Giant cell reparative granuloma of the temporal bone: Case report and review of the literature

Abstract

Jaffe 1 coined the term "giant cell reparative granuloma" (GCRG) in 1953 to describe lesions of the maxilla and mandible. Subsequently, numerous other sites have been reported including the orbit, cranial vault, sphenoid, ethmoid, facial bones, the small bones of the hands and feet, and the long bones of the axial skeleton. [2][3][4][5][6] The first account of GCRG in the temporal bone was recorded by Hirschl and Katz 7,8 in 1974. Since then, because of the rare nature of this tumor in the temporal bone, only a handful of cases have been described. 3,5,6,9,10 Although regarded as a benign process, GCRG may be locally aggressive, and surgical excision is recommended whenever possible. Recurrence rates are thought to be low, ranging between 10% and 15% in most studies. 5,7,[11][12][13] However, some smaller series have reported recurrence rates as high as 69% to 75%. 13,14 We report a case of recurrent GCRG of the temporal bone that involved the glenoid fossa, necessitating reconstruction.

Giant Cell Tumour and Central Giant Cell Reparative Granuloma of the Skull: do These Represent Ends of a Spectrum? A Case Report and Literature Review

“…Expression of p63 has been found by some to be useful to distinguish between GCT and other non-neoplastic giant cell lesions [14]. The term "giant cell lesion" was recommended for these equivocal cases [5].…”

“…Equally, others have reported recurrence rates as high as 69-75% for truncated removal of CGCG in the jaw [6]. There have been only two reported cases of metastasis from a GCT of the skull [5], one of which originated in a patient with Paget's disease [15]. It is of interest that nearly all cases of metastases of long bone GCTs have emerged after surgical manipulation to the primary tumour.…”

“…Surgical reconstruction maybe considered if wide primary excision has been necessary. Curettage alone has been associated with higher recurrence rates [5,6]. The risk of malignant transformation following radiotherapy has decreased significantly since orthovoltage radiation has been largely replaced by megavoltage radiation [5,10].…”

“…Curettage alone has been associated with higher recurrence rates [5,6]. The risk of malignant transformation following radiotherapy has decreased significantly since orthovoltage radiation has been largely replaced by megavoltage radiation [5,10]. Chemotherapy is usually reserved for those cases which remain inadequately controlled by surgery and irradiation and often consists of a combination regimen of methotrexate, adriamycin and cyclophosphamide [10,11].…”

“…It is widely believed that giant cell tumours should be distinguished from other giant cell lesions, importantly central giant cell reparative granulomata (CGCG) which are thought to have a lower recurrence rate and for which no cases of malignant transformation or metastases have been reported; however both lesions may require post operative radiotherapy in order to achieve local control [2][3][4]. Investigators have noted that giant cell lesions in the skull bones may be unique and that GCT and CGCG may be part of a spectrum of a single disease process [5][6][7]. We report a case of GCT of the temporal bone which illustrates the merging features of CGCG and GCT and review the literature on these lesions.…”