Clinicopathological profile of central giant cell granulomas: An institutional experience and study of immunohistochemistry expression of p63 in central giant cell granuloma

Abstract

Background:The central giant cell granuloma(CGCG) of bone constitutes about 10% of benign jawbone lesions. It affects females more often than males, mandible than maxilla. Biological behavior of CGCG ranges from a slow growing asymptomatic swelling to an aggressive process. True giant cell tumor (GCT) should be distinguished from CGCG. The histological distinction between these lesions depends on quite subtle differences. Expression of p63 has been demonstrated in GCT of bone conversely, has not been detected in CGCG. Therefore this short study attempts to study the expression of p63 in CGCG in conjunction with clinicopathological profile of the cases reported in the institute.Aims and objectives: To review all the cases of CGCGs of the jaws reported in the institute from 1998 to 2015 and study their clinicopathological profile.To study the immunohistochemical (IHC) expression of p63 in CGCG cases Methods and materials:The retrospective study reviewed records for clinically and histopathologically diagnosed cases of CGCG from the archives of department of Oral pathology. Data was recorded and analyzed. These cases were subjected for IHC analysis for expression of p63, also RANK, RANKL in selected cases to study the nature of giant cells.Results and Conclusion:This paper is an institutional experience of clinicopathological profile of diagnosed cases of CGCG. Clinicopathological findings were in concurrent with previous literature. Total number of cases was ten. Six occurred in females and four in males. Most of them occurred in the second decade, more commonly involving mandible. Three cases showed recurrence. Histologically most showed classical features. Expression of p63 showed negativity in all the cases in accordance with the previous studies. RANK and RANKL showed strong and diffuse immunoexpression in both mononuclear and giant cells. Thus study supports the finding that p63 expression can be used to differentiate between CGCG and GCT. However, more number of studies with larger sample size are required to confirm reliability of using p63 as a distinguishing marker between GCT and CGCG.

Utility of p63 in differentiating giant cell tumor from other giant cell-containing lesions

“…A careful clinical history of hyperparathyroidism helps in differentiating these two entities. All the other studies except De la Roza have shown negative immunostaining for p63 in all the cases of central giant cell granuloma (CGCG) reflecting a pathogenesis different from GCTB (2)(3)(4)10,15). The latter has shown p63 positivity in all the four cases of CGCG ( 4).…”

Cone-beam computed tomographic imaging of central giant cell granuloma: A comprehensive review

“…There is speculation that this may be the result of hormonal influences and secretion on the development and growth of CGCG. 9 10 11 12 13 14 15 16 17 18 19 …”

“…Genetically, mutations in H3F3A and IDH2 have been observed in true giant cell tumors of bone, but these mutations have not been observed in CGCG. 9 24 25 …”

A Unique Case of Aggressive Central Giant Cell Granuloma in a 10-Year-Old Boy With 16p13.11 Microdeletion Syndrome

“… 1 , 2 The CGCG accounts for approximately 10% of all benign tumors of the jaws affecting the mandible and maxilla in patients aged 10 to 25 years. 3 , 4 The CGCG has a heterogeneous presentation ranging from asymptomatic, slow-growing lesions to more aggressive, rapidly growing lesions with cortical expansion, thinning, and perforations requiring medical and surgical treatment depending on the lesion variation. 5 …”