Giant Cell Lesions Flashcards
Site of PGCG
Site:
9
Gingiva or alveolar mucosa in dentulous or edentulous,
anterior to the molar teeth.
The mandible > maxilla.
Signes of PGCG
- Signs and symptoms:
Painless nodular swelling.
Color:
o Red, dark red, reddish blue due to increased vascularity.
o Brownish due to presence of hemosiderin granules as a
result of hemolysis of the extravasated red blood cells (RBCs).
Consistency: soft with high tendency for bleeding.
> Shape:
o Pedunculated or sessile.
Ⓒ in dentate areas of the jaws, the lesion usually arises interdentally and may have an ho glass shape with buccal and lingual swellings joined by a narrow waist between the tee
> Surface → may be smooth and commonly ulcerated.
Site of cgcg
Site
Mandiblemore than maxilla
CCCC are more common in anterin portions of the jaws and mandibular lesions frequently cross the milline
Aggressive vs non Aggressive cgcg
Non aggressive
- slowly growing
- no root resorption
- not painful
- low recurrence
- cortical thinning but cortical perforation is uncommon
Aggressive
- العكس بس زود
- perforation of cortex with extension into soft tissue and ulceration
- Parathesia and numbness
Giant cell tumor location
Extremely rare in the jaws
If in head and neck would be in sphenoid temporal and ethmoidal bone
Occur in epiphesis of long bones and specially knee joint
S and s of giant cell tumor
Same as cgcg
What is special about giant cells of giant cell tumor
- more nuclei
- larger
- more irregular outline
- more evenly distributed
- more numerous
Ttt of cgcg
Aggressive curettage (bone margin removal ) - more aggressive surgery for aggressive type like resection
Causes of primary hyperparathyroidism
o Parathyroid adenoma (80 % to 90 %).
o Parathyroid hyperplasia (10 % to 15 %).
o Parathyroid carcinoma (less than 2 %).
Clinical features of primary hyperparathyroidism:
- Age: older than 60 years.
- Sex: females > males.
- Signs & symptoms:
Triad of signs and symptoms which are stones, bones and abdominal groans:
(1) Stones and metastatic calcifications
- Because of hypercalcemia, patients have a marked tendency to develop kidney stones..
- Metastatic calcifications may occur involving other soft tissues such as blood vessel walls, lungs, pancreatic, biliary, and salivary duct stones may occur.
(2) Bones refers to a variety of osseous changes 1 Radiographic detection of subperiosteal resorption of the phalanges (This is one of the first
clinical signs of this disease).
- Partial loss of the lamina dura around the teeth may occur. (early manifestation) 3 Decrease in the bone density → blurring in the normal trabecular pattern ground glass
appearance (radiographically)
- Generalized osteoporosis, bone pain and pathological fracture of long bones may occur.
- Joint stiffness due to metastatic calcifications in regions around the joints.
With persistent disease (i.e. at late stages), other osseous lesions develop, such as: 6. Brown tumor of hyperparathyroidism.
- Osteitis fibrosa cystica → result from central degeneration and fibrosis of long standing brown
tumors (sever skeletal manifestation).
(3) Abdominal groans and gastro intestinal manifestations
o Peptic and duodenal ulcers, pancreatitis secondary to pancreatic duct stones.
(As absorption of Ca from intestine needs acidic media which may cause ulceration).
The chief oral findings may be Well defined cystic radiolucencies of the jaw, which may be unilocular or multilocular.
2- Osteoporotic appearance of the mandible and maxilla, reflecting a more generalized condition. 3 Loosening of the teeth may occur as a result of loss of lamina dura.
4- Pulpal obliteration with complete calcification of the pulp chamber and root canals.
Metastatic calcifications of the oral mucosa are rarely seen.
Long standing brown tumor lead to
Osteitis fibrosa cystica
X ray of brown tumor
Well defined scalloped margin uni or multi
With other features of hyper para
Lamina dura partial loss
Ground glass
Subperiosteal resorption
Site of brown tumor
- may be single but mostly multiple
- rare in maxilla
- mostly in shaft and end of long bones like femur and tibia
Also In mandible clavicle ribs belvis
Signes of brown tumor
Painless significant cortical expansion
Treatment of brown tumor
Treat 1ry or 2ry hyperparathyroidism
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