Central giant cell granuloma is a benign but sometimes aggressive lesion that occurs mostly in the jaws of children and young adults. It consists of cellular and fibrous tissue containing multiple giant cells and foci of hemorrhage. While the exact cause is unknown, it is thought to develop due to local trauma or reparative reaction to intramedullary hemorrhage. Clinically, it presents as a painless swelling but can become aggressive with pain, rapid growth, and bone destruction. Radiographically, it appears as a radiolucent lesion ranging from small to large with ill-defined borders. Histologically, it contains multinucleated giant cells in a background of stromal cells with areas of hemor

1. CENTRAL GIANT CELL
GRANULOMA
DR AMITHA G, BDS, MDS
ORAL AND MAXILLOFACIAL PATHOLOGY

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Central giant cell granuloma :
• WHO has defined it as an intraosseous lesion consisting of cellular and fibrous
tissue that contains multiple foci of hemorrhage, aggregation of multinucleated
giant cells and occasionally trabeculae of woven bone

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ETIOLOGY
• JAFFE (1953): considered this lesion to be a local reparative reaction of bone,
possibly to intramedullary hemorrhage or trauma, hence the term reparative
giant cell granuloma was accepted.
• Charles A Waldron & W G Shafer (1966) suggested trauma to be an important
etiological factor in the initiation of the CGCG of the jaws

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• Thoma K H (1986) suggested that, the lesion may be due to capillary injury caused
by defective wall due to some type of trauma
• J V Soames and J C southam (1997) suggested that it could be a reaction to some
form of heamodynamic disturbance in bone marrow, perhaps associated with
trauma and hemorrhage

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REGEZI AND SCIUBBA(1999) :
Suggested that
• Response to previous traumatic or inflammatory episodes.
• This lesion is characterised by proliferation of fibroblasts and
multinucleated giant cells, in a densely packed stroma

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CLINICAL PRESENTATION
• The CGCG is a benign process that occurs
almost exclusively within the jaw bones
• Found predominantly in children and young
adult
• It has a female predilection (2:1)
• Most commonly affected site is the anterior
portion of the jaws, with an increased frequency
of occurrence in mandible

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• Majority of the CGCG of jaws are painless, expansion of bone is detected
on routine examination
• Few cases may be associated with pain, parasthesia or perforation of
cortical bone plate, occasionally resulting in the ulceration of the mucosal
surface by the underlying lesion

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RADIOGRAPHIC FEATURES
• Central giant cell lesions present as
radiolucent defects. Which may be
unilocular or multilocolar.
• The defect is usually well delineated
• The lesion may vary from a 5×5mm
incidental radiographic findings to a
destructive lesion greater than 10cm in
size.

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• The radiographic findings are not specifically diagnostic.
• Small unilocular lesion may be confused with periapical granuloma or
cysts.
• multilocular giant cell lesions cannot be radiographically distinguished
from ameloblastomas or other multilocular lesion.

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• Based on clinical and radiological features CGCG may be divided into two
catogories
- Non aggressive lesion
- Aggressive lesion
• The non aggressive lesion makes up most cases and exhibit few or no
symptoms, they demonstrate slow growth and do not show cortical
perforation or root resorption of teeth involved in the lesion

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• The aggressive lesions are characterized by pain, rapid growth, cortical
perforation and root resorption and show marked tendency to recur when
compared with non aggressive type

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GROSSING
• Soft spongy, brownish to reddish friable tissue of various size.
• Specimen is usually coated with fresh or coagulated blood.

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HISTOPATHOLOGY
• Giant cell lesions of the jaws show a variety of
features. Common to all is the presence of few
to many multinucleated giant cells in a
background of ovoid to spindle shaped
mesenchymal cells.
• The giant cells may be focally aggregated in
the lesional tissue or may be diffusely present
throughout the lesion.

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• In some cases , the stroma is loosely arranged & edematous. In other cases , it
may be quite cellular.
• Stromal cells- are of 2 types
• Resembling fibroblast( oval/ spindled with cigar shaped nuclei)
• Macrophage( small round hyperchromatic nuclei)
• Areas of erythrocyte extravasation and hemosiderin deposition may be
prominent, some lesion show fibrosis of stroma.
• Foci of osteoid and newly formed bone may be present in the lesion.
• These features may be identical with those seen in cherubism and in brown
tumour of hyperparathyroidism

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• Stromal cells- swirls, storiform or herring bone pattern
• Giant cells- foreign body or osteoclast like
Immunohistochemical findings
• Giant cells express phenotypic markers for both macrophages and
osteoclasts
• Evidence suggests- origin is from mononuclear cells

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TREATMENT
• Central Giant Cell lesions of the jaws are usually treated by curettage
• Studies indicate a recurrence rate of about 15-20%.
• Long term prognosis is good & no metastasis reported

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DIFFERENTIAL DIAGNOSIS
• Ameloblastoma
• Brown tumor
• Aneurysmal bone cyst
• Cherubism
• Myxoma
• Intra bony hemangioma

20. Aggressive ossifying fibroma, trabecular type. A, Cellular proliferation of spindle cells with osteoid and woven bone
formation. B, Osteoid formation and reactive or residual bone at left; areas of loose myxoid stroma within cellular
areas. C, Osteoid and woven bone with plump osteocytes and osteoblasts; stellate and spindle cells within
stroma. D, Clusters of multinucleated giant cells within myxoid stroma.

21. Aggressive ossifying fibroma, psammomatoid type. A, Spindle cell proliferation packed with globular cementum
droplets and round or ovoid fragments of woven bone. B,Benign spindle cells with cementum droplets and some
woven bone. C, Both psammomatoid cementum droplets and small trabecular fragments of bone.

22. CGCG

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