Giant Cells Lesions of Oral and Maxillofacial Region – A Proposed Diagnostic Algorithm

Harpreet Kaur¹, Deepika Mishra¹*, Ajoy Roychoudhury², Mehar Chand Sharma³, Ashu Seith Bhalla⁴, Asit Ranjan Mridha³, Aanchal Kakkar³, Rahul Yadav², Sunny Kala¹, Shashwat Mishra⁵

¹Department of Oral Pathology and Microbiology, Centre for Dental Education and Research, All India Institute of Medical Sciences, Delhi, India. ²Department of Oral and Maxillofacial Surgery, Centre for Dental Education and Research, All India Institute of Medical Sciences, Delhi, India. ³Department of Pathology, All India Institute of Medical Sciences, Delhi, India. ⁴Department of Radiodiagnosis, All India Institute of Medical Sciences, Delhi, India. ⁵Department of Neurosurgery, All India Institute of Medical Sciences, Delhi, India.

Abstract

Multinucleated giant cells are commonly encountered in histopathology and are mostly a clue to diagnosis but sometimes pose a diagnostic confusion. The present study elucidates a case series of giant cell lesions (GCL) with emphasis on differential diagnosis and other investigations that contribute towards arriving at a final diagnosis. We also intended to devise an algorithmic approach for the accurate pathological characterization of these lesions. All the cases reported in the department from January 2018 to June 2019 were reviewed by pathologists and the total number of lesions where giant cells were diagnostic or an additional finding were included in this study. Twenty-five cases out of 1000 biopsies were diagnosed based on giant cell morphology. The most frequent lesions were central giant cell granuloma, followed by cherubism, hyperparathyroidism, peripheral giant cell granuloma, tuberculosis, and hybrid lesion. A systematic approach towards differential diagnosis for such cases and a diagnostic algorithm was devised which is being followed as per the reported spectrum of GCL. Radiological, serology, and sometimes ancillary staining techniques are essential for the accurate histopathological diagnosis of giant cell lesions. Our diagnostic algorithm helps narrow down the spectrum of investigations necessary to characterize these lesions, enabling for a swifter and more confident identification of the pathologies.

Keywords: Multinucleated giant cells, Histopathology, Central giant cell lesions, Jaws, Oral and maxillofacial gegion

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