Peripheral giant cell granuloma (giant cell epulis

15,450 views

Published on

3 Comments
32 Likes
Statistics
Notes
No Downloads
Views
Total views
15,450
On SlideShare
0
From Embeds
0
Number of Embeds
11
Actions
Shares
0
Downloads
1,574
Comments
3
Likes
32
Embeds 0
No embeds

No notes for slide

Peripheral giant cell granuloma (giant cell epulis

  1. 1. GIANT CELLS LESIONS OF THE JAW DEPARTMENT OF ORAL MEDICINE
  2. 2. Classification of giant cells lesions of jaw <ul><li>I. Reactive disorders of bone </li></ul><ul><li>(a) Central giant cell granuloma </li></ul><ul><li>(b) Primary hyperparathyroidism </li></ul>
  3. 3. <ul><li>II. Tumors of the bone </li></ul><ul><li>Giant cell tumor (osteoclastoma) </li></ul><ul><li>Idiopathic histiocytosis </li></ul><ul><li>(Langerhans cell diseases) </li></ul><ul><li>-Letterer Siwe disease </li></ul><ul><li>-Hand-Schuller Christian syndrome </li></ul><ul><li>- Eosinophilic granuloma </li></ul>
  4. 4. <ul><li>III. Connective Tissues Hyperplasia </li></ul><ul><li>Peripheral giant cell granuloma (Giant cell epulis) </li></ul>
  5. 5. <ul><li>IV. Non-epithelialized primary bone cyst </li></ul><ul><li>Aneurysmal bone cyst </li></ul><ul><li>Solitary bone cyst (simple bone cyst, traumatic bone cyst) </li></ul>
  6. 6. <ul><li>V. Fibroosseous lesions </li></ul><ul><li>Fibrous dysplasia </li></ul><ul><li>Cherubism </li></ul>
  7. 7. <ul><li>Giant Cells Ultrastructurally -> Derived from mononuclear phagocyte system (macrophages) </li></ul><ul><li>Show features of osteoclasts </li></ul><ul><li>Immunohistochemically -> macrophages and giant cells have similar antigenic marker such as muramidase α-1 antichymotrysin.   </li></ul>
  8. 9. Giant cells
  9. 11. Peripheral Giant Cell Granuloma (Giant Cell Epulis ) Dept: of Oral medicine UDM ( Mdy:)
  10. 13. <ul><li>One of the reparative hyperplasias commonly seen in oral mucous membrane representing an exuberant reparative response. </li></ul><ul><li>It does not represent a true neoplasm but is a reactive lesion caused by local irritation or trauma. </li></ul><ul><li>Distinguishing feature of this lesion is appearance of multinucleated giant cells </li></ul>
  11. 14. <ul><li>CLINICAL AND RADIOGRAPHIC FEATURES </li></ul><ul><li>Occurs exclusively on the gingiva usually in the area between first permanent molars and incisors. </li></ul><ul><li>Red or Reddish-Blue nodular mass (sessile or pedunculated) </li></ul><ul><li>Clinical appearance is similar to the pyogenic granuloma of the gingiva (PGG -> more bluish-purple compared with bright red of a typical pyogenic granuloma). </li></ul>
  12. 15. <ul><li>Peak prevalence -> 5th and 6th decades of life. </li></ul><ul><li>♀ > ♂ (60%); Either anterior or posterior regions of gingiva or alveolar mucosa; </li></ul><ul><li>Mandible > maxilla </li></ul><ul><li>If arising from periodontal ligament or periosteum -> Bone resorption (+) </li></ul><ul><li>X-ray -> Cup-shape radiolucency (cupping resorption of underlying alveolar bone) </li></ul>
  13. 17. <ul><li>Lack of involvement of bone </li></ul>
  14. 19. <ul><li>cuff-shaped radiolucency at the entrance to the alveolus of clinically vital tooth 12. </li></ul>
  15. 20. <ul><li>Cup-shaped osseous defect at 12 teeth </li></ul>
  16. 21. <ul><li>HISTOLOGICAL FEATURES </li></ul><ul><li>Basically -> Hyperplastic granulation tissues (+) </li></ul><ul><li>Proliferation of multinucleated giant cells within a background of plump ovoid and spindle-shaped mesenchymal cells </li></ul><ul><li>Acute or chronic inflammatory cell (+) </li></ul>
  17. 22. <ul><li>Lack of mature collagen, abandance of cells </li></ul>
  18. 23. <ul><li>Peripheral giant cell granuloma arising interdentally </li></ul>
  19. 24. <ul><li>Multinucleated giant cells in peripheral giant cells granuloma </li></ul>
  20. 25. <ul><li>TREATMENT AND PROGNOSIS </li></ul><ul><li>Local surgical excision down to the underlying bone </li></ul><ul><li>The adjacent teeth should be carefully scaled to remove any source of irritation and minimize the risk of recurrence. </li></ul>
  21. 26. <ul><li>D/D OF PGG </li></ul><ul><li>Pyogenic granuloma (PGG -> more likely to cause bone resorption than pyogenic granuloma) </li></ul><ul><li>Central giant cell granuloma (Which is derived from medullary tissues of mandible and maxilla) </li></ul><ul><li>(Clinical features adequately separate these microscopically identical lesions; PGG and CGG) </li></ul>
  22. 27. <ul><li>CENTRAL GIANT CELL GRANULOMA </li></ul><ul><li>(GIANT CELL TUMOR) </li></ul><ul><li>Benign process exclusively occurs within jaw bones </li></ul>
  23. 29. <ul><li>AETIOLOGY AND PATHOGENESIS </li></ul><ul><li>Three possible causes: </li></ul><ul><li>Reparative response to intrabony haemorrhage and inflammation </li></ul><ul><li>A lesion considered to be a true neoplasm </li></ul><ul><li>Developmental anormaly closely related to A.B.C (Aneurysmal Bone Cyst) </li></ul>
  24. 30. <ul><li>CLINICAL AND RADIOGRAPHIC FEATURES </li></ul><ul><li>> 60% of cases -> occur before age 30 </li></ul><ul><li>Less frequent than PGG </li></ul><ul><li>♀ > ♂(2:1); mandible > maxilla (70%); more common in anterior portions of the jaws </li></ul>
  25. 31. <ul><li>Mandibular lesions frequently cross the midline </li></ul><ul><li>Most of the cases -> Asymptomatic </li></ul><ul><li>Minority of the cases -> Associated with pain, paraesthesia or perforation of cortical plate </li></ul>
  26. 32. <ul><li>Based on clinical and radiographic features, CGG can be divided into two categories: </li></ul><ul><li>(A) Non Aggressive lesions </li></ul><ul><li>No symptoms </li></ul><ul><li>Slow growth </li></ul><ul><li>No cortical perforation </li></ul><ul><li>(B) Aggressive lesions </li></ul><ul><li>Pain </li></ul><ul><li>Rapid growth </li></ul><ul><li>Cortical perforation and root resorption (+) </li></ul><ul><li>Marked tendency to recur after treatment. </li></ul>
  27. 34. <ul><li>X-ray = unilocular (or) multilocular radiolucency with well-demarcated presenting scalloping border </li></ul><ul><li>Radiographic finding - not diagnostic </li></ul><ul><li>(small unilocular -> Periapical granuloma </li></ul><ul><li>(or) cysts multilocular -> Amelobastomas) </li></ul>
  28. 37. <ul><li>Multilocular radiolucency with expansion of jaw bone in central giant cells granuloma </li></ul>
  29. 38. <ul><li>Expansion of occlusal projection and multilocular radiolucency across the midline in CGCG </li></ul>
  30. 39. <ul><li>RADIOLUCENCY In midline of mandible,CGCG </li></ul>
  31. 40. <ul><li>Unilocular radiolucency with well defined margin in premolar area ,CGCG </li></ul>
  32. 41. CGCG
  33. 43. <ul><li>HISTOLOGICAL FEATURES </li></ul><ul><li>Many multinucleated giant cells in background of ovoid to spindle-shaped mesenchymal cells </li></ul><ul><li>Giant cells Small and irregular in </li></ul><ul><li>shape </li></ul><ul><li>Large, round containing </li></ul><ul><li>20 (or) more nuclei </li></ul><ul><li>Connective tissue stroma Loosely </li></ul><ul><li>arranged </li></ul><ul><li> Cellular </li></ul>
  34. 45. TREATMENT AND PROGNOSIS <ul><li>Surgical management with aggressive curettage of tumor mass followed by removal of peripheral bone margin -> Good prognosis and low recurrence rate </li></ul><ul><li>15 - 20% recurrence rate (+) </li></ul>
  35. 46. <ul><li>Patients with aggressive tumors, three alternative to surgery </li></ul><ul><li>(1) Corticosteroids </li></ul><ul><li>(2) Calcitonin </li></ul><ul><li>(3) Interferon α 2A </li></ul>
  36. 47. <ul><li>(Weekly injection directly into the tumor with triamcinolone acetonide x 6 weeks -> success + +) </li></ul><ul><li>cases resistant to intralesional steroids->Salmon calcitonin (Systemic administration) </li></ul><ul><li>Intradermal Injection of calcitonin _12 months </li></ul><ul><li>These alternatives can be used for large lesions if treated surgically would result in significant deformity </li></ul>
  37. 48. <ul><li>D/D of CGG </li></ul><ul><li>Due to multilocular radiolucency, </li></ul><ul><li>Ameloblastoma </li></ul><ul><li>Odontogenic myxoma </li></ul><ul><li>Odontogenic keratocyst </li></ul><ul><li>ABC </li></ul>
  38. 49. <ul><li>Histological features of CGG is identical to brown tumor of hyperparathyroidism but no changes in blood chemistry in CGG </li></ul><ul><li>In case of hyperthyroidism </li></ul><ul><li> - ↑ Serum Ca + + </li></ul><ul><li> - ↑ Serum alkaline phosphatase </li></ul><ul><li> - ↓ Serum phosphorus value </li></ul>
  39. 50. Thank You

×