Case ReportGiant cell tumor of the temporal bone with intratumoral hemorrhage
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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Surgical Management of Giant Cell Tumors in Temporomandibular Joint Region Involving Lateral Skull Base: A Multidisciplinary Approach
2016, Journal of Oral and Maxillofacial SurgeryCitation Excerpt :The most common sites of predilection are in the epiphyseal or metaphyseal regions of the long bones.14,15 GCTs arising in the head and neck are rare entities, constituting about 2% of all GCTs, with the majority occurring in the mandible, sphenoid, or temporal bones.16,17 The preference of the latter two bones was due in part to the fact that both the sphenoid bone and petromastoid portions of the temporal bone arise from endochondral ossification, similar to the process of long bone formation.18
Giant cell tumor of bone: A basic science perspective
2013, BoneCitation Excerpt :For example, GCTs often present with large areas of hemorrhage [2], which appear to be correlated with metastasis [26], and were proposed to participate in the pathology of the tumor [191]. Interestingly, incomplete endothelial barriers were previously noted in the GCT vasculature [90], which may promote hemorrhaging and hemosiderin accumulation within the tumor [192–194]. Alternatively, blood vessel permeability may be enhanced by tumor cells in a protease-dependent manner.
Gamma knife radiosurgery for giant cell tumor of the petrous bone
2012, Clinical Neurology and NeurosurgeryCitation Excerpt :Giant cell tumor (GCT) is uncommon bone tumor, and the skull involvement in this tumor is very rare [1]. This tumor frequently shows locally aggressive behavior [1], and a relatively high recurrence rate [2]. Resection is the preferred treatment for GCTs of the skull, and the outcome correlated the extent of resection [2].