Gigantiform cementoma

Last updated
Gigantiform cementoma
Specialty Dentistry

Gigantiform cementoma is a rare, autosomal dental tumor. [1] The tumor is benign, but without intervention it can result in severe disfigurement of the jaw and of the facial skeleton. It is commonly found in the mandible and the maxilla but it is less commonly found in the maxilla. The tumor can be found between the premolars and the molars. The cause of this tumor is currently unknown but there has been new research that there is an overlap between gigantiform cementoma and Gnathodiaphyseal dysplasia (GDD).This is an exceedingly rare tumor with only a handful of documented cases worldwide. The most famous case is of Novemthree Siahaan (who died on September 15, 2005), a young Indonesian boy from Batam Island who received medical care in Haulien, Taiwan through a Buddhist missionary from the Tzu Chi Foundation, which was documented on the Discovery Health Channel. Another famous case is a young Korean girl named Ayun Lee (August 26, 2003~) and her father Young-hak Lee whose case has shown that the tumor can be heritable. She is currently under treatment, which she may need to continue until her growth stops in her early 20s. Cases like Novemthree Siahann and Ayun Lee are included to illustrate the condition's worldwide and heritable nature. It is seen mostly in females with a mean age of 42 years old. [1] The condition typically affects adults between the ages of 20 and 50, which there is a higher incidence in women compared to men. Although it can technically occur in both males and females, it is more frequent in females. There is a chance to get passed down but in recent research it is said that most cases are sporadic and not inherited. The term has been used in the past to describe florid cemento-osseous dysplasia, but it is now reserved for an autosomal dominant condition affecting the maxillae. There is still not enough research to confirm whether it predominately affects on specific group but it is a rare condition and it is not strictly associated with any one ethic group. Treatment is difficult. Surgical removal of the affected bone is needed, and has to be followed by reconstruction.

Contents

Symptoms

Symptoms of Gigantiform cementoma usually occurs in the adolescent age which is from 10-19 years old, and in some cases, it may not be detected or diagnosed in later in life. It has a rapid growth of a tumor that causes the expansion of the maxilla and mandible that results in the deformity of the facial skeleton and malocclusion. [2] A person might seek medical attention if the jaw is swollen and having pain and discomfort. The short term symptoms may be swelling in the jaw and or can cause pain due to the swelling in the jaw. A tumor growing in the jaw can cause there to be a shift in the teeth or even become loose. With a tumor growing in the jaw it can affect the nerves, specifically the trigeminal nerves. The trigeminal nerve consist of three branches, Ophthalmic (V1) nerve, Maxillary (V2) nerve and Mandibular (V3) nerve and each of these have different functions. These are important because it helps with a person to chew food and they run throughout the face. [3] Long terms symptoms and complications over time would be similar to short term such as pain throughout the jaw, change in the alignment of the teeth. The tumor can grow very large and it can affect the appearance of the face. There is always a slight chance reoccurring can occur. [4]

Lower jaw swollen Progressive migrating tumours, presented as swollen manifest Wellcome V0036267EL.jpg
Lower jaw swollen

Cause and Prevention

The cause of Gigantiform cementoma was unknown in previous years but there is a new studies that the gene ANO5 also known as TMEM16E has been linked to mutations. The ANO5 gene encodes a protein called Anoctiamin-5 which is involved with physiological processes that includes ion channel regulation and cell signaling. With the new research there can be genetic testing done for diagnosis. This can help with early detection, close monitoring and treatment plan. There is only a handful of documented cases worldwide. It is an autosomal dominant genetic disorder meaning both females and male are able to develop the tumor. There is a higher incidence in women than men. [5]

Pathophysiology/ Mechanism

The rare benign tumor is an autosomal dominant disorder and there are some cases that are sporadic having no family history with the disorder, meaning it can be due to a spontaneous mutation. But there are some cases where the parent passed down the disorder, it is just a slight chance that it can occur. It is classified as a benign fibro-osseous lesion of the jaw, which means it contains both fibrous tissue and bone like structures. The tumor is a slow growing lesion that can cause the maxilla and the mandible to expand causing a shift in the teeth. There is an inflammatory response due to the tumor leading to discomfort and pain of the jaw. The tumor also affects the growth of the jaw. In early adolescent years the tumor can go undetected because the tumor cannot cause complications until it has grown at a large size. The tumor affects the jaw, which is more commonly found in the mandible and there has been hardly any cases with the maxillary but it can still happen. [6]

Diagnosis

Panoramic X-ray with a view of the jaw and teeth Basic panoramic radiograph.jpg
Panoramic X-ray with a view of the jaw and teeth
Cone Beam Computed Tomography (CBCT) gives a 3D view of the jaw and of a specific area Tooth decay and abscess xray.png
Cone Beam Computed Tomography (CBCT) gives a 3D view of the jaw and of a specific area

Once a person is having symptoms related to Gigantiform cementoma it is suggest to seek medical attention. The health providers that can help would be a Dentist, Oral Surgeon, Oral Pathologist, and Prosthodontist. A dentist can do an exam and take x-rays to evaluate symptoms and to be able to refer the patient to the correct specialist. An Oral Surgeon are specialized with surgical procedures related to the mouth, jaw and the face. An Oral Pathologist is able to help with diagnosis by examining the tissues samples in order to diagnosis and treat diseases related the jaw, and mouth. Prosthodontist are able to aid with the missing teeth. The doctors specialize with dental prosthetics. In order to diagnosis a patient with Gigantiform cementom there has to be X-ray done that provides the doctor with the view of the jaw and the teeth to identify the tumor and to also be able to see the size of the tumor. There are different types of X-rays that can be done which are the Panoramic Radiograph and Cone Beam Computed Tomography (CBCT). Biopsy may be suggested by an Oral Surgeon to be able to collect tissues from the tumor to get samples for histological examine, this is necessary to confirm diagnosis. Blood test can also be done to confirm diagnosis.

Treatment

The recommend treatment for Gigantiform cementoma is surgery and reconstruction of the jaw. The surgery will remove the tumor, the affected bone and teeth which is then followed by reconstruction of the jaw. Gigantiform cementoma affects the jaw and has a rapid growth and can be found in multiple quadrants and has high reoccurring rates. Therefore the goal for treatment is to be able to reset the lesion, preserve the jaw and help restore its function, reduce complications and simply to improve/maintain the patients quality of life. The reconstruction is necessary after the surgery which involves the implant and virtual surgical planning. It is also important to know that it is a rare, benign tumor and it has high reoccurring rates. [7]

Prognosis

The tumor occurs in 3 stages. At the age between 11 and 13 is the range of age where people tend to develop the tumor. By the age 16 the tumor has expanded quickly and there's growth suppression around the age 18-20 years of age. There has been a handful amount of cases that have been reported. There is a slight chance it can be inherited because it is an autosomal disorder which means that a single copy of the mutant allele is present. Both females and males can both can be equally affected but there is a higher chance of occurring in females. It is possible for recurrence because during the skeletal growth of lesions are more cellular and biologically active and it has high chances of recurring even after surgery. It is a benign tumor which does not pose a direct threat to a patient's life but it all depends on the size of it. In the beginning it is not that big and it should not bother the patient but it does expand rapidly and it will start to bother the patient. It will start to feel the swelling around the jaw and the teeth will shift. Life for young adolescents will be difficult with these changes that can grow fast and big in a short period of time. Since there are not a lot of cases more information on prognosis is limited. [5]

Epidemiology

As stated before this is a rare tumor that the epidemiology reflects the rarity of it. There if only a handful of cases and some of them have been discovered by accident during dental exams. The ages ranges from early childhood to early adulthood which most cases ranged from 10 to 50 years of age with a mean of 42 years old. This can be seen more in females than males but this does not mean it cannot affect males at well. There is no strong link with any specific ethnicity or race. There has been more sporadic cases than familial cases, but it does not mean it can not be passed down. The gigantiform cementoma typically affects the mandible compares to the maxilla and causes a significant jaw expansion which can be involved in multiple quadrants of the jaw. There has been high recurrence rates because there is a rapid expansion of the tumor which can cause a difficult surgery when trying to remove it. If the surgeons are not able to completely remove the tumor it will cause reoccurrence and a rapid regrowth of the tumor. [8] It has used to bean unknown rare autosomal genetic disease. [9] But in recent studies there has been a link with the ANO5 mutations. [5]

Research Directions

In recent research there has been a link between the ANO5 gene. The gene is involved in various physiological process such as ion channel regulation and cell signaling. This is exciting news because now there is an actual link to the gene meaning there can be genetic testing to have early genetic diagnosis and can help with identify patients who are at risk before the symptoms worsen. Scientist can be able to do research on how the gene works to be able to target directly the gene mutation or be able to come up with a treatment. This is a great start to understand the sporadic cases that occur around the world. [5] Gigantiform cementoma was first discovered roughly during the 1930 and just in 2023 there has been new research on how it can be linked to the ANO5 gene, and this is only the beginning.

Related Research Articles

<span class="mw-page-title-main">Gardner's syndrome</span> Medical condition

Gardner's syndrome is a subtype of familial adenomatous polyposis (FAP). Gardner syndrome is an autosomal dominant form of polyposis characterized by the presence of multiple polyps in the colon together with tumors outside the colon. The extracolonic tumors may include osteomas of the skull, thyroid cancer, epidermoid cysts, fibromas, as well as the occurrence of desmoid tumors in approximately 15% of affected individuals.

<span class="mw-page-title-main">Prolactinoma</span> Pituitary gland tumor which secretes the hormone prolactin

A prolactinoma is a tumor (adenoma) of the pituitary gland that produces the hormone prolactin. It is the most common type of functioning pituitary tumor. Symptoms of prolactinoma are due to abnormally high levels of prolactin in the blood (hyperprolactinemia), or due to pressure of the tumor on surrounding brain tissue and/or the optic nerves. Based on its size, a prolactinoma may be classified as a microprolactinoma or a macroprolactinoma.

<span class="mw-page-title-main">Familial adenomatous polyposis</span> Pre-cancerous intestinal polyps

Familial adenomatous polyposis (FAP) is an autosomal dominant inherited condition in which numerous adenomatous polyps form mainly in the epithelium of the large intestine. While these polyps start out benign, malignant transformation into colon cancer occurs when they are left untreated. Three variants are known to exist, FAP and attenuated FAP are caused by APC gene defects on chromosome 5 while autosomal recessive FAP is caused by defects in the MUTYH gene on chromosome 1. Of the three, FAP itself is the most severe and most common; although for all three, the resulting colonic polyps and cancers are initially confined to the colon wall. Detection and removal before metastasis outside the colon can greatly reduce and in many cases eliminate the spread of cancer.

<span class="mw-page-title-main">Treacher Collins syndrome</span> Human genetic disorder

Treacher Collins syndrome (TCS) is a genetic disorder characterized by deformities of the ears, eyes, cheekbones, and chin. The degree to which a person is affected, however, may vary from mild to severe. Complications may include breathing problems, problems seeing, cleft palate, and hearing loss. Those affected generally have normal intelligence.

<span class="mw-page-title-main">Crouzon syndrome</span> Genetic disorder of the skull and face

Crouzon syndrome is an autosomal dominant genetic disorder known as a branchial arch syndrome. Specifically, this syndrome affects the first branchial arch, which is the precursor of the maxilla and mandible. Because the branchial arches are important developmental features in a growing embryo, disturbances in their development create lasting and widespread effects. The syndrome is caused by a mutation in a gene on chromosome 10 that controls the body's production of fibroblast growth factor receptor 2 (FGFR2).

<span class="mw-page-title-main">Ameloblastoma</span> Tumor made of enamel-producing cells (ameloblasts) in developing teeth

Ameloblastoma is a rare, benign or cancerous tumor of odontogenic epithelium much more commonly appearing in the lower jaw than the upper jaw. It was recognized in 1827 by Cusack. This type of odontogenic neoplasm was designated as an adamantinoma in 1885 by the French physician Louis-Charles Malassez. It was finally renamed to the modern name ameloblastoma in 1930 by Ivey and Churchill.

<span class="mw-page-title-main">Cherubism</span> Medical condition

Cherubism is a rare genetic disorder that causes prominence in the lower portion in the face. The name is derived from the temporary chubby-cheeked resemblance to putti, the chubby-faced infants featured in Renaissance paintings, which were often mistakenly described as cherubs.

<span class="mw-page-title-main">Metachondromatosis</span> Medical condition

Metachondromatosis is an autosomal dominant, incompletely penetrant genetic disease affecting the growth of bones, leading to exostoses primarily in the hands and feet as well as enchondromas of long bone metaphyses and iliac crests. This syndrome affects mainly tubular bones, though it can also involve the vertebrae, small joints, and flat bones. The disease is thought to affect exon 4 of the PTPN11 gene. Metachondromatosis is believed to be caused by an 11 base pair deletion resulting in a frameshift and nonsense mutation. The disease was discovered and named in 1971 by Pierre Maroteaux, a French physician, when he observed two families with skeletal radiologic features with exostoses and Ollier disease. The observation of one family with five affected people led to the identification of the disease as autosomal dominant. There have been less than 40 cases of the disease reported to date.

<span class="mw-page-title-main">Cleidocranial dysostosis</span> Birth defect of the collarbones, skull, and teeth

Cleidocranial dysostosis (CCD), also called cleidocranial dysplasia, is a birth defect that mostly affects the bones and teeth. The collarbones are typically either poorly developed or absent, which allows the shoulders to be brought close together. The front of the skull often does not close until later, and those affected are often shorter than average. Other symptoms may include a prominent forehead, wide set eyes, abnormal teeth, and a flat nose. Symptoms vary among people; however, intelligence is typically unaffected.

<span class="mw-page-title-main">Nevoid basal-cell carcinoma syndrome</span> Medical condition

Nevoid basal-cell carcinoma syndrome (NBCCS) is a rare inherited medical condition involving defects within multiple body systems such as the skin, nervous system, eyes, endocrine system, and bones. People with NBCCS are prone to developing various cancers, including a common and usually non-life-threatening form of non-melanoma skin cancer called basal-cell carcinomas (BCCs). Only about 10% of people with the condition do not develop BCCs; the vast majority of patients develop numerous BCCs.

Macrodontia is a type of localized gigantism in which teeth are larger than normal. Macrodontia seen in permanent teeth is thought to affect around 0.03 to 1.9 percent of the worldwide population. Generally, patients with macrodontia have one or two teeth in their mouth that is abnormally large; however, single tooth growth is seen in a number of cases as well.

<span class="mw-page-title-main">White sponge nevus</span> Benign lesions on the insides of the cheeks

White sponge nevus (WSN) is an extremely rare autosomal dominant condition of the oral mucosa. It is caused by one or more mutations in genes coding for keratin, which causes a defect in the normal process of keratinization of the mucosa. This results in lesions which are thick, white and velvety on the inside of the cheeks within the mouth. Usually, these lesions are present from birth or develop during childhood. The condition is benign and usually requires no treatment. WSN can, however, predispose affected individuals to over-growth/imbalance of the oral microbiota, which may require antibiotic and/or antifungal treatment.

Rabson–Mendenhall syndrome is a rare autosomal recessive disorder characterized by severe insulin resistance. The disorder is caused by mutations in the insulin receptor gene. Symptoms include growth abnormalities of the head, face and nails, along with the development of acanthosis nigricans. Treatment involves controlling blood glucose levels by using insulin and incorporating a strategically planned, controlled diet. Also, direct actions against other symptoms may be taken This syndrome usually affects children and has a prognosis of 1–2 years.

<span class="mw-page-title-main">Cementoma</span> Medical condition

Cementoma is an odontogenic tumor of cementum. It is usually observed as a benign spherical mass of hard tissue fused to the root of a tooth. It is found most commonly in the mandible in the region of the lower molar teeth, occurring between the ages of 8 and 30 in both sexes with equal frequency. It causes distortion of surrounding areas but is usually a painless growth, at least initially. Considerable thickening of the cementum can often be observed. A periapical form is also recognized. Cementoma is not exclusive to the mandible as it can infrequently occur in the maxilla and other parts of the body such as the long bones.

<span class="mw-page-title-main">Frontonasal dysplasia</span> Medical condition

Frontonasal dysplasia (FND) is a congenital malformation of the midface. For the diagnosis of FND, a patient should present at least two of the following characteristics: hypertelorism, a wide nasal root, vertical midline cleft of the nose and/or upper lip, cleft of the wings of the nose, malformed nasal tip, encephalocele or V-shaped hair pattern on the forehead. The cause of FND remains unknown. FND seems to be sporadic (random) and multiple environmental factors are suggested as possible causes for the syndrome. However, in some families multiple cases of FND were reported, which suggests a genetic cause of FND.

Diffuse infantile fibromatosis is a rare condition affecting infants during the first three years of life. This condition is a multicentric infiltration of muscle fibers with fibroblasts resembling those seen in aponeurotic fibromas, presenting as lesions and tumors confined usually to the muscles of the arms, neck, and shoulder area Diffuse infantile fibromatosis is characterized by fast growing benign tumors. This disorder is known to be caused by mutations in germline variants, PDGFRB and NOTCH3, which may be generationally-inherited through autosomal dominant and recessive traits. Although diffuse infantile fibromatosis is classified as benign, it can still lead to life-threatening complications and damage other organs.

<span class="mw-page-title-main">Cavernous hemangioma</span> Region with a lack of blood flow due to vein malformation

Cavernous hemangioma, also called cavernous angioma, venous malformation, or cavernoma, is a type of venous malformation due to endothelial dysmorphogenesis from a lesion which is present at birth. A cavernoma in the brain is called a cerebral cavernous malformation or CCM. Despite its designation as a hemangioma, a cavernous hemangioma is not a tumor as it does not display endothelial hyperplasia. The abnormal tissue causes a slowing of blood flow through the cavities, or "caverns". The blood vessels do not form the necessary junctions with surrounding cells, and the structural support from the smooth muscle is hindered, causing leakage into the surrounding tissue. It is the leakage of blood, referred to as hemorrhage, that causes a variety of symptoms known to be associated with the condition.

<span class="mw-page-title-main">Tricho–dento–osseous syndrome</span> Medical condition

Tricho–dento–osseous syndrome (TDO) is a rare, systemic, autosomal dominant genetic disorder that causes defects in hair, teeth, and bones respectively. This disease is present at birth. TDO has been shown to occur in areas of close geographic proximity and within families; most recent documented cases are in Virginia, Tennessee, and North Carolina. The cause of this disease is a mutation in the DLX3 gene, which controls hair follicle differentiation and induction of bone formation. All patients with TDO have two co-existing conditions called enamel hypoplasia and taurodontism in which the abnormal growth patterns of the teeth result in severe external and internal defects. The hair defects are characterized as being rough, course, with profuse shedding. Hair is curly and kinky at infancy but later straightens. Dental defects are characterized by dark-yellow/brownish colored teeth, thin and/or possibly pitted enamel, that is malformed. The teeth can also look normal in color, but also have a physical impression of extreme fragility and thinness in appearance. Additionally, severe underbites where the top and bottom teeth fail to correctly align may be present; it is common for the affected individual to have a larger, more pronounced lower jaw and longer bones. The physical deformities that TDO causes become more noticeable with age, and emotional support for the family as well as the affected individual is frequently recommended. Adequate treatment for TDO is a team based approach, mostly involving physical therapists, dentists, and oromaxillofacial surgeons. Genetic counseling is also recommended.

Hereditary gingival fibromatosis (HGF), also known as idiopathic gingival hyperplasia, is a rare condition of gingival overgrowth. HGF is characterized as a benign, slowly progressive, nonhemorrhagic, fibrous enlargement of keratinized gingiva. It can cover teeth in various degrees, and can lead to aesthetic disfigurement. Fibrous enlargement is most common in areas of maxillary and mandibular tissues of both arches in the mouth. Phenotype and genotype frequency of HGF is 1:175,000 where males and females are equally affected but the cause is not entirely known. It mainly exists as an isolated abnormality but can also be associated with a multi-system syndrome.

<span class="mw-page-title-main">Oral torus</span>

An oral torus - also known as: dental torus - is an oral condition in which bony growth occurs in the mouth; there are three locations in which oral tori may appear: the hard palate, in the lower jaw underneath the tongue, and/or on the back or upper gums near the cheeks. While the growth is bony and hard at these locations, they are usually harmless and painless, so treatment is not required to treat this condition. However, while usually harmless and painless, oral tori may start to interfere with an individual's speech, swallowing, other functions, or dental procedures.

References

  1. 1 2 "OMIM Entry - % 137575 - GIGANTIFORM CEMENTOMA, FAMILIAL". omim.org. Retrieved 14 June 2019.
  2. "Gigantiform cementoma (Concept Id: C3495361) - MedGen - NCBI". www.ncbi.nlm.nih.gov. Retrieved 2024-11-03.
  3. "Trigeminal Nerve". Cleveland Clinic.
  4. "Jaw Cancer". Cleveland Clinic.
  5. 1 2 3 4 Zhou, Zheng; Zhang, Ye; Zhu, Lijing; Cui, Yajuan; Gao, Yan; Zhou, Chuan-Xiang (January 2024). "Familial gigantiform cementoma with recurrent ANO5 p. Cys356Tyr mutations: Clinicopathological and genetic study with literature review". Molecular Genetics & Genomic Medicine. 12 (1): e2277. doi:10.1002/mgg3.2277. ISSN   2324-9269. PMC   10767285 . PMID   37649308.
  6. Kasahara, Shun; Amano, Katsuhiko; Kurioka, Kyoko; Minohara, Masato; Kogo, Mikihiko; Tanaka, Susumu (2023-05-01). "A sporadic case of Gigantiform Cementoma with mild and atypical clinical manifestation". Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 35 (3): 233–240. doi:10.1016/j.ajoms.2022.09.006. ISSN   2212-5558.
  7. "Gigantiform cementoma - London Dental Specialists" . Retrieved 2024-11-05.
  8. Prasad, C.; kumar, K. Arun; Balaji, J.; Arulmozhi, M.; Jayanandhini, S.; Priyadharshini, R. (March 2022). "A family of familial gigantiform cementoma: clinical study". Journal of Maxillofacial and Oral Surgery. 21 (1): 44–50. doi:10.1007/s12663-021-01515-2. ISSN   0972-8279. PMC   8934829 . PMID   35400930.
  9. Wang, Hong-Wei; Ma, Chun-Yue; Qin, Xing-Jun; Zhang, Chen-Ping (December 2017). "Management strategy in patient with familial gigantiform cementoma: A case report and analysis of the literature". Medicine. 96 (50): e9138. doi:10.1097/MD.0000000000009138. PMC   5815727 . PMID   29390315.