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Oral Pathology - 16 - Giant Cell Lesions

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Oral Pathology1

Table Of Contents

Disease Categories and Classifications2

  • Developmental Conditions
  • Mucosal Lesions—Reactive
  • Mucosal Lesions—Infections
  • Mucosal Lesions—Immunologic Diseases
  • Mucosal Lesions—Premalignant
  • Mucosal Lesions—Malignant
  • CT Tumors—Benign
  • CT Tumors—Malignant
  • Salivary Gland Diseases—Reactive
  • Salivary Gland Diseases—Benign
  • Salivary Gland Diseases—Malignant
  • Lymphoid Neoplasms
  • Odontogenic Cysts
  • Odontogenic Tumors
  • Bone Lesions—Fibro-Osseous
  • Bone Lesions—Giant Cell
  • Bone Lesions—Inflammatory
  • Bone Lesions—Malignant
  • Hereditary Conditions

Bone Lesions And Giant Cell Conditions

Histological Feature

The lesions in this category are characterized microscopically by the presence of multinucleated giant cells, which is a key diagnostic factor for board examinations.

Central Giant Cell Granuloma

Clinical and Histological Features3

  • Composed of fibroblasts and multinucleated giant cells
  • Anterior mandible is the favored location
    • Radiographic appearance is not pathognomonic; a biopsy is required to confirm the presence of multinucleated giant cells for a definitive diagnosis.

Classification and Presentation

  • Central (CGCG): Occurs within bone; presents as a radiolucency with thin wispy septations
  • Peripheral: Occurs on the gum; presents as a red-purple gingival mass - Does not show a lesion on a radiograph.

Treatment

  • Excision

Aneurysmal Bone Cyst

Clinical Characteristics4

  • Pseudocyst composed of blood-filled spaces
    • Lacks an epithelial lining; it is a vascular bone cavity filled with blood.
  • Presents as a multilocular radiolucency
  • Expansile in nature
  • Posterior mandible is the favored location
    • Diagnosis: An aspirational biopsy (fine needle aspiration) is typically the first diagnostic step, which reveals a blood-filled space.

Treatment

  • Excision

Hyperparathyroidism

Pathophysiology5

  • Causes multiple bone lesions (resembling CGCGs) resulting from excessive levels of parathyroid hormone
  • Brown tumor: Result of excess osteoclast activity
  • Elevated alkaline phosphatase: Caused by excessive breakdown of bone - Alkaline phosphatase is an enzyme involved in the bone apposition and resorption pathway.

Associated Conditions

  • Von Recklinghausen’s disease of bone: The result of this condition (distinct from von Recklinghausen’s disease/neurofibromatosis)

Cherubism

Genetic and Clinical Presentation6

  • Autosomal dominant inheritance
  • Characterized by symmetrical bilateral swelling
  • Presents as expansile bilateral multilocular radiolucencies

Differential Diagnosis

While fibrous dysplasia can cause facial deformities, cherubism is distinct because it is bilateral and symmetric, whereas fibrous dysplasia is usually asymmetrical and radiopaque.

Progression

  • Condition stops growing after puberty

Langerhans Cell Disease

Disease Overview7

  • Also known as idiopathic histiocytosis
  • Classified as a rare type of cancer
  • Involves Langerhans cells (histiocytes), which are normally antigen-presenting cells in the skin but cause damage when accumulating in specific body parts

Radiographic Features

  • Discrete punched out “ice cream scoop” radiolucencies
  • Leads to the clinical appearance of “floating teeth”
    • The appearance of "floating teeth" is considered almost pathognomonic for this condition.

Treatment

  • Excision, radiation, and chemotherapy

Paget Disease Of Bone

Clinical Presentation8

  • Progressive metabolic disturbance affecting multiple bones (spine, femur, skull, jaws)
  • Causes symmetrical enlargement of affected areas
  • Typically affects adults older than 50
  • Patients may report that dentures and hats become too tight

Diagnostic Indicators

  • Elevated alkaline phosphatase: Due to active bone breakdown
  • Cotton wool appearance: Characteristic radiographic feature - Pathognomonic feature where the bone looks like pieces of cotton rather than having normal trabeculations.

Treatment

  • Bisphosphonates and calcitonin
    • Bisphosphonates are used to interrupt osteoclast activity.

Footnotes

  1. Original PDF page 1: Oral Pathology - 16 - Giant Cell Lesions, p.1 ↩

  2. Original PDF page 2: Oral Pathology - 16 - Giant Cell Lesions, p.2 ↩

  3. Original PDF page 3: Oral Pathology - 16 - Giant Cell Lesions, p.3 ↩

  4. Original PDF page 4: Oral Pathology - 16 - Giant Cell Lesions, p.4 ↩

  5. Original PDF page 5: Oral Pathology - 16 - Giant Cell Lesions, p.5 ↩

  6. Original PDF page 6: Oral Pathology - 16 - Giant Cell Lesions, p.6 ↩

  7. Original PDF page 7: Oral Pathology - 16 - Giant Cell Lesions, p.7 ↩

  8. Original PDF page 8: Oral Pathology - 16 - Giant Cell Lesions, p.8 ↩

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