Giant cell tumor of the temporal bone of the diagnosis and treatment of_2851

By Ana Tucker,2014-10-30 18:36
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Giant cell tumor of the temporal bone of the diagnosis and treatment of_2851

    Giant cell tumor of the temporal bone of the diagnosis and treatment of

     Abstract Objective: To explore the temporal bone giant cell tumor of the clinical manifestations, diagnosis, differential diagnosis and treatment. Methods: I Division 1

    cases treated in giant cell tumor of the temporal bone in patients with symptoms, signs, radiological, pathological features, and review the related literature. Results: The patient is female, occurred in the left temporal bone, pathologic grade for the ? ?, underwent radical resection

    and postoperative radiotherapy. Conclusion: The temporal bone in diagnosis of giant cell tumor will be a combination of clinical, imaging and pathology data, treatment with surgical excision, if necessary, supplemented by postoperative


     Key words Giant cell tumor of the temporal bone, diagnosis and treatment

     [ABSTRACT] Objective: To explore the clinical manifestation, diagnosis, differential diagnosis and treatment of giant cell tumor of the temporal bone (GCTTB). Method: The symptom, objective sign, imaging and pathology of one case of

    GCTTB was retrospectively analyzed. Result : The patient, pathologically diagnosed as grade ? ? received tumor

    resection and radiotherapy. Conclusion: The diagnosis of GCTTB should be based on the clinical manifestation, imaging and pathology. Once diagnosed, total resection is necessary and radiotherapy should follow if necessary.

     [KEY WORDS] Temporal bone; Giant cell tumor; Diagnosis;


     Giant cell tumor of bone (giant cell tumor of bone, GCTB) also known as break bone tumor, is more common in Asians

    primary bone tumor, the incidence of foreign reports about 1 / 100 million [1]. Often occurred in the epiphyseal end of long bones. Occurred in temporal bone giant cell tumor of bone (giant cell tumor of temporal bone, GCTTB) is extremely rare

    [2]. In September 2005 our department treated in 1 case, reported as follows.

     A clinical data

     Patients, female, 42 years old. A result of left ear itch, pain and discomfort associated with tinnitus, hearing loss, one and a half years admitted to hospital. Patients 1

    year and a half ago before there left ear itch, pain and discomfort and have tinnitus and hearing loss, not accompanied by dizziness, headache, no history of ear pus water. The local diagnosed as "left otitis externa", did not line treatment.

    After the hearing loss gradually increased over the past two months to open one's mouth is not found before the left ear swelling, uplift, to patient. The left external auditory canal can be seen inside the new creatures, on the wall of subsidence, the still soft-touch, no congestion, blocked ear

    canal, tympanic membrane glimpse unclear. Temporomandibular joints swelling uplift, the skin color to normal. Mastoid area skin to normal, no tenderness. Facial nerve function was normal. Electric audiometry showed conductive hearing loss left ear, the average air-bone gap of 35? DB. Temporal bone CT (inside back cover Screensavers 4) shows the left temporal bone Ministry of large flake drum osteolytic bone destruction zone, see the small pieces inside the high density shadow, the

    left external auditory canal showed disappearance of soft tissue density in the left lateral wall of the eardrum and the mastoid process chamber before , tympanic cover all damage disappeared, the left temporomandibular joint area, see the

    soft tissue mass, the left temporal lobe brain tissue compression, soft tissue mass with unclear boundaries of the left temporal subcutaneous tissue mass and subcutaneous group of Shandong University Journal of Otolaryngology Eye 21 Volume


     WANG Yan-Sheng, et al. Temporal bone giant cell tumor of

the diagnosis and treatment (1 case report)

     Weaving boundaries unclear. Enhanced scan showing (inside back cover color pictures 5) the left temporal bone, and even encourage the Department of obviously enhanced mass, about 3.5? Cm × 4.0? Cm. Subcutaneous tissue and meningeal venous compression passes. MRI (inside back cover color pictures 6) scanning: the left ear is about the Department see a 3.6? Cm × 5.0? Cm of irregular mixed-signal image, in the long T1-

    based short-T2 signal, boundary less clear, some broke into the intracranial pressure lesions adjacent temporal lobe, but with a clear delineation of brain tissue. Down the growth of lesions involving the adjacent soft tissue outside the left

    temporal bone part of the destruction of bone resorption. After the injection of Gd DTPA see the lesions showed

    heterogeneous enhancement of soft tissue adjacent obviously enhanced (inside back cover color pictures 7), within the left mastoid process, see sheet long shadow T1 long T2 signal at different levels, no abnormal signal within the brain mass.

     Anesthesia temporal bone tumor resection, intraoperative see: The tumor in the left temporal bone squamous Department, the Department and drums rock department, about the size of 5? Cm × 4? Cm × 3? Cm, scales large section of the damage, defect of about 5? Cm × 4? cm, Iwabe anterolateral damage

    disappear, the Ministry of the whole drum damage. Total destruction of the mandibular fossa bone absorption, remaining

    thin joint capsule. Tympanic membrane disappeared, ossicular integrity; tumor no obvious capsule, temporal bone squamous tumors with dural adhesion significantly. Operation along the normal tissue around the tumor with the peeling separation,

    surrounded by bone chisel edge to the bone about 1? Cm, electric condensate around the edge of the Ministry of burning rock, along the tumor margin on the tumor capsule stripped from the dura mater. With its outer layer of tumor excision, the last completely remove the tumor. The use of Galeal and temporal scales myofascial flap for repair of defect, intraoperative dural integrity maintained, no cerebrospinal fluid leakage, biological glue Galeal bonding with the dura mater to prevent bleeding and cerebrospinal fluid leakage,

    after the temporal muscle and skin flap reset, sewing. Antibiotics surgery cavity filling gelatin sponge, iodoform gauze packing the external auditory canal. Removal of tumor tissue to send quick frozen section: Consider the temporal

    bone giant cell tumor; routine pathological giant cell tumor of the temporal bone showed ? ? level (inside back cover

    color pictures to 8). After 7? D stitches, 15? D stuffing out of the external auditory canal, 1 month later, radiation therapy (dose of 30? Gy). Patients with good recovery, limited mouth opening situation improved, facial nerve function was normal, no v. headache, dizziness and other symptoms. Follow-

    up of 1 year without recurrence. Reposted elsewhere in the Download Center http:// free papers

     2 Discussion

     GCTB occurred in bone marrow of the connective tissue, most often occurs in the epiphyseal end of long bones, particularly the distal femur, proximal tibia and distal radius. A higher rate of postoperative recurrence (10% 40%).

    Occurred in the head and neck in giant cell tumor of bone is rare, accounting for the total number of bone giant cell tumor of 2%, mainly occurred in the sphenoid and temporal bone. While abroad, information, GCTTB of women is more susceptible

    to the disease than men, but I Statistics of domestic cases reported in the past 10 years, men have a higher prevalence (14/22), right more than left side (13/22 ).

     GCTTB clinical manifestations of violations of due to the tumor location and extent of damage to another, may have

    earache, tinnitus, hearing loss, facial paralysis, and dizziness. Can be no early symptoms, disease development can occur outside ear weeks localized bulge deformation. Only in this case of early and mild ear pain, itching, and gradually

    associated with tinnitus and hearing loss.

     Radiographic, GCTB usually manifested the expansion of non-specific in nature, destructive soft tissue mass. CT examination, soft tissue density mass Duocheng containing many high-density areas, markedly enhanced after injection of

    contrast agent. MRI examination, the majority of giant cell tumor of the border clear signal no tumor characteristic, in the majority of T1WI showed a uniform low-signal or

    intermediate signal, the signal in T2WI uneven, showing a low,

    medium or high mixed-signal, and normal tumor tissues in

    general was relatively high signal, old hemorrhage was significantly higher signals in the formation of cystic areas, hemosiderin compared with low signal of composure. After

    lesions to enhance the performance of a variety, depending on the tumor's blood supply can be irregular was slightly enhanced to a significant strengthening in the form [3].

     Histopathological, Jaffe et al [4] Giant cell tumor of the temporal bone is divided into three: ? level as benign;

    ? grade intermediate; ? grade malignant. Mainly based on

    cell differentiation, nuclear morphology and division, the number of giant cell classification. The cases of pathological grade for the ? ? grade. Giant cell tumor of bone by light

    microscopy, mononuclear stromal cells and multinucleated giant cells, multinucleated giant cells, mostly by a combination of mononuclear stromal cells, thus, stromal cells and multinucleated giant nucleus is the same. Stromal cells in short and plump, spindle-shaped tumor is the main component;

    indefinite number of multinucleated giant nucleus, mostly in 1020 between the components of its characteristic.

     GCTB to be with the temporal bone giant cell reparative granuloma, chondrosarcoma, aneurysmal bone cyst,

    chondroblastoma, dermoid cyst identification. The differential point is the giant cell tumor of the evenly distributed multinucleated giant cells, giant cells, stromal cells, nuclear and nuclear similar to giant cell volume large number

    of multi-core; in other lesions with multinucleated giant cells, the multinucleated giant cells were focal distribution, giant cell volume is small, small number of riboflavin.

     Based on the current reported in the literature, GCTB the preferred surgical treatment, complete tumor resection is the best treatment. Radiotherapy should be used as adjuvant therapy for surgical treatment, the surgery can not be can be used as replacement therapy [5]. Chemotherapy for giant cell tumor of the temporal bone is still not satisfied with

    therapeutic effect.

     In short, occurred in the temporal bone of the bone giant cell tumor of difficult diagnosis, should be combined with clinical, radiological examination, a comprehensive analysis of pathological examination. As the giant cell tumor of bone is a potential cancer treatment in order to complete resection of the main violations of the surrounding soft tissue should also be completely removed. In view of local recurrence after surgical resection rate, can not be considered as an ordinary

    benign tumor, conventional surgery supplemented by radiotherapy, total dose of 50 60? Gy, only long-term cure.


     [1] Sheilch M, Chisti FA, Sinan T. Giant cell tumor of the temporal bone: case report and review of the literature [J].

    Australasian Radiology, 1999, 43:113 115.

     [2] Lee HJ, Lum C. Giant cell tumor of the skull base [J]. Neuroradiology, 1999, 41:305 307.

     [3] Tang JY, Wang CK, Su YC, et al. MRI appearance of giant cell tumor of the lateral skull base: A case report [J]. Journal of Clinical Imaging, 2003, 27 (1): 27 30.

     [4] Jaffe Ht. Giant cell tumor of bone [J]. Arch Pathol, 1940, 30:993.

     [5] Caudell JJ, Ballo MT, Zagars GK, et al. Radiotherapy in the management of giant cell tumor of bone [J]. J Radiation Oncology Biol Phys, 2003, 57:158 165. Reposted elsewhere in

    the paper for free download http://

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