Central giant-cell granuloma

It is a reactive lesion of unknown origin resulting from a process of bone destruction. On the basis of the location, central types can be distinguished, which affect the intra-bone areas, and peripheral types affecting the gingival tissue. In the majority of cases both types are situated in the forward part of the mandible and the lesions are totally asymptomatic. However, some more aggressive types of CGCG present with swelling, perforation of the cortex, ulceration, pain and paresthesia. In these latter cases, there is greater tendency to relapse. Radiographically, a radiotransparent area can be observed, which is uni- or multi-locular. Histologically, CGCG is formed by one connective stroma, which is rich in blood vessels and hemosiderin deposits. Fusiform fibroblasts are also present as well as aggregates of multi-nucleate giant cells, which are derived from osteoclasts. The treatment of choice is curettage. More aggressive lesions require bone re-sectioning even if the intra-lesion administration of corticosteroids or calcitonin can cause a regression of the lesion.