Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

FOREWORD
Year
: 2003  |  Volume : 13  |  Issue : 1  |  Page : 13--14

Giant cell tumor of sinonasal cavity - an uncommon location for a common bone tumor


RB Dubey, NP Tara, SM Desai 
 Dept. of Radiodiagnosis, Pravara Rural Medical College, Loni, India

Correspondence Address:
R B Dubey
Dept. of Radiodiagnosis, Pravara Rural Medical College, Loni
India




How to cite this article:
Dubey R B, Tara N P, Desai S M. Giant cell tumor of sinonasal cavity - an uncommon location for a common bone tumor.Indian J Radiol Imaging 2003;13:13-14


How to cite this URL:
Dubey R B, Tara N P, Desai S M. Giant cell tumor of sinonasal cavity - an uncommon location for a common bone tumor. Indian J Radiol Imaging [serial online] 2003 [cited 2019 Nov 19 ];13:13-14
Available from: http://www.ijri.org/text.asp?2003/13/1/13/28615


Full Text

A 31 year old woman presented to our department with pain in the left eye and complete loss of vision since two weeks. She also had a swelling over the left cheek with history of epistaxis since last 3 months.

On examination, a mass was seen protruding from the lateral wall of the left nasal cavity. She was advised plain radiography.

Radiograph of the paranasal sinuses (water's view) [Figure 1]

Revealed a soft tissue density lesion in the region of the left maxillary sinus extending into the ethmoidal sinuses and nasal cavity on the left side. Erosion of the superior and medial walls of the maxillary sinus and deviation of the nasal septum towards the right side was also noted.

For further evaluation a ct scan was done. Axial and coronal ct sections revealed [Figure 2][Figure 3][Figure 4] a 5.6 x 5.1 x 4.4 cm heterogenous mass in the region of the left maxillary antrum with variable enhancement and multiple fluid levels throughout the lesion. The mass was seen extending into the ethmodial, frontal, sphenoid sinuses, opposite nasal cavity and into the left orbit leading to antero-lateral displacement of the left eyeball. Intracranial extension was also noted in the left frontal region. The differential diagnosis considered in this case was:

Carcinoma of the maxillary sinus.

Giant cell reparative granuloma.

Fibro-osseous tumor, like giant cell tumor.

The patient underwent biopsy of the lesion, which revealed findings typical of a 'giant cell tumor'.

 Discussion



Giant cell tumors (gcts or osteoclastomas) make up 4-5% of all primary bone tumors[1]. They are usually benign, but occasionally, they can be primarily malignant or can undergo malignant transformation. They can behave aggressively and metastasize, More than 75% are located in the epiphyseal region of long bones, with half of the cases occurring about the knee.

True giant cell tumors (GCT) of the head and neck are exceedingly rare and constitute approximately 2% of all GCTs[2]. On ct, they are multilocular and show presence of multiple fluid levels. On MRI, they usually have fairly low signal intensity on all sequences and they enhance on contrast administration. On contrast administration Bertoni, et al described 14 cases of an aggressive lesion with typical features of gct of the skull in their study [5]. Our case revealed similar findings [5].

Many differentials need to be considered. The distinctions between these entities may be impossible to make on a biopsy without radiographic and clinical correlation [1].

Giant cell reparative granuloma (GRCG) generally occurs in women aged above 20 years and is related to prior tooth extraction or an ill-fitting denture. Histopathologically, its haemorrhagic fibroblastic background with innumerable giant cells differentiates it from a GCT [1].

Aneurysmal bone cysts rarely occur in the maxilla, orbit, ethmoid and frontal bones. They are also multilocular and demonstrate multiple fluid levels, but they are comparatively slow growing.

Inverted papillomas are common in 40-70 yrs of age group they generally arise from the lateral nasal wall near the middle turbinate and extend into the sinuses, mainly the maxillary and ethmoid and into the orbit, rarely, they may arise in a sinus without any nasal involvement [6]. Carcinomatous changes in papilloma have also been reported [1].

Squamous cell carcinomas are common in the maxillary sinus. They tend to destroy bone aggressively, but bone remodeling is uncommon. They tend to occur at an older age [1].

Malignant fibrous histiocytomas rarely occur in the paranasal sinuses and orbit. Among its many varieties is a giant cell variety. However, the exact diagnosis remains histopathological [1].

Mucormycosis is an acute fulminant invasive affection of the paransal sinuses. It occurs almost exclusively in diabetic or immuno-compromised hosts. The radiographic features however include a sclerotic reaction from the adjacent bones and fluid levels are uncommon[1].

 Conclusion



A high index of suspicion is necessary on the part of the radiologist to raise the diagnosis of GCT in the location of sinonasal cavity so that aggressive surgery and radiation therapy can be undertaken.

References

1Som PM. Sinonasal cavities: inflammatory disease, tumors, fractures and postoperative findings. In Som PM, Curtin HD. Head and neck imaging; Vol. 1,3rd ed. Mosby-year Book, Inc. 1996: 126-318.
2Lanzieri CF. The sinonasal cavity. In: Hagga J, Lanzieri CF, Sartories DJ, Zerhouini DH. Computerised tomography and mangnetic resonance imaging of the whole body; Vol, 3rd ed. Indian Mosby-Year book, Inc. 1998:471-492.
3Som PM, Lawson N, Cohen BA. Giant Cell lesions of the facial bones. Radiology 1983; 147:129-134.
4Rhea JT, Weber AL. Giant Cell granuloma of the sinuses. Radiology 1983; 147:135-137.
5Bertoni F, Lenmi KK, Beabout JH, Ebersold MJ. Giant cell tumour of the skull. Cancer 1992; 70:1124-1132.
6Hyams VJ. Papillomas of the nasal cavity and paranasal sinuses: a clinico-pathologic study of 315 cases. Ann Otol Rhinol Laryngol 1971; 80:192-206.