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

Abstract

Giant cell tumour (GCT) of bone is an uncommon primary bone neoplasm typically occurring at the epiphyses of long bones in young adults. They are osteolytic neoplasms with approximate local recurrence rates of 25%, and 2% of patients develop pulmonary metastases. These tumours appear very rarely in the skull, with those few reported cases arising predominantly in the sphenoid and occasionally the temporal bones. They demonstrate benign histological features, but are locally aggressive and surgical excision is the treatment of choice. 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. 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. We present a case of a giant cell tumour of the temporal bone which illustrates and re-emphasises this concept and review the literature on these lesions.

Peripheral and central giant cell lesions: etiology, origin of giant cells, diagnosis and treatment

“…The latter lesions cause pain and exhibit rapid growth, usually larger than five centimeters, producing expansion and perforation of the cortical bone, displacement of teeth and root resorption. Besides, there is a high recurrence rate, which generally ranges between 37.5% and 70% (7,8,14,15,25,26,29,30,32,37) .…”

“…When they are multilocular, they may be confused with ameloblastomas or other lesions. Histopathologically, they greatly resemble PGCL, aneurysmal bone cysts, central odontogenic fibroma, brown tumor of hyperparathyroidism, giant cell tumor and cherubism, particularly the latter when the lesion occurs in children and involves multiple locations (26,32) . It is noteworthy that CGCL and brown tumor of hyperparathyroidism are histologically similar, especially in cases in which there is intense endogenous brownish pigmentation of hemosiderin.…”

“…It is noteworthy that CGCL and brown tumor of hyperparathyroidism are histologically similar, especially in cases in which there is intense endogenous brownish pigmentation of hemosiderin. Therefore, it is essential to request additional tests such as serum calcium, phosphate, parathyroid hormone and alkaline phosphatase, whose values are normal in CGCL (6,19,24,25,32,37) .…”

“…The stroma of giant cell tumor is composed of large round and oval cells, which are next to each other. The aneurysmal bone cyst is distinguished from CGCL due to its network of multiple cystic cavities filled with blood within thin walls (21,26,32) .…”

Giant Cell Tumor of Infratemporal Fossa and Mandibular Condyle: A Case Report

“…GCTs are only rarely encountered in the skull; in the few reported cases, tumors arose mostly in the sphenoid and occasionally in the temporal bone. The clinical features of GCT arising from the temporal bone depend upon the site of origin in the temporal bone, and trismus is an unusual presentation [2,4] . Here, we report the case of a huge GCT of the petrous and squamous portions of the temporal bone, which extended into the left mandibular ramus and middle ear and include a review of the literature.…”