NAME-AASTHA

CATEGORY-UG (INTERN)
REGISTRATION NO.-102
 HYBRID LESIONS
COMPRISING CENTRAL
GIANT CELL GRANULOMA
AND FIBROUS
DYSPLASIA:A DIAGNOSITC
CHALLENGE FOR
PATHOLOGIST
 INTRODUCTION

 HYBRID LESIONS: Lesions with features from various pathologies.

 This case has two kinds of different lesions, one is FD and another one is CGCG.
 Till now only nine cases of hybrid lesion comprising of CGCG with fibro-osseous
component have been reported in the literature. .
 Hybrid lesions comprised of both giant cell and fibro-osseous components are rare,
may be due to negligence of the pathologists in diagnosing the cases by considering
only one prominent histopathological feature.
 So even surgeons may end up treating the lesions inadequately or patients may need
to undergo multiple surgeries.
.
 The purpose of this paper is to report a case of FD associated with CGCG and discus the
clinical,imaging and histopathological features of hybrid lesions.
 This case has been published in ‘PUBMED INDEXED’ journal of oral and maxillofacial
pathology [2015 Sep- Dec;19(3):408. DOI : 10.103/097-029X.174631]
 CASE REPORT

 A 33 year old male

 Painless enlargement
 Left side of mandible
 Since 5 years.
 Patient gives the history of surgical recontouring of the lesions 2 year back
 With a histopathological diagnosis of fibroosseous lesions,
 The growth reoccurred again attained the present size.
On Extra oral examination
 Left posterior region of the mandible
 Hard, non tender, swelling with overlying normal skin.
On Intra oral examination,
 Swelling extending from to 33 to 37 regions
 4.0cm *2.5 cm in diameter
 Causing slight obliteration of the buccal vestibule
 Overlying mucosa stretched but intact.
The O.P.G. showed a poorly defined lesions extending from 33 region to ramus of the mandible with varying
degree of opacifications having ground glass appearance at few sites.The lower border of mandible was
intact.
PROVSIONAL DIAGNOSIS: Mixed appearance both RADIOLUCENT &
RADIOOPAQUE areas seen which suggested of fibroosseous lesion.
 Routine blood investigations
 Serum examination
 For alkaline phosphtase activity and calcium profile were
performed
 All were within normal limits.
 After investigations, biopsy tissue was taken was sent to
DEPARTMENT OF ORAL PATHOLOGY,LUXMI BAI
INSTITUTE OF HEALTH AND SCIENCES, PATIALA.
ALL THESE FEATURES SUGGESTED OF
“FIBROUS DYSPLASIA ASSOCIATED
WITH CGCG” WHICH REPRESENTS
‘HYBRID LESION’
 TREATMENT

 RECONTOURING AND DEBULKING OF THE LESION WAS

DONE BY SURGEON.
 REPORTED HYBRID LESIONS OF CGCG AND FD
AUTHOR GENDER AGE SITE RADIOGRAPHIC FEATURES HISTOPATHOLOGICAL
DIAGNOSIS

Penfold et al. Male 41 Left maxilla Radioopaque expansion CGCG,Ossifying fibroma

Shetty et al. Female 39 Left mandible Mixed,multilocular expansion CGCG,Cemento-osseous dysplasia

Farzaneh & Pardis Female 20 Right mandible Radioopaque expansion CGCG,Fibrous dyplasia
Kaplan et al. Female 5 Mandible Mixed,unilocular expansion CGCG, ossifying fibroma
Kaplan et al. Male 68 Maxilla Uniocular expansion CGCG,ossifying fibroma
Kaplan et al. Female 12 Mandible Radiolucent,unilocular expansion CGCG,ossifying fibroma
Crusoe-Rebello et Female 38 Left mandible Mixed unilocular expansion CGCG,ossifying fibroma
al.
Geetha et al. Male 9 Left mandible Mixed unilocular expansion CGCG,juvenile ossifying fibroma
Kurra et al. Female 18 Right mandible Radiolucent,multilocular expansion CGCG,fibrous dysplasia

Jawanda et Male 33 Left mandible Poorly defined lesion with CGCG,fibrous dysplasia
al. varying degree of opacifications
 CONCLUSION

 The relationship between FD and CGCG is well established,but the association of

FD with CGCG is still a dilemma.
 Given that the no of reported cases till date is so small that we are unable to
speculate whether the presence of giant cells in both FD and CGCG is a result of
reactive process or a feature of separate lesions or may actualy represent distinct
phases of a single benign morphological process.
 Hence whether FD had developed more centrally and induced an adjacent giant
cell reaction or whether two lesions simply originated independently is open for
debate.
 There is important need to report similar and other such cases ,as we feel
that many cases are surgically managed but unfortunately not reported.
 All such cases should be reported,so that we can increase the literature
bank that will lead to understand the interrelationship between them in a
better way and will farther clarify their biologic behavior.
 THANK YOU
SPECIAL THANKS TO DR.MANVEEN KAUR
JAWANDA ,DR.PRIYA, DR.SUPREET,
DR.SAVJOT FOR THEIR ESTEMEED GUIDANCE
AND GIVING ME OPPURTUNITY TO PRESENT
THS CASE.