Management of central giant cell granuloma with subcutaneous denosumab therapy

In recent years, the treatment of central giant cell granuloma (CGCG) has become focused on the inhibition of osteoclast differentiation and proliferation. Medications that were developed for the treatment of giant cell tumor of bone and bone resorption from metastatic skeletal disease have shown some success in the treatment of CGCG. The present report describes 2 cases of CGCG of the mandible that were treated effectively with subcutaneous denosumab.

Two cases of histologically diagnosed CGCG of the mandible were treated with monthly subcutaneous injections of denosumab 120 mg primarily or after intralesional corticosteroid therapy. Clinical and radiographic follow-ups were recorded over a period of 24 months (case 1) and 15 months (case 2).

In the 2 cases, progressive radiodensity and osseous regeneration were noted 4 to 6 months after denosumab therapy was initiated. A decrease in lesion size and improvement in bone contour and facial symmetry were seen in the 2 cases.

The major radiographic, clinical, and histologic responses seen in these 2 cases suggest that denosumab may represent a viable alternative or adjunctive procedure to eliminate or decrease the extent of surgical intervention and morbidity in the treatment of CGCG. Future prospective studies with a larger sample would provide more comprehensive information about the long-term effects and possible adverse side effects of treating CGCG of the jaws with denosumab.