Central Giant Cell Granuloma of Posterior Maxilla: First Expression of Primary Hyperparathyroidism

Abstract

A case of 19-year-old male patient reported with the chief complaint of slowly growing diffuse painless swelling over the right part of the face from last 6 months. Intraoral examination revealed a swelling on right side of palate in relation to molar region with buccal cortical plate expansion. Radiographic examination (orthopantograph and 3DCT) showed large multilocular radiolucency in right maxilla with generalized loss of lamina dura. Incisional biopsy was done and specimen was sent for histopathological examination which showed multinucleated giant cells containing 15–30 nuclei. Based on clinical, radiological, and histopathological findings provisional diagnosis of central giant cell granuloma was made. Blood tests after histopathology demonstrated elevated serum calcium level and alkaline phosphatase level. Immunoassay of parathyroid hormone (PTH) level was found to be highly elevated. Radiographic examination of long bones like humerus and femur, mandible, and skull was also done which showed osteoclastic lesions. Considering the clinical, radiographic, histopathological, and blood investigation findings, final diagnosis of brown tumour of maxilla was made. The patient underwent partial parathyroidectomy under general anaesthesia to control primary hyperparathyroidism. Surgical removal of the bony lesion was done by curettage. The patient has been followed up for 1 year with no postoperative complications and the lesion healed uneventfully.

Peripheral giant cell granuloma as an oral manifestation of primary hyperparathyroidism on a pediatric patient: A case report

“…Histologically, PGCG shows proliferation of multinucleated giant cells within a background of mesenchymal cells, which is similar to brown tumors 6,7 , a characteristic feature of primary hyperparathyroidism 7 . Primary hyperparathyroidism is caused by hypersecretion of parathyroid hormone due to idiopathic hyperplasia of parathyroid tissue, generally and less commonly parathyroid adenoma and carcinoma 8 .…”

“…Since giant cell granulomas could be seen as an oral manifestation of hyperparathyroidism 6,7 , and no clinical and radiographic local aetiological factors were present, the patient was consulted with a pediatric endocrinologist for further evaluation of the risk for hyperparathyroidism. As a result of blood sample analyses and clinical examination, primary hyperparathyroidism was diagnosed by the paediatric endocrinologist and treatment was initiated with a prescribed medication.…”

Peripheral and central giant cell lesions in children: Institutional experience at Subharti Dental College and Hospital

“…In some cases, the CGCG lesion may be the first indicator of the primary hyperparathyroidism. [ 23 ] Ameloblastoma tends to occur in an older age group (20–60 years), in the posterior mandible and shows well-defined internal septa radiographically. Conversely, CGCG shows wispy, ill-defined trabeculation.…”

“…Nonsurgical methods of treatment that have been tried involve using intralesional calcitonin,[ 22 25 ] intralesional steroids,[ 23 26 27 ] antiangiogenic therapy using interferons,[ 28 ] and radiotherapy. [ 29 ] The benefits of any nonsurgical treatment are that disfiguring surgery and the potential loss of teeth or tooth germs in children may be prevented.…”

Treatment of an aggressive central giant cell lesion

“…Although the injury is spontaneously resolved after parathyroidectomy, surgical curettage should be well thought out to large lesions, regardless of the lesion site. [6] In cases of isolated CGCL, the treatment of choice should be carefully defi ned in accordance with the peculiarities of each case. [2] Because it is a benign lesion, the correct diagnosis avoids mutilating radical treatments.…”