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 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.
Usually located in the anterior part of the jaw.
Imaging features are generally nonspecific on both CT and MRI 5. It 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 remodelling of the overlying cortex.
History and etymology
It was first described by Jaffe in 1953 4,5.
Treatment and prognosis
Primary resected surgically. Recurrence rates of up to 15% have been reported.
On imaging consider:
- brown tumor (osteitis fibrosa cystica): its appearance both radiologically and histologically is very similar to brown tumors of hyperparathyroidism, however patient demographics (and parathyroid function) make the distinction usually simple
- ameloblastoma 5
- aneurysmal bone cyst 5
- intracranial tumor 7
- 1. Dunfee BL, Sakai O, Pistey R et-al. Radiologic and pathologic characteristics of benign and malignant lesions of the mandible. Radiographics. 26 (6): 1751-68. doi:10.1148/rg.266055189 - Pubmed citation
- 2. Nemoto Y, Inoue Y, Tashiro T et-al. Central giant cell granuloma of the temporal bone. AJNR Am J Neuroradiol. 1995;16 (4): 982-5. AJNR Am J Neuroradiol (abstract) - Pubmed citation
- 3. Fitzpatrick KA, Taljanovic MS, Speer DP et-al. Imaging findings of fibrous dysplasia with histopathologic and intraoperative correlation. AJR Am J Roentgenol. 2004;182 (6): 1389-98. AJR Am J Roentgenol (full text) - Pubmed citation
- 4. Morris JM, Lane JI, Witte RJ et-al. Giant cell reparative granuloma of the nasal cavity. AJNR Am J Neuroradiol. 2004;25 (7): 1263-5. AJNR Am J Neuroradiol (full text) - Pubmed citation
- 5. Nackos JS, Wiggins RH, Harnsberger HR. CT and MR imaging of giant cell granuloma of the craniofacial bones. AJNR Am J Neuroradiol. 2006;27 (8): 1651-3. AJNR Am J Neuroradiol (full text) - Pubmed citation
- 6. Pathology And Genetics of Tumours of the Head And Neck. World Health Organization. ISBN:9283224175. Read it at Google Books - Find it at Amazon
- 7. Ciappetta P, Salvati M, Bernardi C, Raco A, Di Lorenzo N. Giant cell reparative granuloma of the skull base mimicking an intracranial tumor. Case report and review of the literature. (1990) Surgical neurology. 33 (1): 52-6. Pubmed