Pediatric giant cell reparative granuloma of the lower clivus: A case report and review of the literature

Abstract

Giant cell reparative granuloma (GCRG) is a benign nonneoplastic granulomatous lesion and is rare in the cranial bone. We present a pediatric case of this lesion arising from the condyle and lower clivus. A 9-year-old girl presented with slowly progressive hoarseness and dysphagia. She showed left glossopharyngeal, vagus, and hypoglossal nerve palsy. An osteolytic lesion around the lower clivus and condyle joint was accompanied by deformation of the craniovertebral junction. An endoscopic endonasal approach was used to decompress the cranial nerve and confirm the pathological finding. The lesion around the condyle was not resected to preserve occipito-cervical stability. The residual lesion has been observed carefully for 6 months, and regrowth has not occurred. GCRG is a rare granulomatous lesion in the cranial bone. This case is the first report of a pediatric clival GCRG. Treating pediatric GCRG may be helpful.

Keywords: Giant cell reparative granuloma; lower clivus; pediatric case.

Figure 1

Computed tomography images of the illustrative case. (a-c) Preoperative nonenhanced bony computed tomography revealing calcification including an osteolytic lesion. Coronal view revealing a lytic lesion that occupied the condyle and C1 lateral mass. Sagittal view showing the lytic lesion which extends to the upper clivus

Figure 2

Preoperative magnetic resonance images revealing that the lesion had low intensity on T1- and T2-weighted images. The lesion is enhanced heterogeneously by gadolinium administration. (a) T1-weighted image, (b) T2-weighted image, (c) gadolinium-enhanced image

Figure 3

Intraoperative photographs of the illustrative case. An endoscopic endonasal transclival approach is performed to confirm the pathological finding and to decompress the left lower cranial nerves. (a) The lesion below the sellae turcica is exposed. The lesion is hemorrhagic and white-yellow in color, and consists of relatively soft tissue. (b) The lateral side of the lesion is resected until the bilateral internal carotid arteries are exposed. (c) The upper side of the lesion near the dorsum sellae is drilled out. (d) Near the left lateral side of the lesion, the left hypoglossal canal is opened

Figure 4

Postoperative nonenhanced bony computed tomography images of the illustrative case: (a-c) The lesion is resected between the dorsum sellae and lower clivus without the condyle joint

Figure 5

Pathological findings (H and E): (a) Multinucleated giant cells surrounding the focal hemorrhage are seen. (×100) (b) Abundant spindle-shaped fibroblast cells and multinucleated giant cells are present ( ×200)