Central Giant Cell Granuloma of the Mandible and Maxilla; A Clinicopathological Study of 21 Cases

Abstract Background Central giant cell granuloma (CGCG) is an intraosseous, locally invasive, rare non- neoplastic lesion. Histologically, CGCG is characterized by aggregates of multinucleated giant cells, in a background of hemorrhage and reactive fibrous tissue, infiltrating between the eroded bone trabeculae. As an idiopathic non- neoplastic proliferative lesion, CGCG was first described by Jaffe in 1953. Although intraosseous hemorrhages or trauma are possible mechanisms, still the lesion is of unknown histogenesis and etiology. The mandible is a common location of involvement, and CGCG manifest as unilocular or multilocular radiolucent lesion on X rays. Children and young adults are the population most affected, with slight female preponderance. Methods and Materials: A total of 21 cases of CGCG were diagnosed at the oral pathology/pathology department in Temple University Hospital from 2015–2022. All the cases were evaluated retrospectively by studying the following parameters, age, gender, symptoms, radiographic findings, clinical differential diagnosis and the histological confirmation of the cases as central giant cell granulomas. X- Ray of the mandible and maxilla were the main radiographic technique utilized to help establishing the diagnosis. The paraffin embedded tissue was cut at 5um thickness sections and stained by routine H&E stain. No special histochemical or immunohistochemical stains were used. Results Of the total of 21 cases, nine were males and eleven were females, while a single case was of unknown gender. Age range was 15–76 years, with a mean of 50 years. The mandible was the most common location of involvement (17; 81%), and maxilla was affected less commonly (4 cases; 19%). Many of the CGCG lesions were asymptomatic (13; 62%); eight cases (38%) were symptomatic, and the main manifestations were pain, and fullness of the affected dental region. In a minority of cases, brown tumor (severe hyperparathyroidism) and odontogenic neoplasms, such as ameloblastoma, were suspected clinically and radiographically. The diagnosis of central giant cell granuloma with associated acute and chronic inflammation was confirmed in all the cases. Histological evaluation of the H&E-stained sections was the main diagnostic tool utilized. No special stains or molecular studies were required to establish the final diagnosis. Discussion We have concluded that CGCG is non-neoplastic, with aggressive or non-aggressive behavior, predominantly involving the mandible, with rare cases involving the maxilla. No confirmed association with neoplastic lesion was recognized. The lesions followed an indolent clinical course, and some were associated with impacted teeth. CGCG can mimic neoplastic conditions such as ameloblastoma or localized lesion associated with systemic disorders, for instance hyperparathyroidism (brown tumor).