Case Report
Giant cell tumor of the temporal bone with intratumoral hemorrhage

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Abstract

We report a case of hemorrhagic giant cell tumor (GCT) of the temporal bone in a 77-year-old woman. The patient suffered from sudden-onset headache and vomiting associated with left temporal hemorrhage. MRI revealed a left temporal extradural mass lesion expanding to the subtemporal fossa, showing strong hypointensity on T2-weighted imaging. Subsequent MRI revealed tumor growth with multiple cystic components at 1-month follow up. The tumor was found to be a GCT associated with recent intratumoral hemorrhage and abundant hemosiderin pigmentation. T2-weighted MRI of the GCT strongly supported hemosiderin deposition. Secondary formation of cystic components in the GCT can also reflect prior hemorrhage and indicate the progression of shape modification. A literature review revealed that hemosiderin deposition in this rare entity is not as rare as previously thought and that massive intratumoral hemorrhage may occur.

Introduction

Giant cell tumors (GCTs) of the skull are very rare, and are seldom encountered by the neurosurgeon.1 Most data regarding this entity in the skull relate to case reports, and little is known about its pathogenesis. Although GCTs are generally considered to be benign neoplasms, they can exhibit locally aggressive and unpredictable behavior.[1], [2], [3] Hemosiderin deposits, which are regarded as evidence of a history of intratumoral hemorrhage, can be seen histopathologically;4 however, spontaneous hemorrhagic behavior associated with GCT of the skull has not been previously reported. Here we report the case of an elderly patient who presented with hemorrhagic GCT that originated from the temporal bone. We review the pertinent literature with emphasis on the hemorrhagic features of GCTs.

Section snippets

Case report

A 77-year-old woman presented with a sudden-onset left temporal headache and vomiting. Her consciousness was reduced and she had horizontal nystagmus. The patient had been treated for intractable left otitis media and worsening dizziness for about 2 years. She had neither a history of hypertension nor a head injury.

CT revealed a left temporal high-density lesion associated with mild brain edema (Fig. 1a). CT showed that the left temporal bone had undergone osteolytic change with scalloped

Discussion

GCTs are rather uncommon bone tumors that occur at a frequency of approximately one per million people.5 They are benign lesions that typically occur at the epiphyses of long bones, and less than 2% occur in the skull exclusive of the maxilla.[1], [6], [7] On reviewing the available literature, some individual cases were excluded according to the reclassification of giant cell reparative granuloma (GCRG) by Hirschl and Katz in 1974.8 One hundred and ten GCTs of the skull, including Mayo’s

Conclusions

We believe this is the first report of a case of symptomatic hemorrhage associated with GCT of the skull. GCT can contain hemosiderin deposits and secondary aneurysmal bone cystic changes, both of which generally correspond to prior repeated hemorrhage. Considering the MRI and histopathological findings in our case and in the literature, we propose that GCT of the skull, even though it is usually a benign neoplasm, could have a greater potential for hemorrhagic complications than previously

Acknowledgment

We are grateful to Professor Yasuaki Nakashima, MD (Department of Pathology, Faculty of Medicine, Kyoto University, Kyoto, Japan) for his help in reviewing the histological sections and confirming our final diagnosis.

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