Reparative Giant Cell Granuloma
This pseudotumorous lesion is particularly observed in the jaws, either under the gengival mucosa (epulid) or in the bone. It can also occur in the skull and in other skeletal regions, particularly the small tubular bones of the hand.
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This pseudotumorous lesion is particularly observed in the jaws, either under the gengival mucosa (epulid) or in the bone. It can also occur in the skull and in other skeletal regions, particularly the small tubular bones of the hand. The lesion is rare, there is predilection for the female sex and the age below 30 years. Rarely, there is indication of trauma in the clinical history, and occasionally the lesion progressed during pregnancy. Symptoms include moderate pain and swelling. In the extragnathic localizations, imaging shows an osteolytic lesion of small to moderate size, mostly localized in the meta-epiphysis. Osteolysis tends to be eccentric but, in the small tubular bones, it easily involves the entire cross-section of the bone. The limits are more or less well defined but a rind of perilesional sclerosis is not prominent. The cortex may be thinned, slightly expanded, occasionally breached with some extension of the lesion in the soft tissues. The lesion may show a tenuous "ground glass" radiodensity.
49%
0-9
1 0 · 19 20- 29 30 -39 40 - 49 50 - 59 60- 69 AGE
Fig. 56-1. Sex, age and localization in 51 cases of reparative giant cell granuloma (including 20 cases of "solid" aneurysmal bone cyst). M. Campanacci, Bone and Soft Tissue Tumors © Springer-Verlag Wien 1999
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TUMORLIKE LESIONS OF BONE Fig. 56-2. Giant cell reparative granuloma, in a male aged 22 years. The lesion recurred after curettage, was then marginally resected and was cured after 5 years.
Histologically, the pathologic tissue is fairly cellular, with spindle-shaped histiofibroblasts, numerous multinucleated giant cells, areas of hemorrhage, and sparse inflammatory mononuclear cells. There is osteoid and immature bone production. Despite the fact that proliferation may appear to be lively, with the presence of typical mitotic figures, the general features suggest a repair or hyperplastic process, rather than a neoplasm. Histological differential diagnosis particularly involves the giant cell tumor (less fibroblastic, more diffused and large multinucleated giant cells, less production of osteoid), aneurysmal bone cyst, and brown tumors of primary hyperparathyroidism. Serum calcium,
Fig. 56-3. Giant cell reparative granulomas. a) In a female aged 17 years. The lesion was cured 3 years after curettage and bone grafting. b) In a female aged 32 years. The lesion was cured 2 years after curettage and bone grafting.
REPARATIVE GIANT CELL GRANULOMA
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Fig. 56-4. Giant cell reparative granuloma. a) Richly cellular area. b) Production of osteoid. c, d) Production of immature bone (Hemat.-eos., 125, 125, 125, 125 x).
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TUMORLIKE LESIONS OF BONE
Fig. 56-5. Giant cell reparative granuloma. a) Focally abundant giant cells. b) Cystic-hemorrhagic cavities similar to aneurysmal bone cyst. (Hemat.-eos., 125, SOx).
phosphates and parathormone levels should be measured. More easy, even because aided by the clinico-imaging features, is the differential diagnosis with histiocytic fibroma, fibrous dysplasia, chondroblastoma, osteoblastoma, and
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