gms | German Medical Science

Giant cell tumours (osteoclastoma) are very uncommon neoplasms in the facial skeleton. Their usual clinical presentation is in the long bones. The differential diagnosis of giant cell tumour (GCT) in the facial skeleton includes giant cell granuloma (GCG), brown tumour, nonossifying fibroma, chondroblastoma and odontogenic cyst. It can be very difficult to differentiate histologically three lesions: giant cell tumour, giant cell granuloma and brown tumour related to hyperparathyroidism

One case of GCT and five cases of GCG are presented. Four men and one woman aged 14–68 years had GCG that occupied the maxillary sinus and nasal cavity. Clinical symptoms included swelling of the cheek, nasal obstruction and facial pain. CT well demonstrated extension of the lesion and erosion of the alveolar process and sinus walls. The lesions were removed using sublabial approach with disease free 4–15 years follow up.

A 16 years old boy presented with unilateral blindness, headache and biopsy result: giant cell tumour. Imaging radiography revealed involvement of the sphenoid sinus, orbit apex and middle cranial cavity bilaterally. We removed the tumour subtotally using subcranial approach. A year later he was operated again in another institution and this resulted with bilateral blindness and temporary haemiplegia.

Concluding, CT and MRI well demonstrate giant cell lesions and the goal of surgical treatment is radical removal. This might not always be possible when the giant cell tumour invades the skull base.