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      Combination therapies for the treatment of recurrent central giant cell lesion in the maxilla: a case report

      case-report

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          Abstract

          Background

          Central giant cell lesion is a non-neoplastic proliferation, usually asymptomatic, of unknown etiology. The purpose of this case report is to report the diagnosis and the treatment of a recurrent central giant cell lesion in the maxilla.

          Case presentation

          A 31-year-old Brazilian woman presented to our Surgery Service for evaluation of a cystic lesion in her teeth 13 and 15, although she had previously received endodontic treatment for her teeth 13 and 15 without regression of the lesion. On clinical examination, an increase and painless swelling was observed in her right jaw. An excisional biopsy of the lesion was performed under general anesthesia; the material was sent for pathological examination and a diagnosis compatible with central giant cell lesion was made. She presented again, 10 months after the removal of the lesion, with a recurrent lesion that surrounded her incisors, canine, and right premolar. We suggested that she underwent treatment with intralesional corticosteroids injection. The lesion was significantly reduced and the remainder of the lesion was enucleated. She is monitored at 3-month intervals; at 6 months postoperatively there has been no recurrence.

          Conclusions

          Central giant cell lesion can have a high degree of invasiveness, which increases the importance of early diagnosis. Combination therapies can provide a favorable prognosis. Periodic monitoring is recommended, thus avoiding the chance of a relapse.

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          Most cited references16

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          Central giant cell granuloma of the mandibular condyle: a case report and review of the literature.

          Central giant cell granuloma (CGCG) is a benign intraosseous lesion. The true nature of this lesion is controversial and remains unknown; the three competing theories are that it could be a reactive lesion, a developmental anomaly or a benign neoplasm. Furthermore, the actual aetiology of CGCG is still unclear, although inflammation, haemorrhage and local trauma have all been suggested; it has also been hypothesized that CGCG may have a genetic aetiology. Lesions central to the mandibular condylar head are very rare, with only three documented cases in the English language literature, none of which elaborates on the CT features. In this case report, a 31-year-old male patient complaining of a left pre-auricular mass underwent radiographic investigation. CT images revealed a lesion central to the mandibular condyle and demonstrated features that were highly suggestive of CGCG. The patient underwent surgical curettage, and the subsequent histopathological examination confirmed the diagnosis of CGCG. 3 years after the procedure the patient presented with a recurrence and underwent complete resection of the mandibular condyle with immediate reconstruction. This report presents CT characteristics of a rare occurrence of CGCG of the mandibular condyle, compares it with other published cases and poses the question of the role of radiology in predicting the degree of aggressive behaviour of these lesions before surgery.
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            Central giant cell granuloma of the anterior maxilla.

            Central giant cell granuloma (CGCG) formerly called giant cell reparative granuloma is a non-neoplastic proliferative lesion of unknown etiology. It occurs most commonly in the mandible. The case reported here resembled a wide variety of conditions that led to a misdiagnosis both on clinical and radiographic examination but was histopathologically diagnosed as CGCG. We describe a case of central giant cell granuloma arising from the anterior maxilla to highlight to the general dental practitioner the importance of histopathology in the diagnosis of this enigmatic lesion.
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              Glucocorticoid and calcitonin receptor expression in central giant cell lesions: implications for therapy.

              Central giant cell lesion is an uncommon benign jaw lesion, with uncertain aetiology, and variable clinical behaviour. Studies of molecular markers may help to understand the nature and behaviour of this lesion, and eventually may represent a target for pharmacological approaches to treatment. The aim of this study was to analyse the expression of glucocorticoid and calcitonin receptors in central giant cell lesions before and after treatment with intralesional steroid. Paraffin-embedded blocks from patients who underwent treatment with intralesional triamcinolone hexacetonide injections were stained immunohistochemically. Biological material from patients who underwent a surgical procedure after treatment were tested immunohistochemically. 18 cases (9 aggressive and 9 non-aggressive) were included. The difference in calcitonin receptor expression was not statistically significant between the aggressive and non-aggressive lesions and between the patients with a good response and those with a moderate/negative response to treatment. Glucocorticoid receptor expression in the multinucleated giant cells was higher in patients with a good response. It can be postulated that immunohistochemical staining for glucocorticoid receptors may provide a tool for selecting the therapeutic strategy. An H-score greater than 48 for glucocorticoid receptors in multinucleated giant cells predicted a good response in this study. Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                jeff.odontoup@gmail.com
                ferolivete@hotmail.com
                nay.danyele@gmail.com
                afgiovaninni@gmail.com
                jzielak2@gmail.com
                lekluppel@hotmail.com
                rafaela_scariot@yahoo.com.br
                Journal
                J Med Case Rep
                J Med Case Rep
                Journal of Medical Case Reports
                BioMed Central (London )
                1752-1947
                20 March 2017
                20 March 2017
                2017
                : 11
                : 74
                Affiliations
                ISNI 0000 0004 0388 207X, GRID grid.412402.1, , Universidade Positivo, ; 5300 Prof. Pedro Viriato Parigot de Souza St., Campo Comprido, Curitiba, PR 81280-330 Brazil
                Article
                1173
                10.1186/s13256-016-1173-3
                5357802
                0d79096f-4072-4687-af25-fe8817d46994
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 6 December 2015
                : 7 December 2016
                Categories
                Case Report
                Custom metadata
                © The Author(s) 2017

                Medicine
                central giant cell lesion,combination therapies,treatment,diagnosis
                Medicine
                central giant cell lesion, combination therapies, treatment, diagnosis

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