A locally invasive giant cell tumor of the skull base: case report

Abstract

Giant cell tumors (GCTs) are rare, usually affecting the epiphyses in long bones of the extremities. They seldom occur in the skull, where they preferentially affect the sphenoid and temporal bones. Considered to be benign, locally aggressive lesions, they may cause cranial nerve deficits by compression but infrequently invade the dura and parenchyma of the brain. Several case reports with follow-up describe gross total resection of skull base GCT to be curative. Anything short of total resection usually results in recurrence within 4 years. Radiation therapy, although controversial, is reserved for lesions that cannot be completely resected. Some argue, however, against the use of radiation because there are reported cases of malignant transformation. Here we describe the case of a large GCT that was invasive to the dura, temporal lobe, as well as the third division of the trigeminal nerve, and to date gross total resection has been curative of this lesion. The patient has not undergone radiation therapy.

Keywords: GCT; epiphyses; extremities; giant cell tumors; radiotherapy; skull base tumor; temporal bone.

Fig. 1

(A) Photo of the right external auditory meatus taken during an otoscopic examination when the patient was initially seen in the Ear, Nose, and Throat clinic, early July 2011. (B, C) Coronal and (D) axial slices of computed tomography bone windows showing temporal and petrous bone prior to resection. (E) Anteroposterior Towne and (F) lateral view of tumor model.

Fig. 2

(A) Intraoperative photo showing the resection cavity. A portion of the temporal lobe and dura were removed and repaired with a dural substitute and sealant. The temporal floor, zygoma, and portion of the upper mandibular ramus were invested with tumor and resected. Zygomatic arch (asterisk), temporal lobe (double asterisk), and duraplasty (arrow; superior temporal line). (B) Sagittal (C) coronal, and (D) axial views of 19-month follow-up magnetic resonance imaging showing no tumor recurrence and good reconstruction with a rectus free flap.

Fig. 3

(A) Infiltrative giant cell tumor (GCT) beneath the epidermis showing characteristic mononuclear cells, hemosiderin pigment, and multinucleated giant cells. Heavy infiltration of GCT in (B, C) brain and (D) bone.