BRIEF REPORTS

Cytologic Features of CentralGiant-Cell Granuloma of the JawKirti Gupta, M.D., Pranab Dey, M.D., M.I.A.C.,* Ritalin Goldsmith, M.D., andR.K. Vasishta, M.D., F.R.C.Path.

In this present series, we studied in detail the cytologic features offive histopathologically verified cases of central giant-cell granu-loma (CGCG). All the patients in this series were female, with anage range of 11–60 years. There were three cases with involve-ment of the lower jaw and two cases had upper jaw involvement.Cytology smears showed dispersed single cells in the background.Nuclei of the individual cells were round to ovoid with fine chro-matin and inconspicuous nucleoli. The cytoplasm of these cellswas moderate in amount with indistinct cell borders. Many ran-domly scattered multinucleated giant cells with 10–20 nuclei werepresent in the background. Combination of clinical features, ra-diologic pictures, and cytologic features may be helpful for diag-nosis of CGCG on fine-needle aspiration cytology. Diagn. Cy-topathol. 2004;31:113–115. © 2004 Wiley-Liss, Inc.

Key Words: fine-needle aspiration cytology; central giant-cellgranuloma; jaw lesions

The central giant-cell granuloma (CGCG) or central giantcell reparative granuloma is a benign osseous process withdistinct clinicopathologic features. This lesion occurs al-most exclusively within the jaw bones.1 It usually presentsas a painless swelling of the jawbone and is seen radio-graphically as a radiolucent lesion of the maxilla or man-dible.2 Due to thinning of the bony cortex, these radiolucentjaw lesions are amenable to fine-needle aspiration cytology(FNAC).3 In the present study, we have analyzed the cyto-logical features of five cases of CGCG.

Materials and MethodsIn this retrospective study, we selected five cases of CGCGthat were proven on histopathological examinations. Thelesions were aspirated using a 22 gauge needle as an out-patient procedure and the smears were air-dried and fixed inalcohol for May-Grunwald-Giemsa (MGG) and hematoxy-lin-eosin (H&E) staining, respectively. Detailed cytologicfeatures were studied by two different observers indepen-dently (P.D. and K.G.).

ResultsAll the patients in this series were female, with an age rangeof 11–60 years. There were three cases with involvement ofthe lower jaw and two cases had upper jaw involvement.Site of the lesions varied from 1 to 2.5 cm diameters.Detailed clinical and cytologic features have been describedin Table I.

FNAC smears were rich in cellularity in the majority ofthe cases (4/5). The smears showed cohesive monolayeredclusters of round to oval mononuclear cells. There were alsodispersed single cells in the background. Nuclei of theindividual cells were round to ovoid with fine chromatin andinconspicuous nucleoli. The cytoplasm of these cells wasmoderate in amount with indistinct cell borders. Many ran-domly scattered multinucleated giant cells were present inthe background (Fig. 1). Each of the giant cells had 10–20nuclei with frequent overlapping among the nuclei (Fig. 2).A few hemosiderin-laden macrophages and inflammatorycells were also present in the background. One case revealedsignificant proportion of singly scattered mast cells withdense granular cytoplasm. Three cases showed myxoid stro-mal material in the background. Mitotic figures or cellularpleomorphism was absent in all of the cases.

DiscussionThe central giant-cell granuloma (CGCG) is a benign neo-plastic giant-cell lesion arising within the jawbone. Thislesion more frequently involves mandible than maxilla.1

The term “central giant-cell granuloma” was first described

1Department of Pathology, Post Graduate Institute of Medical Educationand Research, Chandigarh, India

2Department of Cytology, Post Graduate Institute of Medical Educationand Research, Chandigarh, India

3Department of Histopathology, Post Graduate Institute of MedicalEducation and Research, Chandigarh, India

Pranab Dey is presently at the Kuwait Cancer Controlling Center,Kuwait.

*Correspondence to: Pranab Dey, M.D., M.I.A.C., Histopathology Lab-oratory, Kuwait Cancer Controlling Center, Post Box 42262, 70653 Shu-waikh, Kuwait. E-mail: deypranab@hotmail.com

Received 27 June 2003; Accepted 21 January 2004DOI 10.1002/dc.20078Published online in Wiley InterScience (www.interscience.wiley.com).

© 2004 WILEY-LISS, INC. Diagnostic Cytopathology, Vol 31, No 2 113

by Jaffe4 in 1953. Since then, this has been described in fewcase reports and short series.2,5–7

The pathogenesis of this entity is not clearly known. Ithas been suggested that the lesion may be due to the result

of the organization of slow minute recurrent giant-cell gran-ulomas.4 A history of trauma is often demonstrated. In thepresent study, only one case had a past history of trauma.

Mandible is affected twice as frequently as the maxilla,particularly in the anterior segment.1 Classically, the tooth-bearing areas are involved; however, rarely mandibularcondyle may also be involved.8 FNAC smears of CGCGshowed round to mildly elongated cells in loosely cohesiveclusters admixed with many multinucleated giant cells hav-ing 10–20 nuclei. Background showed myxoid stromal ma-terial and pigment-laden macrophages.

The common radiolucent lesions of the jawbone maybe included in the differential diagnosis of CGCG. Theselesions are odontogenic cyst, follicular cyst, ameloblas-toma, and rarely giant-cell tumor (GCT) of bone.9 –11 Inameloblastoma, the combination of basaloid, stellate, andoften squamous cells are quite characteristic features.12

Cytologic smears of odontogenic cyst show abundantsheets of elongated and aneucleated squamous cells.11

Follicular cyst on FNAC may yield straw-color fluid,which contain few squamous cells and macrophages. It isdifficult to differentiate CGCG and giant-cell tumor ofbone. Clinical and radiological features may be helpful inthis aspect.

The presence of multinuleated giant cells on FNACsmears is not characteristics for any specific lesion. Com-bination of clinical features, radiologic pictures, and cyto-logic features may be helpful for diagnosis of CGCG onFNAC.

References1. Rosai J. Ackerman’s surgical pathology, vol. 1. St. Louis, MO: C.V.

Mosby; 1981. p 259.

2. Kaw YT. Fine needle aspiration cytology of central giant cell granu-loma of the jaw: a report of two cases. Acta Cytol 1994;38:475–478.

3. Ramzy I, Aufdemorte TB, Duncan DL. Diagnosis of radiolucentlesions of the jaw by fine needle aspiration biopsy. Acta Cytol 1985;29:419–424.

Fig. 1. Randomly scattered multinucleated giant cell with nuclei numberranging from 10 to 20 (MGG, �280).

Fig. 2. Multinucleated giant cells and scattered round to oval cells in thebackground (MGG, �280).

Table I. Cytological Features of Central Giant-Cell Granuloma*

Serialno. FNAC Histopathology

Age/sex Site/size Cellularity

Histiocyte-like cells

Otherinflammatory

cells

Giant-cell

number

Nucleiin giant

cells Pigment AdherenceMyxoidstroma

Mitoticfigures Pleomorphism

1 CGCG CGCG 16/F Right lowerjaw, 1 � 0.9cm

Low �� � �� � � � � � �

2 Giant-celllesion

CGCG 60/F Right upperjaw, 2 cmdiameter

High �� � � �� � � � � �

3 Giant-celllesion

CGCG 30/F Right lowerjaw, 1.5 cmdiameter

High �� � � � � � � � �

4 CGCG CGCG 11/F Right superioralveolus, 2.5� 1 cm

High �� � mast cells � � �� � �� � �

5 Giant-celllesion

CGCG 56/F Lower alveolus High �� � � � � � � � �

*�, mild; ��, moderate; ���, marked. Giant-cell nuclei number: �, less than 20; ��, 20–50; ���, more than 50.

GUPTA ET AL.

114 Diagnostic Cytopathology, Vol 31, No 2

4. Jaffe HL. Giant cell reparative granuloma, traumatic bone cyst, andfibrous (fibro-osseous) dysplasia of the jaw bones. Oral Surg 1953;6:159–175.

5. Austic LT Jr, Dahlin DC, Royer RQ. Giant cell reparative granulomaand related conditions affecting the jaw bones. Oral Surg 1959;12:1285–1295.

6. Waldron CA, Shafer WG. The central giant cell reparative granulomaof the jaws. Am J Clin Pathol 1966;45:437–447.

7. Radcliffe A, Friedman I. Reparative giant cell granuloma of the jaw.Br J Surg 1957;45:50–54.

8. Tasanen A, Konow LV, Nording S. Central giant cell lesion in themandibular condyle. Oral Surg 1978;45:532–539.

9. Ramzy I, Aufdermorte TB, Duncan DL. Diagnosis of radiolucentlesions of the jaw by fine needle aspiration biopsy. Acta Cytol 1985;29:419–424.

10. Levine SE, Mssler JA, Johnton WW. The cytologic appearance ofmetastatic ameloblastoma. Acta Cytol 1981;25:295–298.

11. Ramzy I, Mody DR. Bone and cartilage. In: Ramzy I, editor.Clinical cytopathology and aspiration biopsy: fundamental princi-ples and practice, 2nd ed. New York: McGraw-Hill; 2001, p499 –510.

12. Radhika S, Nijhawan R, Das A, Dey P. Ameloblastoma of the man-dible: diagnosis by fine needle aspiration cytology. Diagn Cytopathol1993;9:310–313.

CENTRAL GIANT-CELL GRANULOMA

Diagnostic Cytopathology, Vol 31, No 2 115