Age/Sex Location at initial presentation Recurrence Davis and Tideman [43] 31/F R mandibular body Reference Smith et al. [40] Martins et al. [35] Loukota [44] Wise and Bridebord [45] 23/M Miloro and Quinn [34] Bilodeau, Chowdhury, and Collins 41/F 35/F 25/F 37/F 42/F R mandibular angle L maxilla R mandible R mandible L mandibular body L and R nasomaxillary area L maxilla Ant. mandible L mandible L maxilla 177 4 months L maxilla 1 year L maxilla 2 years R mandible 9 years L maxillary sinus, nasal bone, orbital ﬂoor and R maxillary sinus 5 years follow-up no recurrence 10 months L maxilla No additional recurrence at 2 years 4 years follow-up no recurrence 1 year L maxilla and ant mandible 1 year L mandible 2 years L maxillary sinus/ethmoid region Head and Neck Pathol (2009) 3:174–178 Table 2 Characteristics of multifocal central giant cell granulomas Given the small number of cases available, it is difﬁcult to draw any conclusions. However, some trends may be observed. Similar to CGCG, there was a female predomi- nance, representing six of the seven patients. Slightly older populations than in most CGCGs were seen. The mean age in our review of published multifocal cases was 33 years, with only two of the seven patients younger than 30 years of age. It is possible that occult or inadequately treated CGCGs spread hematogenously, but this is not a traditional characteristic behavior of these lesions. Multifocal CGCGs are more aggressive than solitary CGCGs as exhibited by increased recurrence and osseous destruction. They should be treated with more aggressive surgical therapy as in ﬁve of seven cases the patients had a recurrence. Central giant cell granuloma remains a challenge for pathologists. There are multiple conditions that must be ruled out clinically, and the controversy surrounding the etiology of this condition has yet to be deﬁnitively resolved. Acknowledgments The authors would like to thank Drs. Leon Barnes, Simion Chiosea, and Raja Seethala for their comments on this paper. References 1. Motamedi MH, Eshghyar N, Jafari SM, et al. Peripheral and central giant cell granulomas of the jaws: a demographic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:39–43. doi:10.1016/j.tripleo.2006.12.022. 2. Waldron CA, Shafer WG. The central giant cell reparative granuloma of the jaws: an analysis of 38 cases. Am J Clin Pathol. 1966;45:437–47. 3. Whitaker SB, Waldron CA. Central giant cell lesions of the jaws: a clinical, radiologic, and histopathologic study. Oral Surg Oral Med Oral Pathol. 1993;75:199–208. doi:10.1016/0030-4220(93) 90094-K. 4. Kaffe I, Ardekian L, Taicher S, et al. Radiologic features of central giant cell granuloma of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81:720–6. doi:10.1016/S1079- 2104(96)80079-5. 5. Lorenzo JC, Dorfman HD. Giant-cell reparative granuloma of short tubular bones of the hands and feet. Am J Surg Pathol. 1980;4:551–63. doi:10.1097/00000478-198012000-00006. 6. Glass TA, Mills SE, Fechner RE, et al. Giant-cell reparative granuloma of the hands and feet. Radiology. 1983;149:65–8. 7. De Lange J, Van den Akker HP. Clinical and radiological fea- tures of central giant-cell lesions of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99:464–70. doi:10.1016/ j.tripleo.2004.11.015. 8. Kruse-Losler B, Diallo R, Gaertner C, et al. Central giant cell granuloma of the jaws: a clinical, radiologic, and histopathologic study of 26 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:346–54. doi:10.1016/j.tripleo.2005.02.060. 9. Ardekian L, Manor R, Peled M, et al. Bilateral central giant cell granulomas in a patient with neuroﬁbromatosis: report of a case and review of the literature. J Oral Maxillofac Surg. 1999;57: 869–72. doi:10.1016/S0278-2391(99)90833-9. 10. Ruggieri M, Pavone V, Polizzi A, et al. Unusual form of recurrent giant cell granuloma of the mandible and lower extremities in a patient with neuroﬁbromatosis type 1. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87:67–72. doi:10.1016/S1079- 2104(99)70297-0. 11. Edwards PC, Fantasia JE, Saini T, et al. Clinically aggressive central giant cell granulomas in two patients with neuroﬁbro- matosis 1. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:765–72. doi:10.1016/j.tripleo.2005.10.038. 12. Cohen MM Jr, Gorlin RJ. Noonan-like/multiple giant cell lesion syndrome. Am J Med Genet. 1991;40:159–66. doi:10.1002/ajmg. 1320400208. 13. Cancino CM, Gaiao L, Sant’Ana Filho M, et al. Giant cell lesions with a Noonan-like phenotype: a case report. J Contemp Dent Pract. 2007;8:67–73.