Injection of steroids intralesional in central giant cell granuloma cases (giant cell tumor): Is it free of systemic complications or not? A case report

• Central giant cell granuloma is considered one of the giant cell lesion affecting the oral cavity with variable histological forms; may be aggressive or non-aggressive.
• Many studies consider giant cell granuloma the same entity as giant cell tumor of long bones.
• Different treatment modalities arise due to its different histological and clinical behavior. Treatment may be medical or surgical.
• Intralesional injection is one of the medical lines used in management of CGCG; with high success and no side effects.
• In our clinical case, Cushing developed in 9 years old patient forced our team to shift toward surgical line and stop intralesional steroid injections.

Central giant tumors commonly occur in long bones. In the oral and maxillofacial region, a counterpart coined with the term Central giant cell granuloma exists. Choung and Kaban classified central giant cell granulomas based on clinical and radiographic findings. The classification includes aggressive and non-aggressive variants. However, to date there has been no molecular method of distinguishing the variants. Different lines of treatment had been reported. The aggressive form showed high recurrence rates with conservative surgical treatment. Intra-lesional steroid, calcitonin, interferon, bisphosphonates and denosumab; have been administered as a treatment lines. Several reports support the injection of intra lesional steroids and its successful outcome. An Egyptian, nine years old female presented with a facial swelling affecting lower left side of the mandible. Biopsy confirmed it to be a CGCG. The treatment plan was intralesional steroid injections to avoid resection of the mandible. The treatment showed acceptable progress but was associated with cushinoid appearance of patient. This forced the operating team to halt the steroid injections and resolute to adjunctive surgical curettage yet sparing the mandible from resection. One-year follow up showed no recurrence, however, the patient still suffers mild cushinoid appearance.