Giant cell reparative ethmoid granuloma: a clinical case with a review of the literature

Giant cell reparative granuloma (GCRG) is a rare benign tumor that develops in the first two decades of life. Data on the incidence of GCRG in children vary significantly depending on the number of observations and methods of statistical data processing. GCRG is more common in long bones, but rare cases of damage to the bones of the facial skeleton, which account for only 2–12 %, have been described. The etiological factors of GCRG are unknown, but genetic predisposition and intraosseous hemorrhages after an injury are the predisposing factors. Despite its benign nature, the process can be locally aggressive. Rapid invasive growth, complex anatomy of the base of the skull in childhood make surgical treatment in this place quite difficult. The clinical symptoms of ethmoid GCRG are nonspecific and depend on the site involved and the degree of local destruction. Distinctive morphological features of this neoplasm are the presence of multinucleated giant cells, cellular fibrous tissue and hemorrhages. Diagnostics of this disease includes endoscopic examination of the nasal cavity and nasopharynx, magnetic resonance and X-ray computed tomography of the skull base, paranasal sinuses with intravenous contrast, radioisotope research methods. We report a case of the development of GCRG in a 6-year-old child, along with the clinical picture, X-ray, scintigraphic and morphological data. The method of choice for the treatment of GCRG was its complete surgical removal.

1. Akinyamoju A.O., Soyele O.O., Saiki T.E., Adesina O.M. Giant Cell Lesions of the Jaws: A Review and Comparative Histopathological Study. West Afr J Med 2020;37(1):26–31. PMID: 32030708.

2. Jaffe H.L. Giant-cell reparative granuloma, traumatic bone cyst, and fibrous (fibro-osseous) dysplasia of the jawbones. Oral Surg Oral Med Oral Pathol 1953;6(1):159–75. doi: 10.1016/0030-4220(53)90151-0.

3. Dutta S., Baishya P. Giant cell reparative granuloma of the nasal cavity: a rare site of presentation with review of literature. Autops Case Rep 2020;10(2):e2020158. doi: 10.4322/acr.2020.158.

4. Arda H.N., Karakus M.F., Ozcan M., Arda N., Gun T. Giant cell reparative granuloma originating from the ethmoid sinus. Int J Pediatr Otorhinolaryngol 2003;67(1):83–7. doi: 10.1016/s0165-5876(02)00348-8.

5. Горбунова Т.В., Родина А.Д., Шишков Р.В., Иванова Н.В., Глеков И.В., Малахова А.А., Поляков В.Г. Подходы к лечению детей с эстезионейробластомой: обзор литературы. Онкопедиатрия 2019;6(2):78–86. doi: 10.15690/onco.v6i2.2019. [Gorbunova T.V., Rodina A.D., Shishkov R.V., Ivanova N.V., Glekov I.V., Malakhova A.A., Polyakov V.G. Approaches to the treatment of children with esthesioneuroblastoma: a literature review. Onkopediatriya = Oncopediatria 2019;6(2):78–86. (In Russ.)].

6. Kairemo K.J., Jekunen A.P., Kestilä M.S. Imaging of olfactory neuroblastoma – an analysis of 17 cases. Auris Nasus Larynx 1998;25(2):173–9. doi: 10.1016/s0385-8146(98)00003-0.

7. Sasajima T., Kinouchi H., Tomura N., Watarai J., Mizoi R. High uptake of 123I-metaiodobenzylguanidine related to olfactory neuroblastoma revealed by single-photon emission CT. AJNR Am J Neuroradiol 2000;21(4):717–20. PMID: 10782784.

8. Крылов А.С., Ширяев С.В., Рыжков А.Д., Михайлова Е.В., Гончаров М.О., Севрюков Д.Д. ОФЭКТ/РКТ с 99mTc-технетрилом в мониторинге эстезионейробластомы. Сибирский онкологический журнал 2017;16(2):97–102. doi: 10.21294/1814-4861-2017-16-2-97-102. [Krylov A.S., Shiryaev S.V., Ryzhkov A.D., Mikhailova Е.М., Goncharov M.O., Sevryukov D.D. SPECT/CT with 99mTc-MIBL in monitoring of esthesioneuroblastoma. Sibirskiy onkologicheskiy zhurnal = Siberian Journal of Oncology 2017;16(2):97–102. (In Russ.)].

9. Крылов А.С., Рыжков А.Д., Крылова М.А., Михайлова Е.В., Станякина Е.Е., Жуков Г.А., Долгушин М.Б. Радионуклидная диагностика с 99mТс-технетрилом злокачественных опухолей головы и шеи у детей. Онкологический журнал: лучевая диагностика, лучевая терапия 2019;2(3):47–57. [Krylov A.S., Ryzhkov A.D., Krylova M.A., Mikhailova E.V., Stanyakina E.E., Zhukov G.A., Dolgushin M.B. Radionuclide diagnostics with 99mTc-technetril of malignant tumors of the head and neck in children. Onkologicheskiy zhurnal: luchevaya diagnostika, luchevaya terapiya = Journal of Oncology: Radiation Diagnostics, Radiation Therapy 2019;2(3):47–57. (In Russ.)].

10. de Lange J., Van Akker H.P., Klip H. Incidence and disease-free survival after surgical therapy of central giant cell granulomas of the jaw in The Netherlands: 1990–1995. Head Neck 2004;26:792–5. doi: 10.1002/hed.20069.

11. Waldron C.A., Shafer W.G. The central giant cell reparative granuloma of the jaws. An analysis of 38 cases. Am J Clin Pathol 1966;45:437–47. doi: 10.1093/ajcp/45.4.437.

12. Rapidis A.D., Vallianatou D., Apostolidis C., Lagogiannis G. Large lytic lesion of the ascending ramus, the condyle, and the infratemporal region. J Oral Maxillofac Surg 2004;62:996–1001. doi: 10.1016/j.joms.2004.04.009.

13. Abdel-Rahim M. Giant cell reparative granuloma of the nasal cavity in an elderly man: a case report and literature review. Otolaryngology Case Reports 2018;9:23–5. doi: 10.1016/j.xocr.2018.10.002.

14. Morris J.M., Lane J.I., Witte R.J., Thompson D.M. Giant cell reparative granuloma of the nasal cavity. AJNR Am J Neuroradiol 2004;25(7):1263–5. PMID: 15313721.