Thorwarth M, Rupprecht S, Schlegel A, Neureiter D, Kessler P
Klinik und Poliklinik für Mund-, Kiefer-, Gesichtschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg.
Mund Kiefer Gesichtschir. 2004 Sep;8(5):316-21. doi: 10.1007/s10006-004-0556-6. Epub 2004 Jul 29.
Giant cell lesions of the bone present similar histological features. The differential diagnosis comprises central giant cell granuloma, giant cell tumor of bone, and osteitis fibrosa cystica (brown tumor) in combination with hyperparathyroidism. Since these lesions may mimic metastatic bone disease in patients with a history of cancer, a malignant process has to be considered. Since the treatment and prognosis of these entities-benign versus malignant osteolytic bone processes-differ greatly, definitive differential diagnosis is of utmost importance.
Two patients presenting with osteolytic lesions of the maxilla are reported here. In both cases a history of cancer (breast and prostate) suggested bone spreading of these malignant tumors. The clinical and histological findings were similar in both patients. One lesion was diagnosed as central giant cell granuloma, the other was found to be brown tumour in osteitis fibrosa cystica as an initial manifestation of hyperparathyroidism.
The presented cases demonstrate the difficulties in establishing the correct diagnosis of patients found to have osteolytic lesions of the jawbones which is critical for the appropriate management of these patients. The article discusses the different entities of osteolytic lesions of the jawbones and the necessary diagnostic and therapeutic approach.
骨巨细胞病变具有相似的组织学特征。鉴别诊断包括中央性巨细胞肉芽肿、骨巨细胞瘤以及与甲状旁腺功能亢进相关的纤维囊性骨炎（棕色瘤）。由于这些病变可能在有癌症病史的患者中模仿骨转移疾病，因此必须考虑恶性病变。由于这些实体（良性与恶性溶骨性骨病变）的治疗和预后差异很大，明确的鉴别诊断至关重要。
本文报告了两名上颌骨溶骨性病变患者。在这两个病例中，癌症（乳腺癌和前列腺癌）病史提示这些恶性肿瘤发生了骨转移。两名患者的临床和组织学表现相似。其中一个病变被诊断为中央性巨细胞肉芽肿，另一个被发现是纤维囊性骨炎中的棕色瘤，为甲状旁腺功能亢进的初始表现。
所呈现的病例表明，对于颌骨溶骨性病变患者，准确诊断存在困难，而这对于这些患者的恰当管理至关重要。本文讨论了颌骨溶骨性病变的不同类型以及必要的诊断和治疗方法。
