Giant-cell tumors of the temporal bone: management strategies

Abstract

Objective: To discuss the current management options for giant-cell tumors (GCTs) involving the temporal bone and present two case reports and a review of the literature.

Method: In a tertiary-care academic medical center, two patients with GCTs of the temporal bone were evaluated and managed. The patients underwent gross total resection and curettage of GCTs involving the temporal bone. Afterward, both patients were evaluated for postoperative complications as well as for recurrence.

Results: Two patients underwent operative excision using curettage. Clinical and radiographic studies demonstrated no evidence of recurrence with 3 years of follow-up in one patient and 10 years of follow-up in the second patient.

Conclusion: Based on these results, we concluded that gross total removal and curettage of GCTs in the temporal bone is a viable treatment option. This finding is contrary to previous studies.

Keywords: Temporal bone; giant-cell tumors; skull base.

Figure 1

Preoperative T1 magnetic resonance imaging from case 1. (A) Axial image after administration of gadolinium demonstrates a large hypointense lesion (arrow) with peripheral rim enhancement and several small areas of enhancement within the lesion on the right. (B) Coronal image after administration of contrast demonstrates the same hypointense lesion (arrow) with small areas of enhancement.

Figure 2

Computed tomographic images with bone window algorithm from case 1. (A) Axial image demonstrates a large lytic lesion on the right with erosion into the otic capsule at the level of the vestibule (arrow). (B) Coronal image demonstrates the same right-sided lesion (arrow) with significant bone remodeling.

Figure 3

Hematoxylin-eosin histopathology slide of specimen from case 1. Numerous multinucleated giant cells are seen in a background of spindle-shaped stromal cells and round monocyte-like cells.

Figure 4

Postoperative magnetic resonance imaging (MRI) scans without fat saturation from case 1. (A) Axial T1 MRI without contrast demonstrates an area of hyperintensity (arrow) at the lateral aspect of the craniotomy. The hyperintense area represents the abdominal fat graft that was placed to reconstruct the defect as a result of tumor removal (B) Postcontrast axial T1 MRI shows no change in the hyperintense area (arrow) and no new areas of enhancement. (C) Coronal T1 MRI with contrast shows an area of hyperintensity (arrow) that did not change from precontrast images.

Figure 5

Hematoxylin-eosin histopathology slide of specimen from case 2. Several very large multinucleated giant cells are seen along with the spindle-shaped stromal cells and round monocyte-like cells.

Figure 6

Postoperative magnetic resonance imaging (MRI) scans without fat saturation from case 2. (A) Axial T1 MRI without contrast demonstrates a very small isodense area (arrow) in the posterior petrous apex. (B) Postcontrast axial T1 MRI demonstrates an isodense area along the posterior petrous apex (arrow), which has remained unchanged for 9 years. (C) Coronal T1 MRI with contrast shows an area of hyperintensity (arrow) in the petrous apex that did not differ in signal from precontrast images and most likely represents bone marrow or fat.