Printer Friendly
The Free Library
22,719,120 articles and books

Giant-cell reparative granuloma of the temporal bone: a case report and review of the literature.



Abstract

Giant-cell reparative re·par·a·tive   also re·par·a·to·ry
adj.
1. Tending to repair.

2. Relating to or of the nature of reparations.
 granuloma granuloma /gran·u·lo·ma/ (gran?u-lo´mah) pl. granulomas, granulo´mata   an imprecise term for (1) any small nodular delimited aggregation of mononuclear inflammatory cells, or (2) such a collection of modified macrophages  (GCRG GCRG Grand Canyon River Guides
GCRG Gloucestershire Cave Rescue Group
) is an unusual, non-neoplastic fibrous lesion that most often arises in the mandible mandible /man·di·ble/ (man´di-b'l) the horseshoe-shaped bone forming the lower jaw, articulating with the skull at the temporomandibular joint.mandib´ular

man·di·ble
n.
 and maxilla maxilla /max·il·la/ (mak-sil´ah) pl. maxil´las, maxil´lae   [L.] the irregularly shaped bone that with its fellow forms the upper jaw. max´illary

max·il·la
n. pl.
. GCRG of the temporal bone is exceedingly rare. To the best of our knowledge, only 17 cases have been previously reported in the international medical literature. Although no case of metastasis has been reported, this malignancy can be locally aggressive, and it often recurs following incomplete excision. We report the case of a young woman with a very large GCRG of the right temporal bone. We discuss the clinical picture, differential diagnosis, histologic evaluation, appearance on computed tomography and magnetic resonance imaging magnetic resonance imaging (MRI), noninvasive diagnostic technique that uses nuclear magnetic resonance to produce cross-sectional images of organs and other internal body structures. , and treatment options. We also review the cases of temporal bone GCRG that have been reported in the literature so far.

Introduction

The term giant-cell reparative granuloma (GCRG) was introduced by Jaffe in 1953 to describe a lesion of the mandible and maxilla that occurred following a trauma-induced intraosseous hemorrhage. (1) He also distinguished GCRG, which is not a true neoplasm neoplasm or tumor, tissue composed of cells that grow in an abnormal way. Normal tissue is growth-limited, i.e., cell reproduction is equal to cell death. , from giant-cell tumor. Since 1953, GCRG has been reported in many other sites, including the axial skeleton and long bones, (2) the hands and feet, (3) the facial bones, (4) the cranial vault, (5) the sphenoid sphenoid /sphe·noid/ (sfe´noid)
1. wedge-shaped.

2. sphenoid bone. sphenoi´dal


sphe·noid
n.
The sphenoid bone.

adj.
1.
 and ethmoid bones, (6-8) the orbit, (9) and the nose. (10) GCRG of the temporal bone was first described by Hirschl and Katz in 1974. (11) Up to now, only 16 other cases have been published in the international medical literature (table).

Although GCRG of the temporal bone has been purported to be a reaction to cranial trauma, (1,2,11,12) its pathogenesis remains unclear. (13,14) It can occur at any age, and there does not appear to be a clear gender predilection. (13) Reported symptoms include hearing loss, tinnitus, a palpable mass, pain, vertigo, and facial weakness. (14) Complete surgical excision is regarded as the treatment of choice. (12-14) Curettage curettage /cu·ret·tage/ (ku?re-tahzh´) [Fr.] the cleansing of a diseased surface, as with a curet.

medical curettage
 of the lesion is not sufficient. (13,14) Whenever complete removal is not possible, radiotherapy should be considered. (13-15) Following complete excision, the prognosis is good, and reported recurrence rates have ranged from 10 to 15% in most studies. (11,16-18)

In this article, we report a new case of temporal bone GCRG, in which a large tumor infiltrated the sphenoid bone sphenoid bone
n.
A compound bone with winglike processes, situated at the base of the skull.


sphenoid bone (sfē´noid),
n
, infratemporal fossa, pterygoid fossa, temporomandibular joint, middle cranial fossa The middle fossa, deeper than the anterior cranial fossa, is narrow in the middle, and wide at the sides of the skull.

It is bounded in front by the posterior margins of the small wings of the sphenoid, the anterior clinoid processes, and the ridge forming the anterior
, and temporal lobe. To our knowledge, infiltration of the temporal lobe by a temporal bone GCRG has not been previously described in the literature.

Case report

A 17-year-old girl came to the Department of Otorhinolaryngology-Head and Neck Surgery in October 1998 with a 2-month history of hearing loss in her right ear. She reported no other symptoms, and she had no history of head or acoustic trauma or exposure to ototoxic ototoxic /oto·tox·ic/ (o´to-tok?sik) having a deleterious effect upon the eighth nerve or on the organs of hearing and balance.

o·to·tox·ic
adj.
 agents. Her family history was negative for hearing loss.

Examination of the head and neck revealed that a mass was obstructing the right auditory canal and had almost completely occluded the lumen. Pure-tone audiometry revealed normal function in the right inner ear and a 20 dB air-bone gap at all frequencies tested. Serum levels of calcium, alkaline phosphatase, phosphorus, and parathyroid hormone were within normal limits. Computed tomography (CT) demonstrated a 4-cm osteolytic lesion of the right temporal bone and infratemporal fossa with intracranial intracranial /in·tra·cra·ni·al/ (-kra´ne-al) within the cranium.

in·tra·cra·ni·al
adj.
Within the cranium.
 but extradural extradural

situated or occurring outside the dura mater. See also epidural.
 extension. The temporomandibular joint was not involved. On magnetic resonance imaging (MRI 1. (application) MRI - Magnetic Resonance Imaging.
2. MRI - Measurement Requirements and Interface.
), the lesion reflected low-intensity signals on both T1- and T2-weighted images, but there was some strong enhancement following the application of gadolinium gadolinium (gădəlĭn`ēəm), metallic chemical element; symbol Gd; at. no. 64; at. wt. 157.25; m.p. 1,312°C;; b.p. 3,233°C;; sp. gr. 7.898 at 25°C;; valence +3.  contrast.

Because of the contrast enhancement, a preoperative embolization of the lesion was performed. Intraoperative rapid section revealed a tumor of unclear dignity. For that reason, the operation was abandoned after the mastoidectomy Mastoidectomy Definition

Mastoidectomy is a surgical procedure to remove an infected portion of the bone behind the ear when medical treatment is not effective. This surgery is rarely needed today because of the widespread use of antibiotics.
 and without complete removal of the tumor. The definitive histology revealed that the tumor was a GCRG. The patient was scheduled to undergo a complete removal of the lesion, but unfortunately she and her mother refused the recommended surgery.

In February 2001, the young woman returned to our institution. Since her initial treatment, time tumor had grown significantly and the patient was experiencing total right-sided sensorineural deafness, intermittent vertigo, tinnitus, facial weakness (House-Brackmann grade II-III), and paresthesia paresthesia /par·es·the·sia/ (par?es-the´zhah) morbid or perverted sensation; an abnormal sensation, as burning, prickling, formication, etc.

par·es·the·sia or par·aes·the·sia
n.
 in the area of the right mandibular nerve.

CT and MRI CT and MRI
Two high technology methods of creating images of internal organs. Computerized axial tomography (CT or CAT) uses x rays, while magnetic resonance imaging (MRI) uses magnet fields and radio-frequency signals. Both construct images using a computer.
 showed a very large tumor in the right temporal bone that involved the sphenoid bone, infratemporal fossa, pterygoid fossa, temporomandibular joint, and middle cranial fossa with extension into the right temporal lobe (figure 1). There were erosions of the labyrinth and the bony canal of the internal carotid artery as well as destruction of the right cochlea cochlea (kŏk`lēə): see ear. .

[FIGURE 1 OMITTED]

The lesion was resected via a combined pterional and infratemporal approach. The operation was performed in cooperation with the Department of Maxillofacial Surgery and the Department of Neurosurgery, and we were continuously assisted by computer-navigation control (Stryker Leibinger Navigation System; Freiburg, Germany). The tumor had damaged a large portion of the right temporal bone. The internal carotid artery, the facial nerve, and the mandibular nerve were ensheathed. During the operation, large portions of time temporal bone (including the cochlea and the labyrinth) and the temporomandibular joint (including the articular disk, masseter masseter /mas·se·ter/ (mas-et´er) masseter muscle. masseter´ic

mas·se·ter
n.
A muscle with origin from the inferior border and medial surface of the zygomatic arch, with insertion into the
, and medial pterygnid muscle), parts of the temporal muscle, the greater wing of the sphenoid, the adventitia adventitia /ad·ven·ti·tia/ (ad?ven-tish´e-ah)
1. adventitial.

2. tunica adventitia.


ad·ven·ti·tia
n.
 of the internal carotid artery, the maxillary artery, the mandibular nerve, parts of the temporal dura, and a small part of the caudal caudal /cau·dal/ (kaw´d'l)
1. pertaining to a cauda.

2. situated more toward the cauda, or tail, than some specified reference point; toward the inferior (in humans) or posterior (in animals) end of the body.
 temporal lobe had to be resected. By performing such a radical operation, we were able to remove all tumor tissue as well as a margin of grossly uninvolved un·in·volved  
adj.
Feeling or showing no interest or involvement; unconcerned: an uninvolved bystander.

Adj. 1.
 tissue. We were able to spare the facial nerve, and we treated it with a nerve stimulator at the completion of surgery. We reconstructed the dura with fascia lata and temporal muscle. Finally, we used a titanium mesh to restore the integrity of the middle cranial fossa and the temporal calotte ca·lotte  
n. Ecclesiastical
A skullcap, especially one worn by Roman Catholic priests.



[French, from Provençal calota or Italian callotta.]
.

The excised lesion was light brown and had a soft, friable friable /fri·a·ble/ (fri´ah-b'l) easily pulverized or crumbled.

fri·a·ble
adj.
1. Readily crumbled; brittle.

2. Relating to a dry, brittle growth of bacteria.
 consistency. Histologically, there was a fibroplastic proliferation with osteoclast-like polynuclear polynuclear /poly·nu·cle·ar/ (-noo?kle-er) having several nuclei; said of cells.

pol·y·nu·cle·ar or pol·y·nu·cle·ate or pol·y·nu·cle·at·ed
adj.
Multinuclear.
 giant cells, newly formed osteoid osteoid /os·te·oid/ (os´te-oid)
1. resembling bone.

2. the organic matrix of bone; young bone that has not undergone calcification.


os·te·oid
adj.
Resembling bone.
 trabeculae, lymphocytic infiltrates, macrophages Macrophages
White blood cells whose job is to destroy invading microorganisms. Listeria monocytogenes avoids being killed and can multiply within the macrophage.
, and hemosiderin hemosiderin /he·mo·sid·er·in/ (he?mo-sid´er-in) an insoluble form of tissue storage iron, visible microscopically both with and without the use of special stains.

he·mo·sid·er·in
n.
 deposits (figure 2, A). Immunohistochemical studies yielded positive vimentin staining of the fibroblastic spindle cells. The osteoclastic origin of the giant cells was confirmed by positive staining with tartrate-resistant acid phosphatase (figure 2, B) in combination with negative reactions for S100 and CD1a; these findings also excluded Langerhans'-cell histiocytosis histiocytosis /his·tio·cy·to·sis/ (-si-to´sis) a condition marked by an abnormal appearance of histiocytes in the blood.

acute disseminated Langerhans cell histiocytosis  Letterer-Siwe disease.
.

[FIGURE 2 OMITTED]

Coronal cor·o·nal
adj.
1. Of or relating to a corona, especially of the head.

2. Of, relating to, or having the direction of the coronal suture or of the plane dividing the body into front and back portions.
 MRI with gadolinium contrast 2 weeks following surgery revealed no signs of residual tumor (figure 3). Postoperatively, the patient exhibited a profound weakness of the right facial nerve (House-Brackmann grade V), but she gradually experienced a complete recovery within 6 months. Her vertigo gradually resolved over 4 weeks. During the first 12 months postoperatively, she complained that her powers of concentration had diminished. She also reported a permanent numbness in the area of the right mandibular nerve and total right-sided deafness.

In view of the size of the tumor and the involvement of bone, muscle, connective tissue, the mandibular joint, the dura mater, and the brain, postoperative radiation was recommended by the Department of Radiation Therapy, but the patient declined. Further treatment of the altered occlusion of her mouth was administered in the Department of Maxillofacial Surgery. The most recent MRI was conducted in March 2003, and there was no sign of recurrence.

Discussion

GCRG is a rare, benign, granulomatous granulomatous /gran·u·lom·a·tous/ (-lom´ah-tus) containing granulomas.
Granulomatous
Resembling a tumor made of granular material.
 lesion. (19) When it does occur, it most often arises in the mandible and maxilla; it can also involve any other bone in the jaw, cheek, and extragnathic region. (20) Including our patient, only 18 cases of GCRG of the temporal bone have been reported in the international medical literature (table). This group includes 6 females and 12 males, aged 4 months to 72 years (mean: 30.2 yr). Although different authors have reported that GCRG of the jaw has a predilection for females, (1,17,21,22) such does not appear to be the case for GCRG of the temporal bone. Even so, because of the small number of cases that have been reported, it is not possible to speculate whether there is a true gender predilection for temporal bone GCRG.

Among the 13 cases in which the authors specified the length of follow-up, monitoring time ranged from 10 months to 15 years (mean: 3.8 yr). Three reports contained no information on the length of follow-up, and two contained no information on follow-up at all. Of the 16 patients who were followed up after treatment, only two (12.5%) experienced a recurrence.

Symptoms. The reported symptoms of GCRG of the temporal bone include heating loss, tinnitus, a palpable mass, pain, vertigo, and facial weakness. Conductive hearing loss Conductive hearing loss
A type of medically treatable hearing loss in which the inner ear is usually normal, but there are specific problems in the middle or outer ears that prevent sound from getting to the inner ear in a normal way.
 was the most common symptom, occurring in 12 of the 18 patients (66.7%). Tinnitus and a palpable mass were noted in 5 patients each (27.8%), pain in 3 (16.7%), and vertigo and facial weakness in 2 each (11.1%). One patient (5.6%) also complained of dysphagia and protrusion protrusion /pro·tru·sion/ (-troo´zhun)
1. extension beyond the usual limits, or above a plane surface.

2. the state of being thrust forward or laterally, as in masticatory movements of the mandible.
.

Etiology. The pathogenesis of GCRG is still controversial. (13,14) Jaffe wrote that the lesion represents a hyperplastic, reparative reaction to an intraosseous hemorrhage induced by trauma. (1) Many authors still share this opinion. (2,12) It must be mentioned, however, that there was no history of head trauma or previous surgery in 9 of the 18 cases of temporal bone GCRG. In another 5 cases, the authors did not report whether there had been any trauma. In fact, only 4 cases involved some previous trauma to the head. In one of those reports, the authors claimed that the lesion had occurred secondary to blunt trauma inflicted by a cricket bat. (19) However, the fact that this trauma had occurred only 6 weeks before the patient sought treatment for his tumor makes it most unlikely that the 3 x 2 x 1.5-cm GCRG had actually been caused by that particular trauma. Other causes that have been proposed include infections, (11) developmental anomalies, (17) and hormonal influences, (23) but no single theory has gained wide acceptance. (14)

Differential diagnosis. The diagnosis of GCRG is based on the combination of clinical information, radiologic data, histopathologic characteristics, and response to treatment. (13) GCRG must be differentiated from the brown tumor of hyperparathyroidism Hyperparathyroidism Definition

Parathyroid glands are four pea-sized glands located just behind the thyroid gland in the front of the neck. The function of parathyroid glands is to produce a hormone called parathyroid hormone (parathormone), which helps
, aneurysmal bone cyst aneurysmal bone cyst
n.
A solitary benign lesion in a long bone or vertebra, consisting of blood-filled spaces separated by fibrous tissue and causing swelling, pain, and tenderness.
, chondroblastoma, fibrous dysplasia, cherubism, osteosarcoma osteosarcoma /os·teo·sar·co·ma/ (os?te-o-sahr-ko´mah) a malignant primary neoplasm of bone composed of a malignant connective tissue stroma with evidence of malignant osteoid, bone, or cartilage formation; it is subclassified as , and true giant-cell tumor. (12-14,18)

Brown tumor of hyperparathyroidism. The histologic appearance of the brown tumor of hyperparathyroidism is often indistinguishable from GCRG. (10,13,14) Still, the differentiation between the two can be made without difficulty by measuring serum calcium, phosphorus, and alkaline phosphatase levels. (21) as well as phosphate clearance and levels of parathyroid hormone and urine hydroxyprotein. (13)

Aneurysmal bone cyst. Aneurysmal bone cyst is another non-neoplastic, reparative process with a giant-cell component. (13,24) A cystic blow-out of the bone is a typical finding on plain x-ray. (21) On MRI, aneurysmal bone cyst is usually not homogeneous and is characterized by a high signal intensity. (12,13) Histologically, it is characterized by thin-walled, blood-containing cystic cavities that are lined with flat fibroblastic cells and bony giant cells. (24) Aneurysreal bone cyst cyst, abnormal sac in the body, filled with a fluid or semisolid and enclosed in a membrane. Cysts can be congenital but are usually acquired, the most common locations being the skin and the ovaries.  of the temporal bone is exceedingly rare, as only 10 cases have been reported in the literature. (24) Chondroblastoma. Chondroblastoma of the head and neck is most often located in the temporal bone. (20) It is characterized by local recurrence and metastasis, and it should be considered clinically to be a malignant tumor. (25) Its important histopathologic features are focal chondroid differentiation, intercellular intercellular /in·ter·cel·lu·lar/ (-sel´u-lar) between or among cells.

in·ter·cel·lu·lar
adj.
Located among or between cells.
 calcification calcification /cal·ci·fi·ca·tion/ (kal?si-fi-ka´shun) the deposit of calcium salts in a tissue.

dystrophic calcification
, and epitheliumlike cells in nodules Nodules
A small mass of tissue in the form of a protuberance or a knot that is solid and can be detected by touch.

Mentioned in: Leprosy
 and ribbons with scattered, multinucleated multinucleated

characterized by having more than one nucleus per cell.


multinucleated giant cell
see giant cell.
 giant cells and granular hemosiderin pigments. (20,25,26) On CT, chondroblastoma appears as a high-density mass with mild contrast enhancement. (25)

Fibrous dysplasia. The typical histopathologic features of fibrous dysplasia are the presence of osteolysis osteolysis /os·te·ol·y·sis/ (os?te-ol´i-sis) dissolution of bone; applied especially to the removal or loss of the calcium of bone.osteolyt´ic

os·te·ol·y·sis
n.
, immature bone trabeculae, and fibro-osseous tissue in the affected part of the bone. (27) Its signal intensity is typically low on both T1 and T2-weighted MRI. (12) Fewer than 80 cases of temporal bone fibrous dysplasia have been reported in the international medical literature. (27)

Cherubism. Cherubism is a rare, benign, autosomaldominant inherited condition characterized by cystic proliferation of the mandible and maxilla in childhood. (28,29) Histologically, it features proliferating vascular fibrous tissue with osteoclastic, multinucleated giant cells. (28) Radiologically, there is a specific finding of bilateral, multilocular multilocular /mul·ti·loc·u·lar/ (-lok´u-ler) having many cells or compartments.

mul·ti·loc·u·lar
adj.
Having or consisting of many small compartments or cavities.
 cystic expansion of the jaws. (28) Cherubism does not occur in the temporal bone.

Osteosarcoma. There might be a large, benign giant-cell component to osteosarcoma, but the presence of atypia of the mononucleated cells is a useful criterion in making the differential diagnosis between it and GCRG. (20)

Giant-cell tumor. Giant-cell tumor is often difficult to distinguish from GCRG. (13,14,20) Prior to Jaffe's report in 1953, (1) all giant-cell lesions were designated as giant-cell tumors.(14) GCRG has often been misdiagnosed as giant cell tumor, (14,21) especially during the years before the first reported case of temporal bone GCRG by Hirschl and Katz in 1974. (11) True giant-cell tumor is a real neoplasm, and it accounts for 3 to 7% of all primary bone tumors. (13) In most cases, it occurs at the ends of long bones. (20,30) Bertoni et al reviewed 2,046 cases of giant-cell tumor and found that only one had occurred in the temporal bone. (20)

The primary difference between giant-cell tumor and GCRG is the prognosis. (13) Giant-cell tumor is reported to have a higher incidence of recurrence than GCRG; reported recurrence rates of giant-cell tumor of the long bones range between 45 and 62%. (14) Giant-cell tumor may undergo malignant transformation, (13,14) and metastatic spread, usually to the lung, occurs in 1 to 6% of cases of giant-cell tumor of the extremities. (14,31) In giant-cell tumor of the craniofacial craniofacial /cra·nio·fa·cial/ (kra?ne-o-fa´sh'l) pertaining to the cranium and the face.

cra·ni·o·fa·cial
adj.
Of or involving both the cranium and the face.
 bones, only one case of lymph node metastasis and no case of pulmonary metastasis has been noted. (14)

On radiologic evaluation, giant-cell tumor and GCRG are indistinguishable. (13,14) On CT, both usually appear as a nonspecific nonspecific /non·spe·cif·ic/ (non?spi-sif´ik)
1. not due to any single known cause.

2. not directed against a particular agent, but rather having a general effect.


nonspecific

1.
 lytic lytic /lyt·ic/ (lit´ik)
1. pertaining to lysis or to a lysin.

2. producing lysis.


lyt·ic
adj.
1. Of, relating to, or causing lysis.

2.
 lesion. (13,14) On MRI, most lesions reflect a low signal intensity on T1-and T2-weighted imaging. (13,14) Both tumors enhance with gadolinium contrast; the degree of enhancement ranges from slight (12) to strong. (13)

Because of the nonspecific nature of the radiologic findings, the differentiation between giant-cell tumor and GCRG must be made histologically. Giant-cell tumor originates in the connective tissue of bone marrow, whereas GCRG arises from periosteal periosteal /peri·os·te·al/ (-os´te-al) pertaining to the periosteum.

periosteal

pertaining to or emanating from the periosteum.
 connective tissue. (13) Several histopathologic differences between the two lesions have been described in the literature. GCRG has been reported to contain fewer multinucleated giant cells than has giant-cell tumor. (14) The giant cells in giant-cell tumor tend to be more evenly distributed and have a more uniform appearance.(11,14,18) GCRG is associated with a greater degree of osteoid formation, hemorrhage, hemosiderin deposition, and inflammation. (14) The spindling spin·dling  
adj.
Spindly.
 quality of the cells that encircle the giant cells has been described as a consistent feature of GCRG. (4,18,20) In giant-cell tumor, typical findings are foci of necrosis and the presence of marked mitotic activity. (14)

There may be areas of a GCRG lesion that cannot be histologically differentiated from giant-cell tumor. (20) Ung et al recommended maintaining the current nomenclature of giant-cell tumor and GCRG whenever a clear distinction between the lesions can be made histologically. (14) In borderline cases, however, they preferred the term giant-cell lesion, which can be further classified as aggressive or nonaggressive on the basis of symptoms. (14) However, we agree with Bertoni et al that it is important to make every effort to separate giant-cell tumor of the skull from GCRG because the prognosis of giant-cell tumor is generally much worse. (20) Bertoni et al described 15 cases of giant-cell tumor of various skull bones; 3 of those patients died of giant-cell tumor. (20) To the best of our knowledge, there is not a single reported case of death caused by GCRG.

Treatment. Complete surgical excision is the therapy of choice for GCRG. (13,14) Some authors have claimed that curettage is sufficient for treatment. (1,15,21) However, Auclair et al noted that the recurrence rate following simple curettage of GCRG was 50%, compared with a recurrence rate of only 10% following complete surgical excision. (31) For large tumors, preoperative superselective intravascular intravascular /in·tra·vas·cu·lar/ (in?trah-vas´ku-lar) within a vessel.

in·tra·vas·cu·lar
adj.
Within one or more blood vessels.
 embolization has been advocated. (32) Unlike giant-cell tumor, GCRG does not undergo malignant transformation, and there is not a single documented case of GCRG metastasis. (14)

Complete excision of giant-cell tumors of the long bones can usually be performed without major difficulty. However, the skull base, with its large number of vital structures, provides a significant challenge to complete surgical removal. (14) In cases where complete resection is not possible, postoperative radiation has been advocated. (13,16) Of the 18 patients who have had GCRG of the temporal bone, 3 underwent radiation therapy--2 after a complete resection and 1 after an incomplete resection. The size of the radiation doses varied greatly--from 600 and 5,000 cGy. Especially in young patients, radiation therapy for this primarily benign lesion should be performed only when complete resection is not possible or when the tumor has infiltrated many different structures, as happened in our patient. Keep in mind that any radiation therapy carries the potential risk of sarcomatous transformation in the decades to come. (14) On the other hand, patients with giant-cell tumor of the temporal bone should always undergo radiation following resection in light of the high risk of recurrence. (20)

De Lange et al (22) and Pogrel et al (33) reported a total of six patients with GCRG of the jaw who experienced a complete remission alter they were treated with calcitonin calcitonin /cal·ci·to·nin/ (-to´nin) a polypeptide hormone secreted by C cells of the thyroid gland, and sometimes of the thymus and parathyroids, which lowers calcium and phosphate concentration in plasma and inhibits bone resorption. . Anti-inflammatory drugs may play a future role in the treatment of GCRG, but more data are needed, especially long-term results, before calcitonin treatment can be regarded as an adequate alternative to surgery. (13)
Table. Summary of all reported cases of temporal bone GCRG

                             Age/                  Initial
Author(s)                    sex           Trauma  symptoms

Hirschl and Katz, (11)       36/F          Yes     Hearing loss
 1974

Colclasure et al, (34) 1981  10/M          NR *    Hearing loss

                             22/M          NR      Hearing loss,
                                                   mass

Tesluk et al, (18) 1989      56/M          No      Mass, pain

Ciappetta et al, (15) 1990   25/M          Yes     Dysphagia, pain,
                                                   protrusion

Cohen and                    ([dagger])/F  No      Mass
 Granda-Ricart, (35) 1993

Lewis et al, (12) 1994       32/F          Yes     Hearing loss

Nemoto et al, (36) 1995      36/M          No      Hearing loss,
                                                   tinnitus

                             28/M          No      Hearing loss,
                                                   tinnitus

Maruno et al, (37) 1997      3/F           No      Facial weakness,
                                                   hearing loss

Ung et al, (14) 1998         36/F          No      Hearing loss

Liu et al, (13) 2001         44/M          No      Hearing loss,
                                                   tinnitus

                             72/M          No      Hearing loss

Khodaei et al, (38) 2001     36/M          NR      Pain, tinnitus,
                                                   vertigo

Sharma et al, (19) 2002      12/M          Yes     Facial weakness,
                                                   hearing loss,
                                                   mass, tinnitus,
                                                   vertigo

Matsui et al, (32) 2002      41/M          NR      Mass

Yoshimura et al, (39) 2002   38/M          NR      NR

Boedeker et al, ([double     17/F          No      Hearing loss
 dagger]) 2003

Author(s)                    Therapy               Follow-up

Hirschl and Katz, (11)       Biopsy plus radiation Well at 17 mo
 1974                        (2,500 cGy)

Colclasure et al, (34) 1981  Total resection       Well at 6 yr

                             Total resection plus  Well at 7 yr
                             radiation (600 cGy)

Tesluk et al, (18) 1989      Total resection       Well at 1 yr

Ciappetta et al, (15) 1990   Total resection       Well at 15 yr

Cohen and                    Total resection       NR
 Granda-Ricart, (35) 1993

Lewis et al, (12) 1994       Total resection       Well; length of
                                                   follow-up NR

Nemoto et al, (36) 1995      Total resection       Well; length of
                                                   follow-up NR

                             Total resection       Well; length of
                                                   follow-up NR

Maruno et al, (37) 1997      Total resection       Recurrence at 1 yr

Ung et al, (14) 1998         Total resection       Recurrence at 4 yr

Liu et al, (13) 2001         Total resection plus  Well at 3 yr
                             radiation (5,000 cGy)

                             Total resection       Well at 21 mo

Khodaei et al, (38) 2001     Total resection       Well at 3 yr

Sharma et al, (19) 2002      Total resection       Well at 10 mo

Matsui et al, (32) 2002      Total resection       NR

Yoshimura et al, (39) 2002   Total resection       Well at 4 yr

Boedeker et al, ([double     Biopsy initially,     Well at 2 yr
 dagger]) 2003               total resection
                             3 yr later

* NR = not reported; ([dagger]) Age: 4 mo.;
([double dagger]) Present report.


References

(1.) Jaffe HL. Giant cell reparative granuloma, traumatic bone cyst Traumatic bone cyst, also called a simple bone cyst, is a condition of the jaws. It is more likely to affect men and is more likely to occur in people in their first and second decades. There is no known cause though it is sometimes related to trauma. , and fibrous (fibroosseous) dysplasia of the jawbones. Oral Surg 1953;6:159-75.

(2.) Oda Y, Tsuneyoshi M, Shinohara N. "Solid" variant of aneurysmal bone cyst (extragnathic giant cell reparative granuloma) in the axial skeleton and long bones. A study of its morphologic spectrum and distinction from allied giant cell lesions. Cancer 1992;70:2642-9.

(3.) Glass TA, Mills SE, Fechner RE. et al. Giant cell reparative granuloma of the hands and feet. Radiology 1983; 149:65-8.

(4.) Som PM, Lawson W. Cohen cohen
 or kohen

(Hebrew: “priest”) Jewish priest descended from Zadok (a descendant of Aaron), priest at the First Temple of Jerusalem. The biblical priesthood was hereditary and male.
 BA. Giant-cell lesions of the facial bones. Radiology 1983; 147:129-34.

(5.) Garza-Mercado R, Cavazos E, Hernandez-Batres F. Giant cell reparative granuloma of the cranial vault: Exceptional bone lesion. Neurosurgery 1984;15:228-32.

(6.) Rhea rhea, in zoology
rhea (rē`ə), common name for a South American bird of the family Rheidae, which is related to the ostrich. Weighing from 44 to 55 lb (20–25 kg) and standing up to 60 in.
 JT, Weber AL. Giant-cell granuloma of the sinuses. Radiology 1983:147:135-7.

(7.) Rogers LF. Mikhael M. Christ M. Wolff A. Case report 276. Giant cell (reparative) granuloma of the sphenoid bone. Skeletal Radiol 1984:12:48 53.

(8.) Wiatrak BJ, Gluckman JL, Fabian RL, Wesseler TA. Giant cell reparative granuloma of the ethmoid sinus. Otolaryngol Head Neck Surg 1987;97:504-9.

(9.) Sebag J, Chapman P, Truman J, Riemersma RR. Giant cell granuloma giant cell granuloma
n.
A non-neoplastic lesion of the gums or jaw bones, characterized by a proliferation of granulation tissue containing many multinucleated giant cells.
 of the orbit with intracranial extension. Neurosurgery 1985;16:75-8.

(10.) Kempe C, Dewes H. Gauer A. Stasche N. [Peripheral giant cell reparative granuloma in the area of the nose floor. A review of current literature with a case report]. HNO HNO Hals Nasen Ohrenheilkunde
HNO Hals-Nasen-Ohren Heilkunde (German: throat, nose and ear medicine)
HNO Host Network Operator
HNO Harvard News Office
HNO Helvetica Narrow Oblique (font) 
 2001;1029-33.

(11.) Hirschl S, Katz A. Giant cell reparative granuloma outside the jaw bone. Diagnostic criteria and review of the literature with the first case described in the temporal bone. Hum Pathol 1974:5:171-81.

(12.) Lewis ML, Weber AL, McKenna MJ. Reparative cell granuloma of the temporal bone. Ann Otol Rhinol Laryngol 1994;103: 826-8.

(13.) Liu J, Zhong DR, Liu LF, et al Giant cell reparative granuloma of the temporal bone. Acta Otolaryngol 2001:121:523-8.

(14.) Ung F, Li KK, Keith DA, McKenna MJ. Giant cell reparative granuloma of the temporal bone: Case report and review of the literature. Otolaryngol Head Neck Surg 198:118:525-9.

(15.) Ciappetta P, Salvati M, Bernardi C, et al Giant cell reparative granuloma of the skull base mimicking an intracranial tumor. Case report and review of the literature. Surg Neurol 1990;33: 52-6.

(16.) Alappat JP, Pillai AM, Prasanna D, Sambasivan M. Giant cell reparative granuloma of the craniofacial complex. Case report and review of the literature, Br J Neurosurg 1992;6:71-4.

(17.) Eisenbud L, Stern M, Rothberg M. Sachs SA. Central giant cell granuloma Central giant cell granuloma (CGCG) is a benign condition of the jaws. It is twice as likely to affect women and is more likely to occur 20 - 40 year old people. Central giant cell granulomas are more common in the mandible and often crosses the midline.  of the jaws: Experiences in management of thirty-seven cases. J Oral Maxillofac Surg 1988;46:376-84.

(18.) Tesluk H. Senders CW. Dublin AB. Case report 562: Giant cell reparative granuloma of temporal bone. Skeletal Radiol 1989: 18:599-602.

(19.) Sharma RR, Verma A, Pawar SJ, et al Pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children.

pe·di·at·ric
adj.
Of or relating to pediatrics.
 giant cell granuloma of the temporal bone: A case report and brief review of the literature. J Clin Neurosci 2002:9:459-62.

(20.) Bertoni F, Unni KK, Beabout JW, Ebersold MJ. Giant cell rumor of the skull. Cancer 1992:70: 1124-32.

(21.) Katz A, Hirschl S. Giant cell reparative granuloma in the temporal bone. Arch Otolaryngol 1974:100:380-2.

(22.) De Lange J, Rosenberg AJ, van den Akker HP, et al. Treatment of central giant cell granuloma of the jaw with calcitonin. Int J Oral Maxillofac Surg 1999:28:372-6.

(23.) Csillag A, Pharoah M, Gullane P. et al. A central giant cell granuloma influenced by pregnancy. Dentomaxillofac Radiol 1997:26:357-60.

(24.) Park AH, Phillips J, Forte V. Aneurysmal bone cyst of the temporal bone. Otolaryngol Head Neck Surg 1999:120:606-10.

(25.) Watanabe N, Yoshida K, Shigemi H, et al. Temporal bone chondroblastoma. Otolaryngol Head Neck Surg 1999:121:327-30.

(26.) Cares HL. Terplan K. Chondroblastoma of the skull. Case report. J Neurosurg 1971:35:614-18.

(27.) Sakamoto M, Hayashida T, Sugasawa M. A case of fibrous dysplasia of the temporal bone: Evaluation of treatment performed 23 years ago. Otolaryngol Head Neck Surg 2001:125: 563-4.

(28.) Lannon DA, Earley MJ. Cherubism and its charlatans. Br J Plast Surg 2001;54:708-11.

(29.) Silva EC, de Souza PE. Barreto DC. et al. An extreme case of cherubism. Br J Oral Maxillofac Surg 2002;40:45-8.

(30.) Motomochi M, Handa Y, Makita Y, Hashi K. Giant cell tumor of the skull. Surg Neurol 1985:23:25-30.

(31.) Auclair PL. Cuenin P. Kratochvil FJ, et al. A clinical and histomorphologic comparison of central giant cell granuloma and the giant cell minor. Oral Surg Oral Med Oral Pathol 1988:66: 197-208.

(32.) Matsui T, Iwamuro K, Ishikawa T, et al. Large giant cell reparative granuloma of the petrous petrous /pet·rous/ (pet´rus) resembling a rock; hard; stony.

pet·rous
adj.
1. Of stony hardness.

2.
 bone--case report. Neurol Med Chir (Tokyo) 2002:42:232-6.

(33.) Pogrel MA, Regezi JA, Harris ST, Godring SR. Calcitonin treatment for central giant cell granulomas of the mandible: Report of two cases. J Oral Maxillofac Surg 1999:57:848-53.

(34.) Colclasure JB, Shea MC, Jr., Graham SS. Giant cell lesions of the temporal bone. Am J Otol 1981;2:188-92.

(35.) Cohen D. Granda-Ricart MC. Giant cell reparative granuloma of the base of the skull The base of the skull (lat. basis cranii) is the most inferior area of the skull.

Structures
Structures found at the base of the skull are for example:
  • Foramen magnum
  • Foramen ovale (skull)
Bones
  • Ethmoid bone
  • Sphenoid bone
 in a 4-month-old infant--CT findings. Pediatr Radiol 1993;23:319-20.

(36.) Nemoto Y. Inoue Y. Tashiro T, et al. Central giant cell granuloma of the temporal bone. AJNR AJNR American Journal of Neuroradiology  Am J Neuroradiol 1995;16:982-5.

(37.) Maruno M. Yoshimine T, Kubo T, Hayakawa T. A case of giant cell reparative granuloma of the petrous bone: Demonstration of the proliferative component. Surg Neurol 1997:48:64-8.

(38.) Khodaei I. Rowley 11, Farrell M. et al. An unusual cause for tinnitus, Ir Med J 2001;94:312-13.

(39.) Yoshimura J. Onda K, Tanaka R. Takahashi H. Giant cell reparative granuloma of the temporal bone: Neuroradiological and immunohistochemical findings. Neurol Med Chir (Tokyo) 2002; 42:510-15.

From the Department of Otorhinolaryngology-Head and Neck Surgery (Dr. Boedeker, Dr. Ridder, Dr. Maier, and Dr. Schipper), and the Department of Pathology (Dr. Kayser), University of Freiburg University of Freiburg can refer to:
  • Albert Ludwigs University of Freiburg in Freiburg, Germany
  • University of Fribourg in Fribourg, Switzerland (Freiburg)
, Freiburg, Germany.

Reprint requests: Carsten Christof Boedeker, MD, Department of Otorhinolaryngology-Head and Neck Surgery, University of Freiburg, Killianstrasse 5, 79106 Freiburg, Germany. Phone: 49-761-270-4201; fax: 49-761-270-4075; e-mail: boedeker@ hno.ukl.uni-freiburg.de
COPYRIGHT 2003 Medquest Communications, LLC
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2003, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

 Reader Opinion

Title:

Comment:



 

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Original Article
Author:Schipper, Jorg
Publication:Ear, Nose and Throat Journal
Geographic Code:4EUGE
Date:Dec 1, 2003
Words:4394
Previous Article:My new patient, Santa Claus *.
Next Article:Mandibular ameloblastoma and maxillary adenoid cystic carcinoma: case report.
Topics:



Related Articles
Giant-cell reparative granuloma.
Incidental petrous apex findings on magnetic resonance imaging.
Cholesterol granuloma of the petrous apex. (Imaging Clinic).
Incidental granulomatous inflammation of the uterus.
Bilateral vocal process papillomas: report of a case.
Plasma cell granuloma of the thyroid with Hashimoto's thyroiditis: report of a rare case. (Original Article).
Unilateral temporal muscle hypertrophy: A rare clinical entity. (Original Article).
Plasma cell granuloma of the thyroid and Hashimoto thyroiditis.
Cholesterol granuloma.
Poststapedectomy reparative granuloma.

Terms of use | Copyright © 2014 Farlex, Inc. | Feedback | For webmasters