm3 )

27. CLINICAL PICTURESAFTER CESSATION OF DENOSUMABTHERAPY

28. In CGCG
• Spindle cell stroma resembling the
osteoblast like cell expressing RANKL
• Multinucleated giant cell formed by
fusion of precursor monocytes and
macrophage lining are of osteoclastic
phenotype expressing RANK.
• Denosumab might cause
hypocalcemia during the therapy.
• Osteonecrosis of jaw
A recent meta-analysis by Qi et al that
pooled 8963 patients from 7 RCTs in
which the incidence of denosumab
osteonecrosis of the jaw (DONJ) was 1.7%

30. Aparna Naidu, DDS, MS Michael P. Malmquist, DMD Claude A. Denham, MD Sterling R. Schow, DMD
Wh Schreuder, MD DDS Aw Coumou, MD Pahw Kessler, MD DDS PhD J. De Lange, MD DDS PhD
Kamala A Kamble1, Sanketh S Guddad2, Sujith S Guddad3, Ashok Lingappa4
Wei-Xiang Qi 1 Li-Na Tang Ai-Na He YangYao Zan Shen
Aparna Naidu, DDS, MS Michael P. Malmquist, DMD Claude A. Denham, MD Sterling R. Schow, DMD (Journal of Oral and Maxillofacial Surgery)
Wh Schreuder, MD DDS Aw Coumou, MD Pahw Kessler, MD DDS PhD J. De Lange, MD DDS PhD (Journal of Oral and Maxillofacial Surgery)
Kamala A Kamble1, Sanketh S Guddad2, Sujith S Guddad3, Ashok Lingappa4(OOOO Journal)
Wei-Xiang Qi 1 Li-Na Tang Ai-Na He YangYao Zan Shen (Int Journal of clinical oncology)
Tara S. Kim, MD1 , Gianina L. Usera, MD1 , Salvatore L. Ruggiero, DMD, MD2 , Stuart A.Weinerman, MD (jbmr)
• Robert Marx Textbook of oral and maxillofacial pathology.