British Journal of Oral and Maxillofacial Surgery (2005) 43, 74—76

SHORT COMMUNICATION

Treatment of a central giant cell granuloma with

intralesional corticosteroid
Evandro Neves Abdo∗, Luiz César Fonseca Alves, Alessandra Sabrina
Rodrigues, Ricardo Alves Mesquita, Ricardo Santiago Gomez

Department of Oral Surgery and Pathology, Faculty of Odontologia, School of Dentistry, Federal
University of Minas Gerais, Av.: Antônio Carlos, 6627 sala 3204, Belo Horizonte,
MG, CEP 31270901, Brazil

Accepted 9 August 2004

KEYWORDS
Summary A recurrent central giant cell granuloma in a 14-year-old girl in the
Cortiosteroid;
anterior region of the mandible was treated successfully by intralesional injection
Giant cell granuloma; of corticosteroid.
Giant cell tumour; © 2004 The British Association of Oral and Maxillofacial Surgeons. Published by
Jaw tumour; Elsevier Ltd. All rights reserved.
Treatment

Introduction Case report

A central giant cell granuloma is an intraosseous
lesion consisting of cellular fibrous tissue that
contains multiple foci of haemorrhage, aggrega-
tions of multinucleated giant cells, and occasion-
ally trabeculae of woven bone. It occurs most
commonly in the anterior part of the mandible
and in women who are less than 30 years of
age.1
The treatment of includes curettage or resec-
tion of the lesion.2 Harris3 used systemic injections
of calcitonin and others have reported intralesional
injections of corticosteroids, both with successful
results.4,5
* Corresponding author. Fax: +55 31 34992472.
E-mail address: enabdo@bol.com.br (E.N. Abdo).
A 14-year-old girl was referred to us with a swelling
in the mandible that had been present for the past
2 months. We found a firm intraoral swelling at the
left symphyseal area (Fig. 1A). Panoramic radio-
graph showed a well-delineated, unilocular radiolu-
cent area extending from the left central incisor to
the left second premolar (Fig. 1B). The teeth at the
site of the lesion were vital.
We did an incisional biopsy and histological ex-
amination showed multiple multinucleated giant
cells together with ovoid to spindle-shaped cells. A
diagnosis of central giant cell granuloma was made
(Fig. 1C).
Assays of parathyroid hormone, calcium and
phosphorus were within reference ranges. Under
local anaesthesia we curetted the lesion. After 38
days a new swelling appeared. A fine needle as-

0266-4356/$ — see front matter © 2004 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2004.08.015
Treatment of a central giant cell granuloma 75

Figure 1. (A) Intraoral view shows a swelling extending from the left first incisor to second premolar. (B) Panoramic
radiograph shows a well-delineated, unilocular radiolucent lesion extending from left central incisor to second premo-
lar. (C) Histological features of the central giant cell granuloma in the incisional biopsy specimen show multinucleated
giant cells and ovoid to spindle-shaped cells (haematoxylin and eosin, original magnification ×200). (D) Cytological
features of the central giant cell granuloma in the fine needle aspiration biopsy specimen show multinucleated giant
cells (haematoxylin and eosin, original magnification ×400). (E) Panoramic radiograph shows complete resolution and
eruption of the second premolar within 18 months treatment.

piration biopsy confirmed the diagnosis of recur-
rent giant cell granuloma (Fig. 1D). A course of in-
tralesional corticosteroid injections was discussed
and accepted by the patient’s parents. We gave in-
jections with a needle 0.5 mm in diameter once a
week for three weeks. Panoramic radiograph after
two months showed a reduction in the radiolucent
area and the swelling had disappeared. There was a
small radiolucent area still present near the left ca-
nine and we gave an additional injection. Although
the injections became progressively more difficult,
the last injection was still possible. The patient was
followed up for 18 months and we noted that the
left second premolar erupted normally and there
was no recurrence of the lesion (Fig. 1E).
Discussion
The multinucleated cells in giant cell granuloma
are osteoclasts.6 As corticosteroids inhibit osteo-
clasts in marrow cultures and in conditions of ab-
sorption of bone by increasing apoptosis, their use
for giant cell granuloma has been advocated.7,8 Bio-
phosphonates have been used to treat giant cell
tumours and fibrous dysplasia in children because
of their action in causing inhibition of osteoclastic
bone resorption.9
The failure of curettage with a rapid recurrence
and the excellent result of intralesional injections
of corticosteroids shows the advantage of this ap-
proach. It is important to avoid unnecessary oper-
ations on growing children.
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76
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