Fonseca, Felipe Paiva; Ribeiro, Ana Carolina Prado; Santos-Silva, Alan Roger dos; Vargas, Pablo Agustin; Lopes, Márcio Ajudarte

doi:10.1590/0103-6440201302196

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Original Articles • Braz. Dent. J. 24 (4) • July-Aug 2013 • https://doi.org/10.1590/0103-6440201302196 copiar

Fine Needle Aspiration Cytology and Intralesional Steroid Injection in a Central Giant Cell Granuloma Affecting the Gingiva: A New Clinical Approach

SCIMAGO INSTITUTIONS RANKINGS

O granuloma central de células gigantes (GCCG) é uma lesão benigna dos maxilares predominantemente encontrada na mandíbula de pacientes jovens do sexo feminino com um variado comportamento clínico. Apesar de o manejo cirúrgico representar a principal modalidade terapêutica para esta lesão, o uso de injeções intralesionais de esteróides tem sido recentemente proposto para seu tratamento. Além do manejo conservador, o uso da punção aspirativa por agulha fina (PAAF) para o diagnóstico do GCCG tem sido comprovado ser uma abordagem segura e eficiente, especialmente útil em casos de lesões localizadas em regiões estéticas. Descrevemos aqui um caso de GCCG estendendo-se para a gengiva adjacente em um paciente do sexo masculino, 15 anos de idade, diagnosticado por meio da PAAF e subsequentemente tratado com injeções intralesionais de uma solução de acetato de triancinolona e oleato de etanolamina que levou a uma importante remissão clínica, permitindo a realização de uma abordagem cirúrgica conservadora preservando a estética periodontal. Por este motivo, ambos os procedimentos podem ser considerados opções de manejo para o GCCG dos maxilares.

Authors	No. patients	Sex/Age	Administration and dose	Treatment length	Results	Follow-up
Present case (2013)	1	1M15 yrs	Intralesional injections of 0.3 mL of a solution consisting of a mixture of 40 mg/mL of triamcinolone and 2% lidocaine that was later substituted by ethanolamine oleate.	Six injections given in different intervals for 4 months	Partial remission	6 months
Ferretti C, et al. (2011)	1	1F16 yrs	Intralesional injection of 6 mL of local anesthetic and steroid solution (0.5% bupivacaine plus triamcinolone acetonide 40 mg/5 mL diluted to 5 mg/mL).	Injections given every two weeks for 4 weeks	Complete remission	4 yrs
Nogueira RLM, et al. (2010)	21	11M:10F15.5 yrs	Intralesional injection of 20 mg/mL triamcinolone hexacetonide diluted in an anesthetic solution of lidocaine 2%; 1.0 mL of the solution was infiltrated for every 1 cm³ of radiolucid area of the lesion.	Injections given every two weeks for 12 weeks	2 patients with no response4 patients with partial response15 patients with good response	3 to 8 yrs
Shirani G, et al (2010)	1	1F13 yrs	Intralesional injection of 40 mg/mL triamcinolone acetonide mixed with 5 cc Lidocaine 1%.	Injections given weekly for 6 weeks	Minimal response and presence of side effects.	10 months
Mohanty S, et al. (2009)	2	1F/1M10 yrs20 yrs	Intralesional injections of 4 mL (Case 1) or 6 mL (Case 2) mixture of triamcinolone acetonide plus lidocaine 2% (epinephrine 1:200,000).	Case 1: Injections given weekly for 5 weeksCase 2: Injections given weekly for 9 weeks	Case 1: Complete remissionCase 2: Good response, with relapse after 10 months and then complete remission	18 months13 months
Wendt FP, et al. (2008)	1	1F8 yrs	Intralesional injection of 2 mL solution consisting of equal parts of triamcinolone acetonide (10 mg/mL) and 0.5% bupivacaine.	Injections given weekly for 11 weeks	Complete remission	6 yrs
Grahan RM, et al. (2008)	1	1M6 yrs	Intralesional injections of an equal mixture of local anesthetic solution (levobupivacaine) and steroid solution (25 mg of triamcinalone acetonide).	Injections given every two weeks for 12 weeks	Partial remission	4 months
Vargas PA, et al. (2006)	1	1M14 yrs	Intralesional injections of a mixture of 1mL of triamcinolone acetonide and 1mL of lidocane 2%.	Injections given for 6 weeks	Complete remission	5 yrs
Comert E, et al. (2006)	1	1M4 yrs	Intralesional injections of 60 mg prednisolone, 40 mg lidocaine and 0.025 mg adrenaline plus 30 mg oral fluocortone.	Injections given weekly for 2 months	Platelet increasePartial remission	3 yrs
Sezer B, et al. (2005)	1	1M11 yrs	Intralesional injection of 5 mL solution consisting of equal parts of triamcinolone acetonide (10 mg/mL) and 2% lidocaine (epinephrine 1:200,000).	Injections given monthly for 6 months	Complete resolution	3 yrs
Abdo EN, et al. (2005)	1	1F14 yrs	Intralesional injections of corticosteroid.	Injections given weekly for 3 weeks	Complete remission	18 months
Carlos R, et al. (2002)	4	1F/3M34.5 yrs	Intralesional injections of 10 mg/mL triamcinolone and either Lidocaine 2% (epinephrine 1:200,000) or Bupivacaine 0.5%. The average dosage was 6 mL for adults and 5 mL for children.	Case 1: Injections given every 3 weeks for 60 weeksCase 2: Injections given every 2 weeks for 34 weeksCase 3: Injections given every 2 weeks for 8 weeksCase 4: Injections given every 2 weeks for 8 weeks	Case 1: Complete remissionCase 2: Complete remissionCase 3: Partial remissionCase 4: Complete remission	Case 1: 7 yrsCase 2: 6 yrsCase 3: 6 yrsCase 4: 2 yrs
Adornato MC, et al. (2001)	1	1F10 yrs	Intralesional injections of a mixture of 7 cm³ of triamcinolone acetonide and Bupivacaine 0.5% (epinephrine 1:200,000) on the first and second appointments. On the other appointments, it was used 6 cm³ of the mixture.	Injections given weekly for 6 weeks	Partial remission	7 months
Kurtz M, et al. (2001)	1	1F10 yrs	Intralesional injections of 15 cm³ of 10 mg/cm³ of triamcinolone acetonide.	Injections given weekly for 12 weeks	Complete remission	1 yr
Khafif A, et al. (2000)	1	1F36 yrs	Intralesional injections of 40 mg triamcinolone acetonide and Bupivacaine 0.5%.	Injections given weekly for 6 weeks	Complete remission	2 yrs
Rajeevan NS, et al. (1998)	1	1F17 yrs	Intralesional injections of 2 mL of a mixture of triamcinolone acetonide 10 mg and Lidocaine 0.5% into every 2 cm of the lesion.	Injections given weekly for 6 weeks	Complete remission	10 months
Terry BC, et al. (1994)	4	NS	Intralesional injections of triamcinolone acetonide 10 mg/mL and Bupivacaine 0.5%.	Injections given weekly for 6 weeks	Complete resolution	16 to 36 months
Kermer C, et al. (1994)	1	1M40 yrs	Intralesional injections of 3 mL of a mixture of 10 mg triamcinolone acetonide and Lidocaine 0.5%.	Injections given weekly for 6 weeks	Complete remission	3 yrs
Platt JC, et al (1993)	1	1F14 yrs	Intralesional injections of 20 mL of a solution of 10 mg/mL triamcinolone and Bupivacaine 0.5% (epinephrine 1:200,000) per 2 cm of radiolucency.	Injections given weekly for 2 weeks	No response	NS
Jacoway JR, et al. (1988)	3	NS	Intralesional injections of 20 mL of a solution of 10 mg/mL triamcinolone and Bupivacaine 0.5% (epinephrine 1:200,000) per 2 cm of radiolucency.	Injections given weekly until bone regeneration be noted radiographically	Complete response	2 yrs
Body JJ, et al. (1981)	1	1M37 yrs	Systemic administration of dexamethasone, 20 mg/day during 21 days; 15 mg during 10 days; 15 mg/every other day during 10 days; 5 mg/every other day during 15 days and 10 mg/every other day during 21 days.		Partial remission followed by relapse and side-effects due to steroid use	6 weeks

Authors	Lesions evaluated	No. of cytological diagnosis of GCG	No. of cases histologically confirmed	Sex/Age (yrs)	Site	Cytological description	Staining
Present case (2013)	1	1	1	1M/15 yrs	Mandible	Numerous multinucleated giant cells in a hemorrhagic background	Diff-Quik and Papanicolaou
Ghandi S, et al. (2011)	44	3	3	NS/NS	NS	NS	May-Grünwald-Giemsa and Papanicolaou
Baykul T, et al. (2010)	100	9	9	NS/NS	NS	NS	Hematoxilin-eosin and Papanicolaou
Vargas PA, et al. (2006)	3	3	3	1M:2F/17 yrs	3 Maxilla	Numerous multinucleated giant cells and macrophages in a hemorrhagic background	May-Grünwald-Giemsa and Papanicolaou
Gupta K, et al. (2004)	5	5	5	5F/34.6 yrs	2 Maxilla3 Mandible	Clusters of round mononuclear cells and scattered multinucleated giant cells	May-Grünwald-Giemsa and Hematoxilin-eosin
August M, et al. (1999)	30	2	2	NS/NS	NS	Mononuclear cells and multinucleated giant cells	Diff-Quik, Wright-Giemsa and Papanicolaou
Alatli C, et al. (1999)^* * Peripheral lesions; NS: Not specified.	90	29	29	NS	NS	Mesenchymal cells and giant cells of the osteoclastic type	May-Grünwald-Giemsa and Papanicolaou
Castro WH, et al. (1998)	4	4	4	4F/21.8 yrs	3 Mandible1 Maxilla	Mononuclear cells associated with many multinucleated giant cells	Papanicolaou
Platt JC, et al. (1993)	4	1	1	1F/14yrs	Mandible	Sheets of fibroblasts and numerous multinucleated histiocytes	Diff-Quik and Papanicolaou
Dakalopol D, et al. (1997)^* * Peripheral lesions; NS: Not specified.	1022	2	1	NS	NS	NS	Giemsa-quick stain, May-Grünwald-Giemsa and Papanicolaou
Kaw YT. (1994)	2	2	2	1M:1F/14 yrs	2 mandible	Moderately cellular smears with multinucleated giant cells and mononuclear cells	Diff-Quik and Papanicolaou
Günhan Ö, et al. (1993)	102	6	5	NS	NS	Proliferative lesion with benign giant cells	Hematoxilin-eosin and Papanicolaou
Ramzy I, et al. (1985)	23	1	1	NS	NS	Abundant spindle cells and multinucleated giant cells, lymphocytes and neutrophils	Papanicolaou

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[1] Correspondence: Prof. Dr. Márcio Ajudarte Lopes, Avenida Limeira, 901, 13414-903 Piracicaba, SP, Brasil. Tel.: +55-19-2106-5320. e-mail: malopes@fop.unicamp.br