Hüseyin GÜLCAN, Uğur GÜLŞEN, Elif Aslı GÜLŞEN

Santral Dev Hücreli Granülom Tedavisinde Kortikosteroid Kullanımı

Sık görülmeyen bir hastalık olan santral dev hücreli granülom (SDHG), neoplazik olmayan bir kemik lezyonudur. Klinik olarak asemptomatik olabilir ya da kök rezorpsiyonu, kortikal kemik yıkımı gibi agresif ve ağrılı bir durum gösterebilir. Bu olgu sunumunun amacı santral dev hücreli granülom tedavisinde daha az invaziv bir yöntem olan lezyon içi kortikosteroid enjeksiyonunun önemini vurgulamaktır. 24 yaşında kadın hasta mandibula sol bölgede ağrı ve şişlikle kliniğe başvurdu. Ağız içi muayenede, bu bölgede 6 aydır bulunduğu öğrenilen kırmızı-mor renkli şişlik tespit edildi. Radyografik muayenede multiloküler radyolüsent lezyon ve diş köklerinde rezorpsiyon tespit edildi. Lokal anestezi altında biyopsi yapıldı. Yapılan histopatolojik incelemenin ardından SDHG tanısı kondu. Hastaya lezyon içi kortikosteroid enjeksiyonu uygulandı. Rutin takiplerde lezyonun küçülüp kaybolduğu görüldü.

Anahtar Kelimeler:

dev hücre, granülom, steroid

The Use of Corticosteroid in the Treatment of Central Giant Cell Granuloma

Central giant cell granuloma (CGCG), an infrequent disease, is a non-neoplastic bone lesion. Clinically, it may be asymptomatic or it may show an aggressive and painful condition that can cause root resorption, cortical bone destruction. The aim of this report is to emphasize the importance of intralesional corticosteroid injection, which is a less invasive technique in the treatment of CGCG. 24 years old female patient came to our clinic with pain and swelling in the left side of the mandible. In intraoral examination, a red-purple swelling, which was found to have been present for 6 months, was detected in this region. Radiographic examination showed a multilocular radiolucent lesion and root resorption. Biopsy was done under local anesthesia. After the histopathological examination, the diagnosis of CGCG was done. Intralesional corticosteroid injection was applied. During routine follow-up, the lesion was observed to decrease and disappear.

Keywords:

giant cell, granuloma, steroid,

PDF

___

1. de Lange J, van den Akker HP, van den Berg H. Central giant cell granuloma of the jaw: a review of the literature with emphasis on therapy options. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104(5):603-15.
2. Regezi JA. Odontogenic cysts, odontogenic tumors, fibroosseous, and giant cell lesions of the jaws. Mod Pathol. 2002;15(3):331-41.
3. Bodner L, Bar-Ziv J. Radiographic features of central giant cell granuloma of the jaws in children. Pediatr Radiol. 1996;26(2):148-51.
4. Yamaguchi T, Dorfman HD. Giant cell reparative granuloma: a comparative clinicopathologic study of lesions in gnathic and extragnathic sites. Int J Surg Pathol. 2001;9(3):189-200.
5. Mintz GA, Abrams AM, Carlsen GD, Melrose RJ, Fister HW. Primary malignant giant cell tumor of the mandible. Report of a case and review of the literature. Oral Surg Oral Med Oral Pathol. 1981;51(2):164-71.
6. Chuong R, Kaban LB, Kozakewich H, Perez-Atayde A. Central giant cell lesions of the jaws: a clinicopathologic study. J Oral Maxillofac Surg. 1986;44(9):708-13.
7. Kara I, Ozan F, Polat S. Agresif tip maksillar santral dev hücreli granulomada konservatif tedavi yaklaşımı: 2 olgu sunumu. Cumhuriyet Dental Journal. 2011;11(2):108-12.
8. Webb DJ, Brockbank J. Combined curettage and cryosurgical treatment for the aggressive "giant cell lesion" of the mandible. Int J Oral Maxillofac Surg. 1986;15(6):780-5.
9. Terry B, Jacoway J. Management of central giant cell lesions: an alternative to surgical therapy. Oral Maxillofac Surg Clin North Am. 1994;6(3):579-600.
10. Shirani G, Abbasi AJ, Mohebbi SZ, Shirinbak I. Management of a locally invasive central giant cell granuloma (CGCG) of mandible: report of an extraordinary large case. J Craniomaxillofac Surg. 2011;39(7):530-3.
11. Dolanmaz D, Esen A, Mihmanlı A, Işık K. Management of central giant cell granuloma of the jaws with intralesional steroid injection and review of the literature. Oral Maxillofac Surg. 2016;20(2):203-9.
12. Sun LM, Lin MC, Muo CH, Liang JA, Kao CH. Calcitonin nasal spray and increased cancer risk: a population-based nested case-control study. J Clin Endocrinol Metab. 2014;99(11):4259-64.
13. Choi JW, Kraut RA. Management of central giant granuloma of mandible with intralesional triamcinolone injections: a case report. N Y State Dent J. 2013;79(3):34-6.
14. Kermer C, Millesi W, Watzke IM. Local injection of corticosteroids for central giant cell granuloma. A case report. Int J Oral Maxillofac Surg. 1994;23(6 Pt 1):366-8.
15. Rajeevan NS, Soumithran CS. Intralesional corticosteroid injection for central giant cell granuloma. A case report. Int J Oral Maxillofac Surg. 1998;27(4):303-4.
16. Kremer M, Judd J, Rifkin B, Auszmann J, Oursler MJ. Estrogen modulation of osteoclast lysosomal enzyme secretion. J Cell Biochem. 1995;57(2):271-9.
17. Kameda T, Mano H, Yuasa T, Mori Y, Miyazawa K, Shiokawa M, et al. Estrogen inhibits bone resorption by directly inducing apoptosis of the bone-resorbing osteoclasts. J Exp Med. 1997;186(4):489-95.
18. Hirayama T, Sabokbar A, Athanasou NA. Effect of corticosteroids on human osteoclast formation and activity. J Endocrinol. 2002;175(1):155-63.