Classification

1. Lucas classification
Bony lesions

Giant cell tumors

Central giant cell granuloma

Browns tumor of hyperparathyroidism

Soft tissue lesions

Giant cell epulis

Peripheral giant cell lesions

2. Chattopadyay classification
Type I giant cells are pathognomic

Hodgkins lymphoma, PGCG

Type II giant cells are characteristic but not

pathognomic

TB, HSV, measels

Type III giant cells are associated

Pagets disease, Cherubism, Fibrous dysplasia

Pagets disease
osteitis deformans
3% of adults over 45 yrs of age
Malignant transformation in 1-2% of cases
Etiology :
Benign tumor of osteoclasts
Viral infection paramyxo virus or respiratory

syncytial virus

Clinical features
Deformities of skull, jaw, back pelvis legs
Painless irregular over growth of bones
Initial bone resorption followed by dense sclerotic bony

deposition
Fracture of long bones
Repeated complaints of ill fitting dentures and hats
Narrowing of skull bones neurologic pain
In jaw bones maxilla common leontiasis ossea
Loss of lamina dura and root resorption
Excessive post surgical bleeding and delayed healing after

Xn.

Radiologic features
Stage I osteolytic phase

Massive bone resorption large radioluscent areas

Stage II bone deposition phase

Mixed radiodensity

Stage III sclerotic phase

Cotton wool appearance of the medullary bone between

widened cortical plates

Histologic features
Pagetoid bone pattern

Jig-saw puzzle pattern of bone

Superimposition of resting and reversal lines of bone

Investigations
Serum alkaline phosphatase, urine hydroxyproline raised

Treatment Mainly medicinal

1. Antibiotics Mitramycin i.v

Inhibits osteoclastic activity

2. Bisphosphonates - disphosphonate etidronate

Reduces bone resorption

3. Hormones

Human calcitonin s.c or nasal spray

High dose glucocorticoids intralesional or systemic

4. Cytotoxic agents

Plicamycin, dactinomycin

Giant cell granuloma

First described by Jaffe
Etiology
Benign inflammatory hyperplasia of bone cells

Types
Central
Peripheral

Differential diagnosis
Giant cell tumor

Clinical features
Peripheral: central = 5:1
Peripheral lesions

Exophytic lesions on gingiva

Highly vascular brown colour and bleed profusely

To be differentiated from pyogenic granuloma

Central lesions

Jaw, skull or facial bones

Mandible common anerior to Ist molar and cross midline

Painless expansion of cortical plates

Highly vascular and therefore bleed on biopsy

Radiographic features
Mixed radiodensity with diffuse margins

Histologic features
Resorbed bony cavities with
Multinucleated giant cells in inflammatory

stroma
Numerous capillaries and areas of hge
Increased no. of fibroblasts and collagen fibres

Treatment
Medical
Reduce the size of lesion by reducing resorption
and increasing deposition of bone
Bisphosphonates - intralesional
Calcitonin nasal spray
Corticosteroids intralesional triamcinolone
40mg/ml

Surgical
Complete elimination
Curettage (recurrance 12-37%)
Curettage and cryosurgery of bony walls
Aggressive lesions segmental resection

Cherubism
Etiology exact cause unknown
Hereditary dominant gene

Seen in infants and children below 6 yrs of

age
Self limiting condition - Regress by 12 yrs and

resolve by adulthood

Clinical features massive destruction of alveolar bone

Mandible common

Bilateral painless posterior swelling

Fullness of cheeks

Protruding intra-alveolar masses

Maxilla

bilateral facial chubbiness cherub appearance

looking toward heaven appearance distention of infraorbital

skin

Missing, displaced or impacted teeth

Submandibular lymphadenopathy till 5 yrs of age
Difficulty in mastication, swallowing, speech and

respiration

Radiologic features
Multiple well defined multilocular radioluscencies
teeth floating in cavity appearance
Displaced and impacted teeth

Histologic features
Similar to cgcg more fibrous tissue and less giant cells
Distinct feature perivascular eosinophilic cuffing

Treatment
No active treatment self limiting
Extraction of malposed teeth
Surgical contouring and curettage

Other lesions
Giant cell epulis
Pyogenic granuloma
Browns tumor
Hodgins lymphoma
Aneurysmal bone cyst
Ewings sarcoma