Classification
1. Lucas classification
Bony lesions
Giant cell tumors
Central giant cell granuloma
Browns tumor of hyperparathyroidism
Soft tissue lesions
Giant cell epulis
Peripheral giant cell lesions
2. Chattopadyay classification
Type I giant cells are pathognomic
Hodgkins lymphoma, PGCG
Type II giant cells are characteristic but not
pathognomic
TB, HSV, measels
Type III giant cells are associated
Pagets disease, Cherubism, Fibrous dysplasia
Pagets disease
osteitis deformans
3% of adults over 45 yrs of age
Malignant transformation in 1-2% of cases
Etiology :
Benign tumor of osteoclasts
Viral infection paramyxo virus or respiratory
syncytial virus
Clinical features
Deformities of skull, jaw, back pelvis legs
Painless irregular over growth of bones
Initial bone resorption followed by dense sclerotic bony
deposition
Fracture of long bones
Repeated complaints of ill fitting dentures and hats
Narrowing of skull bones neurologic pain
In jaw bones maxilla common leontiasis ossea
Loss of lamina dura and root resorption
Excessive post surgical bleeding and delayed healing after
Xn.
Radiologic features
Stage I osteolytic phase
Massive bone resorption large radioluscent areas
Stage II bone deposition phase
Mixed radiodensity
Stage III sclerotic phase
Cotton wool appearance of the medullary bone between
widened cortical plates
Histologic features
Pagetoid bone pattern
Jig-saw puzzle pattern of bone
Superimposition of resting and reversal lines of bone
Investigations
Serum alkaline phosphatase, urine hydroxyproline raised
Treatment Mainly medicinal
1. Antibiotics Mitramycin i.v
Inhibits osteoclastic activity
2. Bisphosphonates - disphosphonate etidronate
Reduces bone resorption
3. Hormones
Human calcitonin s.c or nasal spray
High dose glucocorticoids intralesional or systemic
4. Cytotoxic agents
Plicamycin, dactinomycin
Giant cell granuloma
First described by Jaffe
Etiology
Benign inflammatory hyperplasia of bone cells
Types
Central
Peripheral
Differential diagnosis
Giant cell tumor
Clinical features
Peripheral: central = 5:1
Peripheral lesions
Exophytic lesions on gingiva
Highly vascular brown colour and bleed profusely
To be differentiated from pyogenic granuloma
Central lesions
Jaw, skull or facial bones
Mandible common anerior to Ist molar and cross midline
Painless expansion of cortical plates
Highly vascular and therefore bleed on biopsy
Radiographic features
Mixed radiodensity with diffuse margins
Histologic features
Resorbed bony cavities with
Multinucleated giant cells in inflammatory
stroma
Numerous capillaries and areas of hge
Increased no. of fibroblasts and collagen fibres
Treatment
Medical
Reduce the size of lesion by reducing resorption
and increasing deposition of bone
Bisphosphonates - intralesional
Calcitonin nasal spray
Corticosteroids intralesional triamcinolone
40mg/ml
Surgical
Complete elimination
Curettage (recurrance 12-37%)
Curettage and cryosurgery of bony walls
Aggressive lesions segmental resection
Cherubism
Etiology exact cause unknown
Hereditary dominant gene
Seen in infants and children below 6 yrs of
age
Self limiting condition - Regress by 12 yrs and
resolve by adulthood
Clinical features massive destruction of alveolar bone
Mandible common
Bilateral painless posterior swelling
Fullness of cheeks
Protruding intra-alveolar masses
Maxilla
bilateral facial chubbiness cherub appearance
looking toward heaven appearance distention of infraorbital
skin
Missing, displaced or impacted teeth
Submandibular lymphadenopathy till 5 yrs of age
Difficulty in mastication, swallowing, speech and
respiration
Radiologic features
Multiple well defined multilocular radioluscencies
teeth floating in cavity appearance
Displaced and impacted teeth
Histologic features
Similar to cgcg more fibrous tissue and less giant cells
Distinct feature perivascular eosinophilic cuffing
Treatment
No active treatment self limiting
Extraction of malposed teeth
Surgical contouring and curettage
Other lesions
Giant cell epulis
Pyogenic granuloma
Browns tumor
Hodgins lymphoma
Aneurysmal bone cyst
Ewings sarcoma
