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      Granuloma de células gigantes mandibular. Tratamiento de una recidiva y rehabilitación dental: presentación de un caso Translated title: Giant cell granuloma of the jaw. Treatment of a recurrence and dental rehabilitation: a case report

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          Abstract

          RESUMEN El granuloma de células gigantes (GCG) es una patología de etiología no esclarecida que aparece tras traumatismos o procesos inflamatorios. Puede ser asintomático, debutar como una masa de comportamiento inflamatorio o comportarse de forma localmente agresiva. El diagnóstico resulta de la combinación de datos clínicos, radiológicos e histológicos. El tratamiento puede ser quirúrgico, mediante cirugías más o menos extensas, así como médico con diferentes fármacos. Se presenta el caso de un paciente intervenido de un GCG mandibular que acudió a nuestra consulta con una recidiva de la lesión, manejada quirúrgicamente mediante resección segmentaria y reconstrucción con colgajo libre de peroné, añadiendo al tratamiento la rehabilitación dental para realizar un manejo global del caso.

          Translated abstract

          ABSTRACT Giant cell granuloma (GCG) is a pathology of unclear aetiology that appears after trauma or inflammatory processes. It may be asymptomatic, have an early presentation as a mass with inflammatory reaction, or behave in a locally aggressive manner. Diagnosis results from a combination of clinical, radiological and histological data. Treatment can be surgical, with more or less extensive surgery, as well as medical with different drugs. We present the case of a patient who underwent surgery for a mandibular GCG who came to our hospital with a recurrence of the lesion, which was managed surgically by segmental resection and reconstruction with a fibula free flap, adding dental rehabilitation to the treatment for a global management of the case.

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          Most cited references10

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          Central giant cell lesions of the jaws: a clinicopathologic study.

          The biologic behavior of central giant cell lesions of the jaws ranges from quiescent to aggressive with destructive expansion. To date, these variations have not been explained by the findings of routine histologic examination. This retrospective clinicopathologic study of giant cell lesions was performed to search for histologic correlates of biologic behavior. Lesions in 17 patients were classified clinically as nonaggressive (group I) or aggressive (group II). In general, group II lesions affected children at an earlier age, were larger at the time of diagnosis, and recurred more frequently. The following histologic parameters were assessed: fractional surface area occupied by giant cells (FSA), relative size index of giant cells (RSI), stromal characteristics, mitotic index, inflammatory cells, and hemosiderin content. Histologic differences between the two groups were not as clear as the differences in biologic behavior. However, aggressive lesions had a higher RSI, and recurrent giant cells lesions had a higher RSI and FSA; these parameters warrant further study. In addition, electron microscopic differences in a small number of aggressive and nonaggressive lesions were documented.
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            Limited regression of central giant cell granuloma by interferon alpha after failed calcitonin therapy: a report of 2 cases.

            Central giant cell granuloma (CGCG) is a benign lesion of the jaws with a sometimes locally aggressive behaviour. The most common therapy is surgical curettage which has a high recurrence rate, especially in lesions with aggressive signs and symptoms (i.e. pain, paresthesia, root-resorption and rapid growth). Alternative therapies such as interferon alpha (INFalpha) or calcitonin are described in the literature. In this study 2 patients with an aggressive CGCG are presented who were treated with INF mono-therapy. INF mono-therapy was capable of terminating the rapid growth of the lesion in both patients and induced a partial reduction. Total resolution, however, was not obtained and alternative treatment is still necessary.
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              Cellular mechanisms of osteoclast formation and lacunar resorption in giant cell granuloma of the jaw.

              Giant cell granuloma (GCG) is an osteolytic tumour of the jaw which is characterised by the presence of both mononuclear and multinucleated (osteoclast-like) giant cell components. The nature of these component cells and the pathogenesis of the extensive osteolysis associated with this lesion is uncertain. Using cell culture techniques and immunohistochemistry, we defined the phenotypic characteristics of the mononuclear and multinucleated cells present in four cases of GCG of the jaw. We also analysed the cellular and humoral factors associated with osteoclast formation and osteolysis in these tumours and determined whether GCG stromal cells are capable of supporting osteoclast formation. GCG-derived giant cells expressed the phenotypic characteristics of osteoclasts (TRAP+, VNR+, and calcitonin responsive) and were capable of lacunar resorption. In addition to macrophages, the mononuclear cell population contained numerous spindle-shaped stromal cells which proliferated in culture and expressed RANKL; these GCG-stromal cells were capable of supporting human osteoclast formation from circulating monocyte precursors. Our findings indicate that the giant cells in GCG of the jaw are osteoclast-like and formed from monocyte/macrophage precursors which differentiate into osteoclasts under the influence of RANKL-expressing mononuclear stromal cells found in this lesion.
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                Author and article information

                Journal
                maxi
                Revista Española de Cirugía Oral y Maxilofacial
                Rev Esp Cirug Oral y Maxilofac
                Sociedad Española de Cirugía Oral y Maxilofacial y de Cabeza y Cuello (Madrid, Madrid, Spain )
                1130-0558
                2173-9161
                June 2022
                : 44
                : 2
                : 87-91
                Affiliations
                [1] Madrid orgnameHospital Universitario La Princesa orgdiv1Servicio de Cirugía Oral y Maxilofacial España
                Article
                S1130-05582022000200087 S1130-0558(22)04400200087
                10.20986/recom.2022.1325/2021
                f17794e9-e57f-439b-af80-14a29e3571d9

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 23 June 2022
                : 20 November 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 5
                Product

                SciELO Spain

                Categories
                Casos Clínicos

                fibula graft,mandible,Giant cell granuloma,injerto de peroné,Granuloma de células gigantes,rehabilitación dental,mandíbula,dental rehabilitation

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