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Aggressive CGCL Treatment — MFDS Part 1 MCQ

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HardOral PathologyAggressive CGCL TreatmentMFDS Part 1

A 29-year-old patient has a histologically confirmed central giant cell lesion of the mandible. Biochemical assessment has excluded hyperparathyroidism. Six months after curettage, the lesion has enlarged rapidly and now causes pain, root resorption and cortical perforation. The oral and maxillofacial surgery multidisciplinary team considers all the listed treatments technically feasible. Which treatment is most likely to provide the most durable local control?

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Correct answer: E — Segmental resection of the involved mandibular segment

The correct answer is E. Rapid growth, pain, root resorption, cortical perforation and early recurrence after curettage identify a high-risk aggressive central giant cell lesion. In this setting, segmental resection provides the most reliable local control; a large systematic review found greater recurrence after curettage, enucleation or marginal resection than after segmental resection. Repeat curettage alone is therefore inadequate salvage treatment. Intralesional corticosteroids and systemic agents such as denosumab can produce regression and may be considered to reduce surgical morbidity in selected patients, but their evidence base is predominantly case reports or series and they are not the most dependable sole treatment for this recurrent destructive lesion. Radiotherapy is not standard primary treatment for a resectable benign jaw lesion.

Reference: Chrcanovic BR, Gomes CC, Gomez RS. Central giant cell lesion of the jaws: An updated analysis of 2270 cases reported in the literature. Journal of Oral Pathology & Medicine. 2018;47(8):731-739. https://pubmed.ncbi.nlm.nih.gov/29751369/