Unusual presentation of Aggressive Giant cell Granuloma with non-vital tooth Case report: The importance of using CBCT in diagnosis of the non-odontogenic lesions.
Author(s): Sandra HEl-khatib, Dontra BScott & Asgeir Sigurdsson
Introduction: This case reports a Central Giant Cell Granuloma (CGCG); a lesion that is uncommon, idiopathic, and benign. However, it can be quite invasive and has reported high rate of recurrence. Its radiographic similarity to routine inflammatory peri-radicular lesions can lead to not only delay in diagnosis, but also further delay in successful treatment.
Method: a 55-year-old Caucasian man presented with tenderness on palpation of the apical area of upper canine, patient had no other symptoms. A large periapical lesion associated with the canine and first premolar was realized on a periapical radiograph. Based on radiographic signs and symptoms the patient underwent regular endodontic treatment. During the endodontic visits, there was a suspicion of a more complex diagnosis. A CBCT taken that further increased the concern about the lesion such that a biopsy was thought to be needed.
Result: Evaluation of every single detail of a radiographic image, signs and symptoms must be taken in consideration. If there is a large radiolucent lesion on the radiographic image, CBCT image should be considered, which is a very versatile tool for early diagnosis of Odontogenic and Non–Odontogenic lesions especially with cases of unusual presentation. The Diagnosis is confirmed by histological biopsy and blood tests, which are important tools to diagnose the Giant Cell Granulomas.
Conclusion: The importance of computed tomography-guided biopsy in the diagnosis of such inaccessible lesions, cone beam images help in detecting cases misdiagnosed non-odontogenic lesions from the normal digital periapical radiograph films.