Case Report: Denosumab in Maxillary Central Giant Cell Granuloma Initially Suspected as Cancer

Introduction: Central Giant Cell Granuloma (CGCG) is a benign osteolytic lesion of the jaw that can present with aggressive radiographic features such as cortical thinning, root resorption, tooth displacement, and ill-defined margins that mimic malignancy and risk misdiagnosis. While surgical management remains the first-line therapy for CGCG, this case covers the use of denosumab, which successfully prompted ossification and lesion regression without the need for disfiguring surgery.

Case Report: We report the unusual case of a 32-year-old Caucasian female who presented in April 2023 at an emergency dental appointment with a 5 x 3 cm firm, non-ulcerated right palatal mass and mobile upper right molars. CBCT and MRI demonstrated an ill-defined, expansile, vascular lesion of the right maxilla invading the sinus, nasal floor and pterygoid plates without orbital or intracranial extension. Deep biopsies were taken under GA via Caldwell-Luc and palatal incision. Histology reported a fibro-cellular stroma with numerous osteoclast-type giant cells. Giant cell tumour of bone, aneurysmal bone cyst and brown tumour were excluded by immunohistochemistry testing and blood tests. A multidisciplinary team (MDT) discussion confirmed the diagnosis of CGCG. Given the lesion’s size and location, systemic therapy with denosumab was initiated. Multiple CT scans indicated progressive ossification and reduction in lesion volume following administration of denosumab. At a 12-month follow-up after discontinuation of treatment, the lesion remained stable, with preserved dentition and no functional or aesthetic deficits.

Discussion: Our case illustrates the diagnostic dilemma in CGCG, necessitating deep surgical biopsy, comprehensive immunohistochemistry, and multidisciplinary team coordination to rule out malignancy. It also demonstrates denosumab as an effective, tissue-sparing alternative to the extensive resection typically carried out.