Central giant cell lesions (granuloma)

Last revised by Travis Fahrenhorst-Jones on 25 Dec 2023

Central giant cell lesions (granulomas), also known as giant cell reparative cysts/granulomas, occurs almost exclusively in the mandible, although cases in the skull and maxilla have been reported.

It is most frequently seen in young women (F:M 2:1) 5 and typically presents in the 2nd and 3rd decades. The lesion accounts for 7% of all benign tumors of the jaw 8.

Imaging alone cannot distinguish central giant cell granuloma from other lesions of the craniofacial bones and therefore definitive diagnosis requires histologic and immunohistochemical analysis 5.

Signs and symptoms at presentation are predominantly dependant on the site of the lesion and degree of mass effect 5. Soft tissue swelling and pain are the most common findings with proptosis, nasal obstruction and cranial nerve palsy being less common 5.

The lesion consists of non-neoplastic vascular tissue, with giant cells and hemosiderin. It is thought to occur as a local reparative inflammatory process likely relating to trauma.

Central giant cell granulomas share similar characteristics histological and immunochemical characteristics with giant cell tumors 5. Differentiation is important as giant cell tumors carry a higher risk of recurrence, metastasis and malignant transformation 5.

Usually located anterior to the first molars of the mandible 8. The maxilla however is less commonly affected with a relative proportion ranging between 2:1 to 11:9 8. Very rarely lesions may appear in other craniofacial bones or the small bones of the hands and feet 5.

Imaging features are generally nonspecific on both CT and MRI 5. The lesion begins as a small lucent region, and gradually as it enlarges thin trabeculae of bone become apparent, giving it a honeycomb multilocular appearance. The lesion may demonstrate expansion, root resorption, and erosion through or remodeling of the overlying cortex.

Some authors believe that cherubism (usually considered a form of fibrous dysplasia) is actually a special form of giant cell reparative granuloma 3.

It was first described by Jaffe in 1953 4,5.

Primary resected surgically. Recurrence rates of up to 15% have been reported.

On imaging consider:

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Cases and figures

  • Case 1
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  • Case 2: maxillary lesion
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  • Case 3: mandibular lesion
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