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CASE REPORT
Year : 2014  |  Volume : 20  |  Issue : 1  |  Page : 39-40

Giant cell reparative granuloma of temporal bone


1 Department of Otorhinolaryngology, Head and Neck Surgery, Nitte University, Deralakatte, Mangalore, Karnataka, India
2 Department of Pathology, K.S. Hegde Medical Academy, Nitte University, Deralakatte, Mangalore, Karnataka, India

Date of Web Publication1-Apr-2014

Correspondence Address:
Natashya H Rent
Department of Otorhinolaryngology, Head and Neck Surgery, K S Hegde Medical Academy, Deralakatte, Mangalore - 575 018, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-7749.129820

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  Abstract 

Giant cell reparative granuloma (GCRG) is a benign osteolytic lesion of unclear etiology, commonly affecting the maxilla and mandible. These lesions which may occur as an inflammatory response due to intraosseous hemorrhage following trauma, rarely occur in the temporal bone. Here we present a case of a 38-year-old female patient who presented with a swelling in the left pre-auricular area, involving the squamous temporal bone. She underwent a curettage of the lesion which on histopathological examination led to diagnosis of GCRG. A follow-up of 6 months indicated no recurrence.

Keywords: Giant cell reparative granuloma, Giant cell tumor, Temporal bone


How to cite this article:
Rent NH, Kamath SD, Shetty KC, Mathias M. Giant cell reparative granuloma of temporal bone. Indian J Otol 2014;20:39-40

How to cite this URL:
Rent NH, Kamath SD, Shetty KC, Mathias M. Giant cell reparative granuloma of temporal bone. Indian J Otol [serial online] 2014 [cited 2019 Jun 27];20:39-40. Available from: http://www.indianjotol.org/text.asp?2014/20/1/39/129820


  Introduction Top


Giant cell reparative granuloma (GCRG) is a benign bony lesion which commonly affects the maxilla and mandible. [1] Although first described in 1953, the first case of temporal bone GCRG was reported by Hirschl and Katz in 1974 following which similar cases have been reported in other sites such as orbit, paranasal sinuses, cranial vault, sphenoid and ethmoid bones. [2] These lesion are locally aggressive and should be distinguished from a Giant cell tumor which has a higher chance of recurrence. [3] We report a case of a 38-year-old female patient with a GCRG of temporal bone.


  Case Report Top


The present case report is about a 38-year-old female patient who presented with a 3 month history of swelling in front of the right ear. The swelling was associated with intermittent dull aching pain. There was no associated hearing loss, facial weakness and no history of preceding trauma. Clinical examination revealed a 3 × 3 cm solitary, smooth, non-tender swelling in the left pre-auricular area extending inferiorly from the left tragus, to involve the squamous temporal bone superiorly and anteriorly 3 cm in front of the left helix. Fine-needle aspiration cytology of the swelling was inconclusive. Computed tomography scan revealed a bony, expansile lesion with soft tissue involvement along the squamous temporal bone extending from the skull base superiorly to the masticator space inferiorly, with minimal uptake of contrast. The patient underwent a surgical curettage of the lesion [Figure 1]. A 3 cm × 3 cm solitary, cystic lesion was found deep to the temporalis muscle. The lesion was dark red in colour, soft in consistency and vascular with surrounding bony destruction exposing the intact duramater deep to the squamous temporal bone [Figure 2]. Histopathological examination showed predominantly bland, fibroblast like spindle cells and multinucleated giant cells with phagocytosed iron and red cells seen amidst the spindle cells. Extensive areas of hemorrhage and osteoid was also present [Figure 3], suggestive of GCRG.
Figure 1: Bony expansile lytic lesion with soft tissue involvement along the squamous temporal bone, extending from skull base superiorly, to masticator space inferiorly

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Figure 2: Well‑encapsulated, cystic swelling in left pre‑auricular area, dark red in colour with surrounding areas of bony destruction

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Figure 3: High power view showing fibroblast like spindle cells and multinucleated giant cells with phagocytosed iron and red cells seen amidst the spindle cells. Areas of hemorrhage and osteoid also seen (H and E, ×40)

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  Discussion Top


GCRG is a benign, osteolytic lesion most commonly found to involve the mandible and the maxilla. [1] First described by Jaffe in 1953 in the jaw bone, it is thought to occur as a local reparative process as a result of trauma induced by interosseous hemorrhage, however infections and developmental aetiologies have also been proposed as not all patients have a preceding history of trauma. [3]

Histologically these lesions consists of a number of multinucleated giant cells in clusters within a stroma of fibroblastic cells. In addition, GCRG may also contain foci of osteoid substances, hemorrhage and hemosiderin deposits.

GCRG of the temporal bone are more commonly seen below 35 years of age, but have been reported in patients ranging from 4 months to 72 years of age with female preponderance. [2],[4] It usually presents with hearing loss, mass, pain, facial paresis and tinnitus. [2] Differential diagnosis includes giant cell tumour, aneurysmal bone cyst, brown tumor of hyperparathyroidism, chondroblastoma and fibrous dysplasia. Giant cell tumour is the most challenging due to their histological similarities. [1],[2],[3],[4]

Giant cell tumour consists of larger, multinucleated giant cells containing a greater number of nuclei and the giant cells are found to be more uniformly dispersed when compared with GCRG where they are found to cluster in uneven patches. In addition, GCRG contain foci of hemosiderin, hemorrhage and osteoid which are less likely in Giant cell tumour. [1]

The treatment of GCRG includes curettage or complete surgical excision. However, in cases where complete surgical excision if not possible radiation therapy has been advocated. The risk of sarcomatous transformation however in a concern. [3] GCRG has a good prognosis, which a recurrence rate of 12-16% following surgical excision, with no cases of metastasis or malignant transformation being reported. [2]

 
  References Top

1.Yu JL, Qu LM, Wang J, Huang HY. Giant cell reparative granuloma in the temporal bone of the skull base: Report of two cases. Skull Base 2010;20:443-8.  Back to cited text no. 1
[PUBMED]    
2.Williams JC, Thorell WE, Treves JS, Fidler ME, Moore GF, Leibrock LG. Giant cell reparative granuloma of the petrous temporal bone: A case report and literature review. Skull Base Surg 2000;10:89-93.  Back to cited text no. 2
[PUBMED]    
3.Kim HJ, Lee HK, Suh DC, Choi CG, Kim JK, Lee JH, et al. Giant cell reparative granuloma of the temporal bone: MR findings with pathologic correlation. AJNR Am J Neuroradiol 2003;24:1136-8.  Back to cited text no. 3
    
4.Reis C, Lopes JM, Carneiro E, Vilarinho A, Portugal R, Duarte F, et al. Temporal giant cell reparative granuloma: A reappraisal of pathology and imaging features. AJNR Am J Neuroradiol 2006;27:1660-2.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


This article has been cited by
1 Case Reports of a Giant Cell Reparative Granuloma and a Giant Cell Tumor on Temporal Bone
Wei-Ying Dai,Chao Tian,Li Liu
Chinese Medical Journal. 2018; 131(18): 2254
[Pubmed] | [DOI]



 

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