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      Aspectos radiológicos e epidemiológicos do granuloma central de células gigantes Translated title: Radiological and epidemiological aspects of central giant cell granuloma

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          Abstract

          OBJETIVO: Este estudo teve como objetivo avaliar os principais aspectos radiográficos e epidemiológicos das lesões de células gigantes (granulomas centrais de células gigantes e tumores marrons do hiperparatireoidismo). MATERIAIS E MÉTODOS: A amostra consistiu de 26 lesões de células gigantes diagnosticadas em 22 pacientes divididos em dois grupos, um deles composto por 17 pacientes que não tinham hiperparatireoidismo (grupo A) e o outro formado por cinco pacientes portadores de tal distúrbio (grupo B). RESULTADOS: O sexo feminino (72,7%) foi o mais acometido. As lesões ocorreram mais freqüentemente na segunda década de vida, com média de idade de 27 anos. A mandíbula (61,5%) foi o arco mais envolvido. Radiograficamente, 57,7% das lesões eram multiloculares e 42,3% eram uniloculares com limites definidos. Todas as 26 lesões provocaram expansão óssea, 15,4% produziram reabsorção radicular, 50% causaram deslocamento dentário e 11,5% produziram dor. Na mandíbula, 18,7% das lesões cruzavam a linha média. O grupo A apresentou 66,7% das lesões na mandíbula e o grupo B mostrou igualdade na distribuição das lesões entre os arcos. O grupo A apresentou 66,7% das lesões multiloculares e 33,3%, uniloculares. O grupo B apresentou 62,5% das lesões uniloculares e 37,5%, multiloculares. CONCLUSÃO: As lesões de células gigantes podem manifestar-se, radiograficamente, com um amplo espectro, desde pequenas lesões uniloculares de crescimento lento até extensas lesões multiloculares. Elas apresentam características de benignidade, embora algumas lesões possam demonstrar um comportamento localmente agressivo.

          Translated abstract

          OBJECTIVE: The present study was aimed at evaluating main radiological and epidemiological aspects of giant cell lesions (central giant cell granuloma and brown tumors of hyperparathyroidism). MATERIALS AND METHODS: The sample consisted of 26 giant cell lesions diagnosed in 22 patients divided into two groups, one of them including 17 patients who were not affected by hyperparathyroidism (group A) and another including five patients with such a disorder (group B). RESULTS: Prevalence was higher in female patients (72.7%). Most frequently, lesions occurred more in the second decade of life (mean age, 27 years). The mandible arc was most frequently involved (61.5%). Radiographically, 57.7% of lesions were multilocular and 42.3% were unilocular with defined limits. All of the 26 lesions caused expansion of bone, 15.4% radicular resorption, 50% dental displacement, and 11.5% produced pain. In the mandible 18.7% of the lesions crossed the midline. Group A showed 66.7% of lesions in the mandible and group B showed an even distribution of lesions between arches. In group A 66.7% of lesions were multilocular, and 33.3% unilocular; in group B 62.5% were unilocular, and 37.5% multilocular. CONCLUSION: Giant cells lesions may present themselves with a wide spectrum, from small, slow-growing unilocular lesions to extensive multilocular lesions. They present features of benignity, though some lesions may demonstrate a locally aggressive behavior.

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          Most cited references29

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          Odontogenic cysts, odontogenic tumors, fibroosseous, and giant cell lesions of the jaws.

          J Regezi (2002)
          Odontogenic cysts that can be problematic because of recurrence and/or aggressive growth include odontogenic keratocyst (OKC), calcifying odontogenic cyst, and the recently described glandular odontogenic cyst. The OKC has significant growth capacity and recurrence potential and is occasionally indicative of the nevoid basal cell carcinoma syndrome. There is also an orthokeratinized variant, the orthokeratinized odontogenic cyst, which is less aggressive and is not syndrome associated. Ghost cell keratinization, which typifies the calcifying odontogenic cyst, can be seen in solid lesions that have now been designated odontogenic ghost cell tumor. The glandular odontogenic cyst contains mucous cells and ductlike structures that may mimic central mucoepidermoid carcinoma. Several odontogenic tumors may provide diagnostic challenges, particularly the cystic ameloblastoma. Identification of this frequently underdiagnosed cystic tumor often comes after one or more recurrences and a destructive course. Other difficult lesions include malignant ameloblastomas, calcifying epithelial odontogenic tumor, squamous odontogenic tumor, and clear-cell odontogenic tumor. Histologic identification of myxofibrous lesions of the jaws (odontogenic myxoma, odontogenic fibroma, desmoplastic fibroma) is necessary to avoid the diagnostic pitfall of overdiagnosis of similar-appearing follicular sacs and dental pulps. Fibroosseous lesions of the jaws show considerable microscopic overlap and include fibrous dysplasia, ossifying fibroma, periapical cementoosseous dysplasia, and low-grade chronic osteomyelitis. The term fibrous dysplasia is probably overused in general practice and should be reserved for the rare lesion that presents as a large, expansile, diffuse opacity of children and young adults. The need to use clinicopathologic correlation in assessing these lesions is of particular importance. Central giant cell granuloma is a relatively common jaw lesion of young adults that has an unpredictable behavior. Microscopic diagnosis is relatively straightforward; however, this lesion continues to be somewhat controversial because of its disputed classification (reactive versus neoplastic) and because of its management (surgical versus. medical). Its relationship to giant cell tumor of long bone remains undetermined.
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            Giant-cell reparative granuloma, traumatic bone cyst, and fibrous (fibro-oseous) dysplasia of the jawbones.

            Dena Jaffe (1952)
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              Brown tumour of hyperparathyroidism in the mandible associated with atypical parathyroid adenoma.

              The brown tumour of hyperparathyroidism is a localized bone tumour and an uncommon manifestation of hyperparathyroidism. A 27-year-old woman presented with a mandibular 8 x 10 cm solid mass diagnosed as central giant cell granuloma. Chemical blood analysis revealed increased serum calcium levels of 12.46 mg/dL and the parathyroid hormone level was 124 pg/dL. The patient underwent surgery with removal of a parathyroid mass. Histologically, this parathyroid tissue was seen to be limited by a fibrous capsule with morphological features consistent with atypical parathyroid adenoma. The mandibular tumour has receded and the patient declined further procedures. This is the first case reported of brown tumour as the primary manifestation of an atypical parathyroid adenoma, a lesion that shares some features with parathyroid carcinoma without the unequivocal properties of malignancy.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rb
                Radiologia Brasileira
                Radiol Bras
                Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (São Paulo )
                1678-7099
                June 2007
                : 40
                : 3
                : 167-171
                Affiliations
                [1 ] Universidade Federal do Rio de Janeiro
                [2 ] Universidade do Estado do Rio de Janeiro Brasil
                [3 ] Universidade Federal Fluminense Brazil
                [4 ] Centre NHS Trust Inglaterra
                [5 ] Harvard Medical School
                Article
                S0100-39842007000300007
                10.1590/S0100-39842007000300007
                906233bd-5b12-496d-b787-8c02eba231ac

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0100-3984&lng=en
                Categories
                RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

                Radiology & Imaging
                Central giant cell granuloma,Radiological aspects,Brown tumor,Hyperparathyroidism,Granuloma central de células gigantes,Aspectos radiológicos,Tumor marrom,Hiperparatireoidismo

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