Imaging features, staging system, and surgical management of giant cell lesions of the temporal bone

Abstract

Background

Giant cell tumors (GCTs) and giant cell granulomas (GCGs) are giant cell-rich lesions that occur extremely rarely in the temporal bone and have similar clinical presentations.

Objectives

We aimed to analyze the clinical features and introduce our staging system and surgical treatment.

Methods

Forty-six patients pathologically diagnosed with a giant cell lesion involving the temporal bone between October 2001 and October 2020 were reviewed retrospectively. The clinical characteristics, surgical approaches, and risk factors for recurrence were analyzed.

Results

GCTs and GCGs presented as masses centered on the temporomandibular joint with similar imaging features, including a thin, calcified shell and central scattered calcifications on a computed tomography scan. Differences were detected on magnetic resonance imaging in 29.6% (4/14) of GCG and 50% (16/32) of GCT cases; the remaining cases were not distinguishable. Based on our staging system and surgical strategy, 31.8% (7/22) of GCT and 10% (1/10) of GCG cases experienced recurrence, which compares to recurrence rates of 60% in GCT cases and 20% in GCG cases in previous studies.

Conclusions

Specific clinical and preoperative imaging features help to make a diagnosis of temporal giant cell-rich lesions. Our staging system and surgical strategy could help surgeons tailor the surgical strategy.

Chinese Abstract

背景：巨细胞瘤 (GCTs) 和巨细胞肉芽肿 (GCGs) 是富含巨细胞的病变。它们在颞骨内极少发生, 临床表现相似。

目的：我们旨在分析临床特征并介绍我们的分期系统和手术治疗。

方法：回顾性审查了46例在 2001 年 10 月至 2020 年 10 月期间经病理化验诊断为颞骨巨细胞病变的患者。分析了临床特征、手术方法和复发危险因素。

结果：GCT 和 GCG 表现为以颞下颌关节为中心的肿块, 具有相似的成像特征, 包括电脑断层扫描显示的薄钙化壳和中心散在钙化。在 29.6% (4/14) 的 GCG病例 和 50% (16/32) 的 GCT 病例中, 磁共振成像检测到差异；其余病例不可区分。根据我们的分期系统和手术方法, 31.8% (7/22) 的 GCT 病例和 10% (1/10) 的 GCG 病例出现复发；相较于之前的研究中, GCT 病例的复发率为 60%, GCG 病例的复发率为 20%。

结论：特定的临床特征和术前影像学特征有助于诊断颞骨富巨细胞病变。我们的分期系统和手术方法可以帮助外科医生们定制手术方案。

Keywords:

• Giant cell tumor (GCT)
• Giant cell granuloma (GCG)
• Temporal bone
• Infratemporal fossa
• Skull base
• Middle cranial fossa approach

Ethical approval

Study protocols were performed with the approval of the Ethics Committee of the Chinese PLA General Hospital (approval number S2016-103-01).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that supports the findings of this study are available in the supplementary material of this article.

Additional information

Funding

This work was supported by grants from the National Key Research Project. [grant number 2017YFC1001800], National Major Scientific Instrument and Equipment Development Project [grant number 61827805], and National Natural Science Foundation of China [grant number 82171155].