18.1. CENTRAL GIANT CELL GRANULOMA (GIANT CELL REPARATIVE GRANULOMA)
Central giant cell granuloma is a tumor-like bone lesion localized exclusively in the alveolar process of the upper jaw and the alveolar part of the lower jaw in the form of a limited tumor-like formation on the gum. A similar lesion that develops in the soft tissues of the gums without the involvement of bone tissue is called peripheral giant cell granuloma and is addressed in tumor-like lesions of soft tissues. Both of these lesions used to be applied to giant cell epulis.
Central giant cell granuloma is clinically similar to peripheral granuloma, but differs from it radiographically. Around giant cell granuloma, there is a zone of bone destruction in the form of a rarefaction with clear boundaries and an even contour, against which thin bone septa are sometimes visible and root resorption is possible, or there may be a limited bone defect.
Central giant cell granuloma is microscopically represented by cellular fibrous tissue with multiple foci of hemorrhages, clusters of multinucleated giant cells; hemosiderin can be found in some places. Some authors emphasize that giant cells are of vascular origin; they are not classified as bone structures.
The diagnosis of central giant cell granuloma is established on the basis of the clinical, radiological and morphological picture.
The differential diagnosis is often quite difficult and includes giant cell tumor, cherubism and the brown tumor of hyperparathyroidism, so clinical and radiological manifestations are essential.
The treatment is surgical. In addition to the removal of the lesion within healthy tissues, scraping and drilling of the altered bone is also performed. Relapse is often noted. In such a case, a more radical operation with the removal of mobile teeth in the affected area is performed. Malignancy and metastases in case of central giant cell granuloma are not observed.