Head and Neck Imaging

Giant cell granuloma

osseous lesion, consisting of richly vascular connective tissue and a variable number of multinucleated giant cells. It presents in two forms: a peripheral form, involving the gingiva or alveolar bone (also called epulis), and a central form, localized within the jaw bones. The peripheral form is more common. It is not clear whether the two forms are different anatomical localizations of the same process. The aetiology is unknown; a history of trauma is commonly present, hence the often used prefix 'reparative'.

The central form is seen more often in the mandible, and occurs typically in the second or third decade. It may produce a local deformity of the jaw. Radiologically, the lesion causes osteolysis and may have a bubble-like appearance; it is usually well delineated and may contain calcifications. The differential diagnosis includes brown tumour of hyperparathyroidism, ameloblastoma and others. Treatment is surgical. Histologically, it cannot be distinguished from a brown tumour of hyperparathyroidism. Hyperparathyroidism needs to be excluded biochemically, especially in older patients, if the lesion is in an atypical location or if there are frequent recurrencies.

RH