giant cell tumor ( gct ) is an aggressive but benign neoplasm containing spindle - shaped stromal cells , mononuclear round to oval cells resembling histiocytes and abundant evenly distributed osteoclastic giant cells . the frequency of occurrence is 25% in the epiphyses of long bones and 2% in the craniofacial bones . we report a rare case of gct of the mandible in a young patient causing massive resorption . a 12-year - old female patient was referred to the department of oral and maxillofacial surgery with a complaint of painless swelling of the lower jaw . the patient had noticed the swelling 4 years back which gradually increased to the present size . extraoral examination revealed the presence of an asymmetric swelling of the mandible causing deviation of the chin to the right side . the jaw movements and the temporomandibular joint ( tmj ) movements were normal [ figure 1 ] . on intraoral examination , the swelling was seen to extend from the right angle to the ramus on the left side . the teeth present were 33 , 36 , 41 , 42 , 43 , 45 and 46 with multiple missing teeth and displacement of 33 , 41 , 42 and 43 [ figure 2 ] . extraoral swelling exhibiting asymmetry and deviation of the chin intraoral view of the swelling orthopantomograph ( opg ) revealed a multilocular radiolucency extending from the right ramus to the left ramus region with an expansile swelling in the lower border of the mandible [ figure 3 ] . apart from the teeth present clinically , impacted second permanent molars on both sides as well as an impacted paramolar on the right side were discerned . displacement of 33 , 41 , 42 and 43 and resorption of roots of 41 , 42 , 43 , 36 and 46 could be appreciated . preoperative orthopantomograph exhibiting an expansile swelling of the lower border of the mandible visor incision was placed , layer by layer dissection was performed at the subplatysmal layer and flap was elevated to explore the mandible from the right to left condylar region . facial artery and vein the affected portion of the body of the mandible was resected from right to left subcondylar region after making bilateral osteotomy cuts . right fibular graft harvested by the plastic surgery team was osteotomized at the bilateral canine region , adapted to the titanium reconstruction plate and fixed with screws . it was closed with 3 - 0 vicryl suture and 4 - 0 ethilon sutures . a specimen x - ray was taken which revealed similar radiologic findings as the preoperative opg [ figure 4 ] . the cut section shows areas of yellowish white coloration along with pale hemorrhagic areas with rough borders . it was creamy white in color , hard in consistency , measured 2.7  2.3 cm in dimension and contained the second permanent molar . radiograph of the resected specimen grossing of the specimen the histopathological examination of the soft tissue revealed a richly cellular stroma comprising of plenty of evenly distributed multinucleated giant cells [ figure 6 ] . high power view showed multinucleated giant cells with agglomeration of around 2550 nuclei in center surrounded by clear cytoplasm , the proliferating stromal cells were hyperchromatic and pleomorphic [ figures 8 and 9 ] . decalcified section of the specimen with impacted teeth showed dentin , bony trabeculae and myeloid tissue . the serum calcium levels and alkaline phosphatase levels were evaluated to rule out hyperparathyroidism . a richly cellular stroma with evenly dispersed giant cells ( h&e , x40 ) areas of pathologic resorption of bone ( h&e stain , x200 ) giant cells with agglomeration of nuclei in the center ( h&e stain , x400 ) a composite photomicrograph of four different fields exhibiting cellular stroma with giant cells ( h&e stain , x100 ) . inset of each image shows high power view of the giant cell in the particular field ( h&e stain , x400 ) based on the characteristic appearance of giant cells , stromal cells findings and lab investigations ; a diagnosis of gct was given . gct makes up 4.95% of all osseous neoplasms , 21.87% of the benign tumors of bone and head and neck region accounts for 2% of all gcts.;most of the lesions occur in the ethmoid , sphenoid and temporal bones ; the occurrence in the mandible is less than 2% . this is in concurrence with the cases reported to have occurred in jaw bones in the literature ( based on pubmed search engine ) . the symptoms were pain , swelling of the affected region , weakness and limitation of the jaw movement associated with elicitation of moderate tenderness and eggshell crackling . the case was painless with swelling of the affected region without limitation of the jaw movements . eggshell crackling was elicited , but the case did not exhibit tenderness , pathologic fracture or atrophy of muscles . the typical radiologic features are an expanding zone of radiolucency either eccentric or central with either cortical thinning or involvement of the soft tissue without a sclerotic margin similar radiologic features are observed in our case which had a multilocular radiolucency with poor margination evincing a stretching of the lower border of the mandible . the gross appearance exhibits chocolate brown or greyish white foci with yellowish discoloration interspersed with hemorrhagic or cystic areas with a soft and friable consistency . the characteristic histopathology of gct is well - appreciated in the histopathology of the case being discussed . the differential diagnoses include central giant cell granuloma ( cgcg ) , aneurysmal bone cyst , hyperparathyroidism and other giant cell lesions . the frequently described histological differences between the gct and cgcg are;(i ) the rounded , larger giant cells which are uniformly dispersed with an increased number of nuclei which tends to aggregate centrally in the gct , ( ii ) fresh hemorrhage and hemosiderin deposits and inflammatory component being found more commonly in the cgcg than in the gct , ( iii ) osteoid or new bone formation and increased number of spindled fibroblasts with areas of fibrosis in the cgcg and ( iv ) the presence of necrotic areas in the gct , but not in the cgcg . characteristic differences between giant cell tumor and central giant cell granuloma the stroma of the case was very cellular with an almost even distribution of giant cells . the striking feature was that the giant cells exhibited a general tendency towards central aggregation of nuclei with a peripheral zone of eosinophilic cytoplasm . the histopathological features observed were in favor of gct . the normal serum calcium and alkaline phosphatase levels found in our case ruled out hyperparathyroidism . in aneurysmal bone cyst and other such lesions , giant cells are found close to areas of hemorrhage ; whereas in our case , the giant cells were evenly distributed . the case underwent resection from right to left subcondylar region . the documented recurrence in the literature after these range from benign lesions such as ossifying fibroma to locally aggressive lesions like cgcg , aneurysmal bone cyst , high - grade sarcomas and also metabolic disorders such as hyperparathyroidism which is disguised by masses of reactive osteoclast - like giant cells . careful histopathological examination is emphasized on with exclusion of other possible lesions to arrive at the appropriate diagnosis . the case being discussed was in a 12-year - old female , the age being concurrent with cases occurring in the jaw and in accordance with the female predilection usually observed . histopathologically , the even distribution of giant cells throughout the cellular stroma composed of hyperchromatic and pleomorphic cells , the giant cells with central aggregation of nuclei close to 2550 all led to the diagnosis being made in favor of gct of the mandible .
giant cell tumor ( gct ) of bone is a distinctive neoplasm characterized by abundance of multinucleated giant cells scattered throughout the stroma of mononuclear cells . 
 its importance lies in recognizing and differentiating the characteristic histology , which at times may mimic several other bone tumors and endocrine disorders ranging from locally aggressive giant cell granulomas to hyperparathyroidism to malignant tumors . 
 the jaw bones account for less than 1% of the lesion . 
 ina literature search , we found only five cases of gct of jaw bones based on the new criteria . 
 we present a rare case of gct of the mandible which occurred in a 12-year - old female .