Giant cell tumor of bone - maxilla

Case contributed by Micheál Anthony Breen
Diagnosis certain

Presentation

Presented to his orthodontist with increased mobility of his left upper teeth.

Patient Data

Age: 16 years
Gender: Male

CT of maxilla low dose...

ct

CT of maxilla low dose "cone beam" technique

There is an expansile lucent lesion within the left maxilla, measuring 30 x 29 x 35 mm AP by TR by CC. It is centered between the permanent left upper canine and first premolar with lobulated margins protruding into the floor of the left nasal cavity, left maxillary sinus, and left hard palate where there are areas of either frank osseous deficiency or extremely thin bone. The remaining osseous margins are sharply defined with nonaggressive borders. Lesional attenuation is misleading on cone beam CT though there is some suggestion that the lesion is more solid than cystic; no discrete lesional calcification/matrix. 

Case Discussion

Moderate sized lucent lesion within the left maxilla, splaying apart the left permanent canine and first premolar with protrusion into adjacent structures (left nasal cavity, left maxillary sinus, and left hard palate). There is limited characterization of this lesion by cone beam CT, but the appearance is suggestive of a benign neoplasm (solid) or cyst: giant cell granuloma, adenomatoid odontogenic tumor, keratocystic odontogenic tumor, Langerhans cell histiocytosis, simple bone cyst, and aneurysmal bone cyst are among the differential considerations. Definitive diagnosis will require biopsy, but preoperative MRI could provide further tissue characterization if indicated.

Subsequent biopsy confirmed the lesion to be a giant cell tumor and the lesion was treated with surgical enucleation.

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