Surgical treatment and reconstruction of central giant cell granuloma (CGCG) of mandible of aggressive behaviour – case report and literature review

Introduction Central giant cell granuloma (CGCG) is a benign tumor-like lesion of a bone, mainly localized in mandible. It usually occurs in children and young adults under 30 y.o., predominantly in females. The etiology of the disease remains unknown. Clinically, two different types of CGCG have been distinguished – an unaggressive one, in which the granuloma grows slowly, often asymptomatically, and aggressive type which is characteristic for increased bone destruction, severe pain, large size, rapid growth, high recurrence rate and complications such as root resorption, tooth displacement or cortical bone perforation. The treatment of CGCG depends on its type. In cases of granulomas of aggressive behaviour the following therapeutic procedures have been proposed: intralesial corticosteroid injections, interferon and calcitonin therapy as well as immunotherapy with anti-bone resorptive human monoclonal antibody like denosumab. However, in most cases nonsurgical management remains insufficient. Also, local curettage of the lesion results in high risk of recurrence. Therefore, radical surgical resection, commonly combined with bone reconstruction, is the most recommended way of treatment for aggressive of CGCG. Case report The authors present a case of a 31-year-old female patient treated at the Department of Oncological and Reconstructive Surgery, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology in Gliwice due to central giant cell granuloma of a mandible. The resection of CGCG localized in mandible on the right side together with fibular free flap reconstruction has been performed, with satisfactory aesthetic effect. Positive staining for CD68 and CD31 was found in immunohistochemic examination and expression of Ki67 marker was 13%. No complications were reported in the postoperative period. The six-month follow up revealed no recurrences. Conclusions The authors claim that radical surgical management should be performed in all patients with CGCG of aggressive behaviour. Fibular free flap is recommended for reconstruction in large bone defects. It results in tumor-free margins at the resection and satisfactory cosmetic outcome. Quality of life and facial appearance can be improved with dental implantation after certain disease-free period. A regular follow-up is essential as an element of holistic oncological process.