Age and Expression of CD163 and Colony-Stimulating Factor 1 Receptor (CD115) Are Associated With the Biological Behavior of Central Giant Cell Granuloma.
OBJECTIVE
Central giant cell granulomas (CGCGs) are clinically classified as nonaggressive (nA-CGCGs) and aggressive (A-CGCGs). However, histopathologically, all lesions feature spindle mononuclear cells (MCs) and multinuclear giant cells (GCs) in a hemorrhage-rich stroma. We aimed to investigate the presence of cells with a monocyte- or macrophage-related phenotype and, together with clinical variables, to examine their predictive potential for the biological behavior of CGCGs.


METHODS
For our investigation, we implemented a retrospective cohort study. Sections were immunohistochemically stained for colony-stimulating factor 1 receptor (CSF-1R) (CD115), CD163, CD68, and nuclear factor κB. The clinical variables included age, gender, and location of lesions. Associations between immunostains, clinical variables, and CGCG aggressiveness were analyzed by the Wilcoxon (Mann-Whitney) exact test and t test. Significant variables were further analyzed by a logistic regression model followed by receiver operating characteristic (ROC) curve analysis for diagnostic sensitivity. Significance was set at P < .05.


RESULTS
Patients with A-CGCGs (n = 36) were younger than those with nA-CGCGs (n = 31) (P = .002). Logistic regression showed that CD163-GC (β = -0.870, P = .031) and CD115-MC (β = -0.783, P = .027) had a significant protection effect (odds ratio, 0.419 [95% confidence interval, 0.190 to 0.925], and odds ratio, 0.457 [95% confidence interval, 0.229 to 0.913], respectively). ROC curve analysis showed that CD163-GC and CSF-1R (CD115)-MC combined were the best predictor in distinguishing nA-CGCGs from A-CGCGs (area under ROC curve, 0.814; P < .001). At the optimal cutoff value (0.408), sensitivity was 87% and specificity, 65%.


CONCLUSIONS
Increasing age and high expression of CD163-GC and CSF-1R (CD115)-MC can serve as significant predictors of nA-CGCGs. A functional link between CD163-GC and the characteristic areas of extravasation of erythrocytes is discussed.
Lecturer, Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: dr.adykahn@gmail.com.
Adrian
A
Kahn
Associate Professor and Head, Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel; and Head, Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Petah Tikva, Israel.
Gavriel
G
Chaushu
Student (as part of fulfillment of DMD degree), School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
Lana
L
Ginene
Associate Professor and Head, Department of Oral Pathology and Oral Medicine, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
Marilena
M
Vered
D000328:Adult; D015703:Antigens, CD / Q000096:biosynthesis*; D015214:Antigens, Differentiation, Myelomonocytic / Q000096:biosynthesis*; D015331:Cohort Studies; D005260:Female; D006101:Granuloma, Giant Cell / Q000378:metabolism* / Q000473:pathology*; D006801:Humans; D007571:Jaw Diseases / Q000378:metabolism* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016186:Receptor, Macrophage Colony-Stimulating Factor / Q000096:biosynthesis*; D011956:Receptors, Cell Surface / Q000096:biosynthesis*; D012189:Retrospective Studies; D000098902:CD163 Antigen
D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D000098902:CD163 Antigen; D011956:Receptors, Cell Surface; D016186:Receptor, Macrophage Colony-Stimulating Factor