„Methods of treating endosseous giant cell lesions of maxillo-facial area -

Central Giant Cell Granulomas (CGCG).”

KEY WORDS: Central Giant Cell Lesion (CGCG), Giant cell tumor (GCT)

INTRODUCTION

The endosseous giant cell lesion - Central Giant Cell Granuulomas (CGCG) and Giant Cell

Tumors (GCT) are rated among benign lesions developing as a result of the bone tissue

response to an injury, inflammation or as a reparative bone reaction. It occurs in patients of

different ages. It is usually detected in the second or third decade of life, more often in

women, therefore some authors think that there is a connection between female hormones

secretion and the development of the disease. The lesion may also occur in patients at the

developmental age, then in occurs in boys more often. CGCG's constitutes about 7% of

benign tumours of the jaws. It is usually located in the bones of the facial part of the cranium,

mainly in the mandible ( 75%) and the maxilla. The lesion usually develops unifocally

although the cases of bifocal or multifocal location have been described, particularly in

patients with Noonan syndrome (Cohen and Gorlin, 1991), neurofibromatosis type I, Paget’s

disease and cherubism (Curtis and Walker, 2005, de Lange et al., 2007).

The clinical features of the tumour may be variable. Two forms of CGCG can be

distinguished. The non-aggressive form (60-80%) is characterised by: slow growth, weakly

intensified symptoms, the lack of cortical bone destruction and roots resorption as well as the

low probability of recurrence. The aggressive form (19-40%), which clinically behaves like a

classic semi-malignant neoplasm, is characterised by fast growth, pain in the site of lesion

growth, rapidly progressing facial asymmetry, roots resorption, paraesthesiae, cortical bone

plate destruction, pathological fractures and frequent recurrence. The radiological image of

CGCG, in the opinion of many authors , presents itself as an osteolytic bone loss with quite

clear boundaries. The non-aggressive form is usually single-cavity losses without features of
teeth displacement and their roots resorption. In the area of the tumour, tiny, round

calcifications, which may form osseous septums, frequently occur. If the septums go out from

the perimeter of the focus at a right angle and cause incisions in the distended outer cortical

bone plate then this is the image characteristic for CGCG. In the aggressive form a multi-

cavity osteolytic loss usually occurs, with the above described septums, causing considerable

mandibular or maxillary distension. Teeth displacement as well as their roots resorption

frequently occur. It should be emphasised that the radiological image is not pathognomonic

for CGCG and may suggest lesions of another character. CGCG exhibits no pathognomonic

histologic changes either. Histologic analysis reveals giant cells around a fibrous stroma and

some degree of cellular atypia, it is very similar to brown tumour of bone occurring in

hyperparathyroidism. In differential diagnostics the results of blood chemistry should be taken

into consideration in order to exclude the brown tumour. An increase in the level of calcium

in the serum, alkaline phosphatase and parathormone or a decrease in the level of phosphorus

indicate hyperparathyroidism. Whereas radiological images should be differentiated with:

single bone cyst, odontogenic cysts and granulomas (the non-aggressive form), aneurysmal

cyst, solid ameloblastoma - SMA and odontogenic myxoma (the aggressive form).

In the opinion of the authors of the literature the method of treatment of such tumours

depends on: location, extensiveness and aggressiveness of a lesion and a patient’s age. The

traditional method of CGCG treatment is surgery in the form of lesion curettage or the

resection of the involved bone section with the margin of 0,5 cm of unaffected tissues.

Chuong et al. claim that a large size of the lesion as well as its aggressive character qualify it

exclusively for surgical treatment. Surgical treatment, especially at the developmental age,

entails growth and differentiation of tissues disorders as well as it deforms and disturbs the

functioning of the stomatognathic system.