MANDİBULADA GÖRÜLEN SANTRAL DEV HÜCRELİ GRANÜLOMUN SİSTEMİK KALSİTONİN UYGULAMASI İLE TEDAVİSİ: BİR OLGU SUNUMU

Year 2018, , 73 - 79, 01.04.2018

Nagehan Burcu Bayrak Bozkurt Kubilay Işık Özgür Hilal Erinanç , Doğan Dolanmaz

https://doi.org/10.15311/selcukdentj.393375

Abstract

Amaç: Çene
kemiklerinde görülen santral dev hücreli granulom (SDHG) çoğunlukla kadınlarda
ve 30 yaş öncesinde görülen, iyi huylu, agresif seyreden, intraosseöz bir
lezyondur. Tedavisinde sıklıkla küretaj tercih edilmesinin yanında, son
yıllarda intralezyonel steroid ve interferon- α (IFN-α) uygulaması, sistemik
kalsitonin kullanılması gibi yöntemlerden de faydalanılmaktadır. Bu olgu
raporunda 11 yaşında erkek hastanın, mandibular molar bölgesinde teşhis edilen SDHG’
ye tedavi yaklaşımından bahsedilecektir.

Gereç ve Yöntemler:Hasta
klinik ve radyolojik değerlendirildikten sonra, hiperparatiroidizmin (brown tumor) elimine
edilmesi için kan testi de yaptırılmış ve kan değerleri normal bulunmuştur.
Kesin teşhis konulması için mevcut lezyondan insizyonel biyopsi yapılmış ve ön
teşhisde düşünülen SDHG doğrulanmıştır. Hastanın tedavisi haftada 1 kez beş
hafta süreyle intralezyonel steroid uygulaması şeklinde başlamıştır. Ancak kontrol
radyograflarında lezyonda herhangi bir rezolusyona veya yeni kalsifiye alana
rastlanmamıştır. Bu sebeple alternative tedavi olarak hasta 6 ay boyunca günde
bir kez olacak şekilde intranasal kalsitonin kullanmaya başlamıştır. 

Bulgular:6
ayın sonunda alınan son kontrol
radyografında lezyonda belirgin küçülme olduğu ve kallus formasyonunun
başladığı gözlenmiştir. 6 yıllık takipte herhangi bir rekürrense
rastlanmamıştır.

Sonuçlar:Genç
hastalarda fonksiyonel ve estetik
deformitelerden kaçınmak için sistemik kalsitonin ile SDHG tedavisi, cerrahi
olmayan, minimal girişimsel ve tercih edilebilir bir tedavi yöntemidir.

Anahtar Kelimeler: Kalsitonin,
santral dev hücreli granulom, mandibula

Keywords

Kalsitonin, santral dev hücreli granulom, mandibula

References

• Abdo EN, Alves LC, Rodrigues AS, Mesquita RA, Gomez RS, 2005. Treatment of a central giant cell granuloma with intralesional corticosteroid. Br J Oral Maxillofac Surg, 43, 74-76.
• AgisoftPhotoScan. User Manual Professional Edition, v 0.9.0 2012. Available from: www.agisoft.ru [Accessibility 12 September 2014].
• Aoki T, Karakida K, Sakamoto H, Yamazaki H, Otsuru M, Sasaki M, et al., 2012. Successful treatment by intralesional steroid injection in management of central giant cell granuloma of the jaw—Report of two cases. J Oral and Maxillofac Surg Med Pathol, 24, 213-217.
• Carlos R, Sedano HO. Intralesional corticosteroids as an alternative treatment for central giant cell granuloma 2002. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 93, 161-166. Chuong R, Kaban LB, Kozakewich H, Perez-Atayde A. Central giant cell lesions of the jaws: a clinicopathologic study, 1986. J Oral Maxillofac Surg, 44, 708-713.
• de Lange J, Rosenberg AJ, van den Akker HP, Koole R, Wirds JJ, van den Berg H. Treatment of central giant cell granuloma of the jaw with calcitonin, 1999. Int J Oral Maxillofac Surg, 28, 372-376.
• de Lange J, van den Akker HP, Klip H. Incidence and disease-free survival after surgical therapy of central giant cell granulomas of the jaw in The Netherlands: 1990-1995, 2004. Head & Neck, 26, 792-795.
• de Lange J, Van den Akker HP. Clinical and radiological features of central giant-cell lesions of the jaw, 2005. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 99, 464-470.
• de Lange J, van den Akker HP, Veldhuijzen van Zanten GO, Engelshove HA, van den Berg H, Klip H. Calcitonin therapy in central giant cell granuloma of the jaw: a randomized double-blind placebo-controlled study, 2006. Int Journal Oral Maxillofac Surg, 35, 791-795.
• 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, 2007. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 104, 603-615.
• de Lange J, van Rijn RR, van den Berg H, van den Akker HP. Regression of central giant cell granuloma by a combination of imatinib and interferon: a case report, 2009. Br J Oral Maxillofac Surg, 47, 59-61.
• Eisenbud L, Stern M, Rothberg M, Sachs SA. Central giant cell granuloma of the jaws: experiences in the management of thirty-seven cases, 1988. J Oral Maxillofac Surg, 46, 376-384.
• Farrier SL, Farrier JN, Smart MK, Nash ES. A 10-year review of the occurrence and treatment of central giant cell granulomas, in a District General Hospital, 2006. J Oral Pathol Med, 35, 332-337.
• Ficarra G, Kaban LB, Hansen LS. Central giant cell lesions of the mandible and maxilla: a clinicopathologic and cytometric study, 1987. Oral Surg Oral Med Oral Pathol, 64, 44-49.
• Flanagan AM, Nui B, Tinkler SM, Horton MA, Williams DM, Chambers TJ. The multinucleate cells in giant cell granulomas of the jaw are osteoclasts, 1988. Cancer, 62, 1139-1145.
• Fonseca FP, Ribeiro AC, Santos-Silva AR, Vargas PA, Lopes MA. Fine needle aspiration cytology and intralesional steroid injection in a central giant cell granuloma affecting the gingiva: a new clinical approach, 2013. Braz Dent J, 24, 420-427.
• Gaston CL, Puls F, Grimer RJ. The dilemma of denosumab: Salvage of a femoral head giant cell tumour, 2014. IJSCR, 5, 783-786.
• Jacoway JR, Howell FV, Terry BC. Central giant cell granuloma- an alternative to surgical therapy, 1988. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 66, 572.
• Jadu FM, Pharoah MJ, Lee L, Baker GI, Allidina A. Central giant cell granuloma of the mandibular condyle: a case report and review of the literature, 2011. Dentomaxillofac Radiol, 40, 60-64.
• Harris M. Central giant cell granulomas of the jaws regress with calcitonin therapy, 1993. Br J Oral Maxillofac Surg, 31, 89-94.
• Kaban LB, Mulliken JB, Ezekowitz RA, Ebb D, Smith PS, Folkman J. Antiangiogenic therapy of a recurrent giant cell tumor of the mandible with interferon alfa-2a, 1999. Pediatric, 103, 1145-1149.
• Kaban LB, Troulis MJ, Ebb D, August M, Hornicek FJ, Dodson TB. Antiangiogenic therapy with interferon alpha for giant cell lesions of the jaws, 2002. J Oral Maxillofac Surg, 60, 1103-1111.
• Khafif A, Krempl G, Medina JE. Treatment of giant cell granuloma of the maxilla with intralesional injection of steroids, 2000. Head & Neck, 22, 822-825.
• Kramer IRH, Pindborg JJ, Shear M. Histological typing of odontogenic tumours Berlin: Springer-Verlag; 1991.
• Kurtz M, Mesa M, Alberto P. Treatment of a central giant cell lesion of the mandible with intralesional glucocorticosteroids, 2001. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 91, 636-637.
• Nicholson GC, Horton MA, Sexton PM, D'Santos CS, Moseley JM, Kemp BE, et al. Calcitonin receptors of human osteoclastoma, 1987. Horm Metab Res, 19, 585-589.
• Nogueira RL, Teixeira RC, Cavalcante RB, Ribeiro RA, Rabenhosrt SH. Intralesional injection of triamcinolone hexacetonide as an alternative treatment for central giant-cell granuloma in 21 cases, 2010. Int J Oral Maxillofac Surg, 39, 1204-1210.
• Nogueira RL, Faria MH, Osterne RL, Cavalcante RB, Ribeiro RA, Rabenhorst SH. Glucocorticoid and calcitonin receptor expression in central giant cell lesions: implications for therapy, 2012. Int J Oral Maxillofac Surg, 41, 994-1000.
• 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, 2011. J Craniomaxillofac Surg, 39, 530-533.
• Rachmiel A, Emodi O, Sabo E, Aizenbud D, Peled M. Combined treatment of aggressive central giant cell granuloma in the lower jaw, 2012. J Craniomaxillofac Surg, 40, 292-297.
• Tobon-Arroyave SI, Franco-Gonzalez LM, Isaza-Guzman DM, Florez-Moreno GA, Bravo-Vasquez T, Castaneda-Pelaez DA, Vieco-Duran B. Immunohistochemical expression of RANK, GRα and CTR in central giant cell granuloma of the jaws, 2005, Oral Oncology, 41, 480–488.
• Tosco P, Tanteri G, Iaquinta C, Fasolis M, Roccia F, Berrone S, et al. Surgical treatment and reconstruction for central giant cell granuloma of the jaws: a review of 18 cases, 2009. J Craniomaxillofac Surg, 37, 380-387.
• U.S. Food and Drug Administration (FDA), 2013. Avaliable from: www.fda.gov/Drugs/DrugSafety
• Vered M, Buchner A, Dayan D. Immunohistochemical expression of glucocorticoid and calcitonin receptors as a tool for selecting therapeutic approach in central giant cell granuloma of the jawbones, 2006. Int J Oral Maxillofac Surg, 35, 756-760.
• Vered M, Buchner A, Dayan D. Giant cell granuloma of the jawbones--a proliferative vascular lesion? Immunohistochemical study with vascular endothelial growth factor and basic fibroblast growth factor, 2006. J Oral Pathol Med, 35, 613-619. Whitaker SB, Waldron CA. Central giant cell lesions of the jaws. A clinical, radiologic, and histopathologic study, 1993. Oral Surg Oral Med Oral Pathol, 75, 199-208.