oral radiology seminar.pptx

8/10/2019 Oral radiology seminar.pptx

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Other bone diseases.(Central giant cell granuloma, Aneurysmal bone cyst)

Chapter 23/part 3.

By :Minas Salah



Other lesions of the bone.

Central giant cell granuloma (CGCG):

Synonyms: giant cell reparative granuloma, giant celllesion, giant cell tumor.

Mechanism: reactive lesion to an unknown yet stimulusor a neoplastic lesion (debate).

Imaging characteristics: similar to that of benign tumors,maxillary lesions have some aggressive malignant typecharacteristics (ill-defined borders)



Clinical features:

• common lesion in the jaws

• mostly affecting adolescents & young adults

(60% of cases occur < 20 years)

• most common sign is painless swelling

• may elicit tenderness on palpation

•

overlying mucosa purple• sometimes no symptoms

• usually slow growth.



Imaging features:

1-location:• Mx : Mn 1:2

• in first 2 decades epicenter anterior to first molarin Mn and anterior to cuspids in Mx

• older individual greater frequency in posterioraspect.

2-Periphery:

• well-defined in Mn

• no cortication

• ill-defined in Mx (almost malignant appearingboarders).



3-Internal structure:

• some show no evidence of internal structure

(especially small lesions),



• Others show subtle granular pattern of

calcification organized into ill-defined wispysepta.



• Septa are characteristic of the lesion especially

if they are at right angles from the periphery

and if a small indentation of the expandedcortical margin is seen at the point where the

right angled septa originated this becomes a

stronger characteristic of CGCG.



4-effect on surrounding structure:

•

displaces and resorbs teeth• missing lamina dura

• ID canal displaced inferiorly

• strong propensity to expand the corticalboundaries of Mx & Mn.



• Differential diagnosis:

1- if internal structure contains septa then DD includes• Ameloblastoma

• odontogenic myxoma

• aneurysmal bone cyst (ABC)

• Simple bone cyst

• Brown tumors of hyperparathyroidism

• Cherubism.

2- if granular internal structure present then DDincludes

• ossifying fibroma.



disease differentiating feature

ameloblastoma Older age group

Posterior Mn

Coarse curved, well defined trabeculae.

Odontogenic myxoma Older age group

Sharper straight septa

Don’t have the same propensity to expand.

Aneurysmal bone cyst Rare lesion

More often in the posterior aspect

Usually cause profound expansion.

Cherubisum Lesions are multiple

Epicenters located most posterior of Mx

and Mn.



• Management: CT scan (establish extent and

involvement), if in second decade of lifehyperparathyroidism should be considered

and test for elevated calcium level.

• Treatment: may include enucleation,curettage, resection of the jaw in some cases.

• recurrence is rare, but if occurs it is more

likely in Mx



Aneurysmal bone cyst (ABC)

Considered a reactive lesion of bone, however

there have been several chromosomal

translocations described that give some

credence to a neoplastic nature of the lesion.



Clinical features:

• 90%of jaw lesions in individuals younger than 30years old

• have a predilection for females

• fairly rapid bony swelling usually buccal or labial

• pain (occasional complaint)

• tender to palpation.

Imaging features:

1-location:• Mn:Mx 3:2

• molar and ramous region more involved thananterior region.



2-periphery and shape:

• well-defined periphery

• circular or hydraulic shape.

3-internal structure:

• small initial lesion shows no evidence ofinternal structure

• often the internal aspect has a multilocular

appearance• wispy ill-defined septa and at right angle to

the outer expanded border (as in CGCG).



4-effect on surrounding structure: can

displace and resorb teeth.



• Differential diagnosis:

• CGCG

• Amelobastoma

•

CherubismDiagnosis is based on biopsy, a hemorrhagic

aspirate favors diagnosis of ABC. CT scan will

determine the extent of the lesion.



disease Feature similar to ABC Differentiating feature

CGCG Internal granular septa Expand to a lesser degree

Ameloblastoma Expansion to the same

degree in posterior

mandible

Older age

cherubism Giant cell like feature Multifocal bilateral



• Management: surgical curettage and partial

resection.

• Recurrence rate is from 19% to about 50%

after curettage and approximately 11% after

resection.



• reference: oral radiology principles and

interpretations 7th edition by Stuart C. White

and Michael J. Pharoah.



THE END.

oral radiology seminar.pptx

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