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CASE REPORT
Year : 2014  |  Volume : 9  |  Issue : 1  |  Page : 48-49

Giant cell tumor of the clivus with presence of epithelioid histiocytes


1 Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, India
2 Departments of Oral and Maxillofacial Surgery, Narayana Dental College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
3 Department of Pathology, Narayana Dental College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India

Date of Web Publication19-Apr-2014

Correspondence Address:
Amit Agrawal
Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1793-5482.131078

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  Abstract 

Giant cell tumor (GCT) is a benign neoplasm but locally aggressive tumor that uncommonly involves the skull bone. We report a case of a 62-year-old male presented with increasing headache and diplopia. Investigations were suggestive of an expanding mass lesion of the clivus. Histopathology was suggestive of diagnosed with GCT with abundant histiocytes.

Keywords: Clivus, giant cell tumor, histiocytes, skull


How to cite this article:
Agrawal A, Gali R, Shanthi V, Ramakrishna BA, Mohan KM. Giant cell tumor of the clivus with presence of epithelioid histiocytes. Asian J Neurosurg 2014;9:48-9

How to cite this URL:
Agrawal A, Gali R, Shanthi V, Ramakrishna BA, Mohan KM. Giant cell tumor of the clivus with presence of epithelioid histiocytes. Asian J Neurosurg [serial online] 2014 [cited 2019 Jul 21];9:48-9. Available from: http://www.asianjns.org/text.asp?2014/9/1/48/131078


  Introduction Top


Giant cell tumor (GCT) is a benign neoplasm but locally aggressive tumor that uncommonly involves the skull bone (preferentially, the sphenoid and the temporal bones), [1],[2] with ooccasional instances of orbital, calvarial, and occipital bones involvement. [3] In the present article, we report a case of GCT of the clivus and review the relevant literature.


  Case Report Top


A 62-year-old male underwent transphenoidal biopsy of the sellar mass lesion and it was diagnosed as GCT. Now, he presented with an increasing in headache and diplopia of 3 months duration. He was a known diabetic controlled with medication. There was no history of hypertension. His general and systemic examination was normal. Neurological examination was normal, except bilateral 6 th nerve paresis. Magnetic resonance imaging (MRI) of the brain showed a large well-defined hyperdense contrast-enhancing lesion involving the clivus. In view of the enlarging size of the lesion and increase in headache, the patient was planned for resurgery [Figure 1]. The patient underwent extended bifrontal craniontomy and orbitoomy, subfrontal approach, and decompression of the tumor. Postoperatively was uneventful, the headache improved but diplopia and 6 th nerve paresis was persisting. Microscopically, the lesion is composed of multinucleated giant cells admixed with mononuclear stromal cells. The stromal cells are polygonal, and some of them are elongated spindle-shaped. The cells have vesicular round to oval nuclei with prominent nucleoli in some of them. Increased vacularity was noted in some areas of tumor. Few foci showed sheets of clear histiocytes having small round nuclei and clear cytoplasm. Bony trabeculae rimmed by osteoblasts are noted in some foci [Figure 2] and [Figure 3].
Figure 1: MRI of the brain showing extensive lesion involving the clivus

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Figure 2: (a) Sheets of histiocytes with small round nuclei and clear cytoplasm (H and E, ×100) and (b) Sheets of histiocytes with small round nuclei and clear cytoplasm (H and E, ×400)

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Figure 3: Tumor showing multiple osteoclast-like giant cells admixed with stromal cells (H and E, ×100)

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  Discussion Top


Primary GCTs of the clivus are a rare lesion with only few reported cases in the literature. [4],[5],[6] The clinical features of these tumors depend on the location of cranial lesion and symptoms vary in accordance with their actual location. GCT of the sphenoid can present with headache, visual field defects, blindness, diplopia, second through 8 th cranial nerve dysfunction, endocrinopathy, and altered mental status; [4],[5],[6] on the contrary, temporal bone tumors can present with pain behind the ear, deafness, and facial weakness. [7] GCT is characterized by vascularized tissue that contains numerous cytologically benign multinucleated giant cells dispersed through plump, spindly, and/or ovoid cells. [1],[8] Nuclei of the cells are generally hypochromatic with inconspicuous nucleoli and uncommon mitotic figures. [9] Presence of epithelioid histiocytes is rare in GCT and it was described in case of GCT of the tendon sheath, which was largely composed of epithelioid; histiocytes are very rare and in the reported case, the tumor was composed of cellular and hypocellular zones, celluar zone was composed of spindle cells and osteoclast-like giant cells, and the hypocelluar zone was composed of epithelioid clear histiocytes, and it was suggested that the epithelioid histiocytes were the neoplastic cells. [10] GCTs needs to be differentiated from other lesion including chondrosarcoma and chordomas, aneurysmal bone cyst, giant cell reparative granuloma, "Brown tumor" of hyperparathyroidism, and fibrous dysplasia. [9] Skull X-rays and angiography have been the traditional investigations for the diagnosis of the GCTs of the skull. [3],[9] Recently, computed tomography (CT) and MRI have been increasingly used for the diagnosis of these lesions, and the CT appearance of GCT is that of a homogeneous hyperdense mass highly enhancing after contrast administration. [2],[11] Bony erosions can also be demonstrated by CT scan examination, [3],[11] and the bone adjacent the lesion can appear hyperplastic in some cases. [12] The treatment of choice of GCTs is complete surgical excision and if it can be achieved it is curative; however, as was seen in the present case, it is may not always be feasible. [9],[11],[12] Although controversial, in cases of unresectable tumors or with incomplete excision, radiotherapy remains the other option. [2],[4],[7],[9],[11]

 
  References Top

1.Dahlin DC. Caldwell lecture. Giant cell tumor of bone: Highlights of 407 cases. AJR Am J Roentgenol 1985;144:955-60.  Back to cited text no. 1
[PUBMED]    
2.Pai SB, Lalitha RM, Prasad K, Rao SG, Harish K. Giant cell tumor of the temporal bone: A case report. BMC Ear Nose Throat Disord 2005;5:8.  Back to cited text no. 2
    
3.Vernet O, Ducrey N, Deruaz JP, de Tribolet N. Giant cell tumor of the orbit. Neurosurgery 1993;32:848-51.  Back to cited text no. 3
    
4.Gupta R, Mohindra S, Mahore A, Mathuriya SN, Radotra BD. Giant cell tumour of the clivus. Br J Neurosurg 2008;22:447-9.  Back to cited text no. 4
    
5.Zhang QH, Kong F, Yan B, Ni ZL, Lu HL. Endoscopic endonasal surgery for clival tumor. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2007;42:7-10.  Back to cited text no. 5
    
6.Zorlu F, Selek U, Soylemezoglu F, Oge K. Malignant giant cell tumor of the skull base originating from clivus and sphenoid bone. J Neurooncol 2006;76:149-52.  Back to cited text no. 6
    
7.Pradhan S, Datta NR, Krishnani N, Ayyagari S, Tandon P. Giant cell tumour of the petrous bone. Indian J Cancer 1991;28:177-80.  Back to cited text no. 7
[PUBMED]    
8.Silvers AR, Som PM, Brandwein M, Chong JL, Shah D. The role of imaging in the diagnosis of giant cell tumor of the skull base. AJNR Am J Neuroradiol 1996;17:1392-5.  Back to cited text no. 8
    
9.Wolfe JT 3 rd , Scheithauer BW, Dahlin DC. Giant-cell tumor of the sphenoid bone. Review of 10 cases. J Neurosurg 1983;59:322-7.  Back to cited text no. 9
    
10.Terada T. Giant cell tumor of the tendon sheath composed largely of epithelioid histiocytes. Int J Clin Exp Pathol 2012;5:374-6.  Back to cited text no. 10
[PUBMED]    
11.Findlay JM, Chiasson D, Hudson AR, Chui M. Giant-cell tumor of the middle cranial fossa. Case report. J Neurosurg 1987;66:924-8.  Back to cited text no. 11
[PUBMED]    
12.Watkins LD, Uttley D, Archer DJ, Wilkins P, Plowman N. Giant cell tumors of the sphenoid bone. Neurosurgery 1992;30:576-81.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


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