Case 32-2021: A 14-Year-Old Girl with Swelling of the Jaw and Hypercalcemia
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A 14-year-old girl presented with progressive swelling of the jaw. Six weeks before this admission, a nonpainful lump in the left lower jaw developed. The mass increased in size, and swelling of the left side of the face and neck developed. A biopsy specimen from the mass showed abundant giant cells. The calcium level was 11.8 mg per deciliter.
Giant cell, also called Langhans giant cell, large cell characterized by an arc of nuclei toward the outer membrane. The cell is formed by the fusion of epithelioid cells, which are derived from immune cells called macrophages. Once fused, these cells share the same cytoplasm, and their nuclei become arranged in an arc near the outer edge of the cell. Langhans giant cells typically form at the centre of granulomas (aggregates of macrophages) and are found in the tubercle, or primary focus of infection, in tuberculosis, in lesions of syphilis, leprosy, and sarcoidosis, and in fungal infections.
Large cells that form by fusion in reaction to the presence in the body of foreign substances differ from Langhans giant cells in that their many nuclei are scattered throughout the cell. In giant-cell tumours of bone and tendon the cells have many nuclei crowded together. The megakaryocytes, the normal bone-marrow cells thought to be the source of the blood platelets, are also called giant cells.
Presentation of Case. Dr. Austin Be (Surgery): A 14-year-old girl was admitted to this hospital because of swelling of the left jaw. The patient had been well until 6 weeks before this admission, when she noticed a lump in the left lower jaw; there was no pain, tenderness, or discomfort in the jaw.…
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