Multiple Central Giant Cell Granulomas in the mandible - A rare presentation with literature review.

Abstract

Central giant cell granulomas (CGCG) are rare, benign destructive osteolytic lesion of osteoclastic origin with variable aggressiveness that occur in the maxilla and mandible. It has a peak prevalence between the ages of 10 to 25 years old with a clear preponderance for the mandible and female population. CGCG typically presents as a solitary lesion, appearing as a multilocular radiolucency with scalloped margins and a honeycomb or soap bubble like appearance. These lesions are histologically characterised by mononuclear and multinuclear giant cells on a mesenchymal stromal background. First reported by Jaffe the lesion was coined giant cell reparative granuloma; a term no longer used as understanding of the pathogenesis develops. Genetic sequencing has shown familial association and a connection with “RAS/MAPK syndromes” as they are linked by overlapping facial features and are caused by mutations at different points along the RAS/MAPK pathway. Thirty percent of CGCG present as aggressive lesions characterised by rapid growth and bone destruction. The most common treatment is surgical curettage. However, increasing knowledge of the underlying pathogenesis has led to development of non-surgical treatments such as intralesional corticosteroid injections, therapy with calcitonin, interferon and monoclonal antibodies. This paper presents the rare case of an asymptomatic 14-year-old boy with bilateral CGCG which were noted as an incidental finding on a panoramic radiographic as part of an orthodontic assessment. It was treated successfully through surgical curettage.