Table 3.
Differential diagnosis of giant cell lesions
| Central giant cell lesions | Age | Sex | Site | Clinical features | Radiographic | Histopathology | Serum calcium | Serum phosphorus | Serum ALP |
|---|---|---|---|---|---|---|---|---|---|
| CGCG (nonneoplastic lesion) | <30 years | Female > male | Exclusively in jaws Anterior mandible crossing midline | Asymptomatic, seen during routine radiographic examination, nonaggressive form-painless expansion of affected bone, aggressive form-pain, cortical perforation and root resorption | Expansile, well demarcated, scalloped border, noncorticated multilocular, less commonly unilocular radiolucency | Loose fibrillar connective tissue with many interspersed proliferating fibroblasts, hemosiderin laden macrophages and extravasated RBCs, capillaries- snmall and inconspicuous, multinucleated giant cells are in focal aggregates or patches (zonation phenomenon) or diffusely scattered | N | N | N |
| Giant cell tumor (osteoclastoma)- benign but locally destructive neoplasm | 3rd-4th decade | Male > female | Rare in skull, preferential sites-sphenoid, ethmoid and temporal bones | Pain, swelling and pathological fracture | Radiolucent with poorly defined and irregular margins | Stromal cellularity is prominent, minimal collagen production. Mitotic figures may be found. Giant cells in larger, 40-60 nuclei than CGCG, more homogenous pattern of distribution. May contain inflammatory cells and areas of necrosis but relative absence of hemorrhage and hemosiderin pigment | N | N | N |
| PHPT (present case) | Female > male | Old age | Refer to text | Refer to text | Refer to text | Refer to text | ↑ | ↓ | N or osteolytic lesions |
| SHPT | Female > male | Old age | Same as PHPT | Same as PHPT | Same as PHPT | Same as PHPT | ↓ | ↑ | N or in osteolytic lesions |
| Cherubism - An AD disease SH3BP2 mutation on chromosome 4 | Female > male | 2-4 years, regresses after puberty | Mandible and maxilla | Characteristic renaissance cherub faces with rounded jaws, vertical displacement of orbital floor ‘eyes upturned to heaven appearance’, Submandibular and cervical lymphadenopathy-common | Bilateral symmetrical multilocular radiolucent lesions in the jaw with thick sclerotic borders. Unerupted teeth -“Floating tooth syndrome” | Numerous giant cells in a collagenous stroma, containing abundant fibroblasts. Perivascular eosinophilic cuffing is specific for the lesion | N | N | N (in active growth period there may be physiological increase in ALP) |
| Noonan like multiple gaint cell lesion syndrome-AD | - | Congenital anomaly | - | Short stature, craniofacial dysmorphisms and congenital heart defects | Multilocular radiolucency | Numerous giant cells in a collagenous stroma, containing abundant fibroblasts. Perivascular eosinophilic cuffing is specific for the lesion | N | N | N (in active growth period there may be physiological increase in ALP) |
| Aneurysmal bone cyst | Male=female | <20 years | Nearly every part of skeleton, long bones, vertebral column- common Mandible > maxilla | Painful firm swelling Two clinicopathologic forms: Primary lesion/a secondary lesion (arising in other neoplastic/nonneoplastic osseous conditions) | Multilocular radiolucency with honeycomb or soap bubble appearance, eccentrically ballooned | Cavernous or sinusoidal blood filled spaces without endothelial lining. Giant cells (patchy distribution similar to CGCG) along with varying amounts of hemosiderin pigment are present | - | - | - |
↑: Increase downward arrow decrease. ALP: Alkaline phosphatase, CGCG: Central Giant cell granuloma, PHPT: Primary hyperparathyroidism, SHPT: Secondary hyperparathyroidism