[Central giant cell granuloma and osteitis fibrosa cystica of hyperparathyroidism. A challenge in differential diagnosis of patients with osteolytic jawbone lesions and a history of cancer].
BACKGROUND
Giant cell lesions of the bone present similar histological features. The differential diagnosis comprises central giant cell granuloma, giant cell tumor of bone, and osteitis fibrosa cystica (brown tumor) in combination with hyperparathyroidism. Since these lesions may mimic metastatic bone disease in patients with a history of cancer, a malignant process has to be considered. Since the treatment and prognosis of these entities-benign versus malignant osteolytic bone processes-differ greatly, definitive differential diagnosis is of utmost importance.


METHODS
Two patients presenting with osteolytic lesions of the maxilla are reported here. In both cases a history of cancer (breast and prostate) suggested bone spreading of these malignant tumors. The clinical and histological findings were similar in both patients. One lesion was diagnosed as central giant cell granuloma, the other was found to be brown tumour in osteitis fibrosa cystica as an initial manifestation of hyperparathyroidism.


CONCLUSIONS
The presented cases demonstrate the difficulties in establishing the correct diagnosis of patients found to have osteolytic lesions of the jawbones which is critical for the appropriate management of these patients. The article discusses the different entities of osteolytic lesions of the jawbones and the necessary diagnostic and therapeutic approach.
Klinik und Poliklinik für Mund-, Kiefer-, Gesichtschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg. Michael.Thorwarth@mkg.imed.uni-erlangen.de.
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Thorwarth
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Rupprecht
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Kessler
D000236:Adenoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D006101:Granuloma, Giant Cell / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008297:Male; D008437:Maxilla / Q000473:pathology / Q000601:surgery; D008439:Maxillary Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008441:Maxillary Neoplasms / Q000175:diagnosis / Q000556:secondary; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D010002:Osteitis Fibrosa Cystica / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010014:Osteolysis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D016105:Parathyroidectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery