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 trabaculae of woven bone 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 be an important etiological factor in the initiation of the CGCG of the jaws 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 hemodynamic disturbance in bone marrow, perhaps associated with trauma and hemorrhage REGEZI AND SCIUBBA(1999) : Suggested that Response to previous traumatic or inflammatory episodes. This lesion is charecterised by proliferation of fibroblasts and multinucleated giant cells, in a densely packed stromaThe CGCG is a benign process that occurs almost exclusively within the jaw bones CLINICAL PRESENTATION 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 the mandible Majority of the CGCG of jaws are painless, expansion of bone is detected on routine examination Few cases may be associated with pain, paresthesia or perforation of a cortical bone plate, occasionally resulting in the ulceration of the mucosal surface by the underlying lesion Radiographic featuresCentral giant cell lesions present as radiolucent defects. Which may be unilocular or multilocular. 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. radiographic findings A small unilocular lesion may be confused with periapical granuloma or cysts. multilocular giant cell lesions cannot be radiographically distinguished from ameloblastomas or other multilocular lesions. Based on clinical and radiological features CGCG may be divided into two categories - 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. 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 typeSoft spongy, brownish to reddish friable tissue of various size. A specimen is usually coated with fresh or coagulated blood. Giant cell lesions of the jaws show a variety of features. Common to all is the presence of few to many multinucleated

1. Central Giant Cell Granuloma
DR AMITHA . G, BDS, MDS
DEPT OF ORAL AND MAXILLOFACIAL PATHOLOGY

2. 2
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 trabaculae of woven bone

3. 3
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

4. 4
 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

5. 5
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

6. 6
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

7. 7
 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

8. 8
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.

9. 9
 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.

14. 14

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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

16. 16
 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

23. THANK YOU
DR AMITHA . G, BDS, MDS
DEPT OF ORAL AND MAXILLOFACIAL PATHOLOGY