Selected Giant Cell Rich Lesions of the Temporal Bone

Abstract

Giant cell rich lesions of the temporal bone encompass a wide spectrum of disease that includes infectious, reactive, and neoplastic processes. When dealing with any lesion that can potentially involve bone, it is important to understand both the clinical presentation and to correlate the histologic findings with the radiologic imaging. This review discusses the clinical, the pathologic features including the differential diagnosis, and the treatment of some of the more commonly encountered giant cell rich entities in this region.

Keywords: Chondroblastoma; Giant cell reparative granuloma; Langerhans cell histiocytosis; Sarcoidosis; Temporal bone; Tenosynovial giant cell tumor.

Fig. 1

a Langerhans cell histiocytosis showing a mix of osteoclast giant cells, larger mononuclear cells and mixed inflammation including eosinophils. b Higher power shows the reniform or cleaved nuclei of Langerhans cell histiocytosis that stain with c Langerin and d CD1a

Fig. 2

Sarcoidosis with non-caseating, epithelioid granulomas involving a lymph node (a) and between bony trabeculae in a case involving the temporal bone (b)

Fig. 3

a T1 and b T2 coronal MRI of tenosynovial giant cell tumor showing involvement lateral and superior to the right TMJ. There are some T1 and T2 low signal areas suggestive of hemosiderin

Fig. 4

a Low power view of tenosynovial giant cell tumor showing a mix of mononuclear cells and foamy histiocytes. b The true lesional cells are the larger, plasmacytoid mononuclear cells with eosinophilic cytoplasm that can have a rim of hemosiderin. c Occasional chondroid nodules mimicking chondroblastoma can be seen. d Clusterin staining in the larger mononuclear cells

Fig. 5

Chondroblastoma a at low power showing eosinophilic chondroid lobules with sheets of mononuclear cells and b osteoclast giant cells. c At high power, the mononuclear cells are oval with ample eosinophilic cytoplasm, occasional nuclear grooves and d sometimes the classic pericellular “chicken-wire” calcification can be seen

Fig. 6

a Giant cell granuloma showing spindled and polygonal mononuclear cells with eosinophilic cytoplasm and osteoclast-like giant cells in a hemorrhagic, vascular background. b At higher power, note how the nuclei in the osteoclasts differ from the mononuclear cells in contrast to those seen in giant cell tumor of bone