Giant cell bone lesions in the craniofacial region: a diagnostic and therapeutic challenge
Giant cell bone lesions in the craniofacial region: a diagnostic and therapeutic challenge
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DOI：
10.1002/alr.21050
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发表时间：
2012-11-01
影响因子：
6.4
通讯作者：
Voegels, Richard Louis
中科院分区：
文献类型：
--
作者：
Pinto Borges, Bruno Barros;Fornazieri, Marco Aurelio;Voegels, Richard Louis
背景资料：骨巨细胞瘤（GCT）常见于长骨，但在颅面区域罕见，仅1%的病例发生在后者。这种局部侵袭性疾病的临床，放射学和解剖学诊断，发生在创伤或肿瘤转化，在临床实践中提出了一个重大挑战。研究方法：本研究描述了一系列4例病例，并强调了这些病变的鉴别诊断和治疗的主要特征：GCT、巨细胞修复性肉芽肿（GCRG）和甲状旁腺功能亢进症的棕色肿瘤。结果：骨巨细胞瘤是一种良性肿瘤，最典型的影响膝盖，很少在颞骨和蝶骨。由于其溶解性、边界不清的表现，在放射学上与GCRG难以区分。这种区别只能在显微镜下进行，因为多核巨细胞的存在分散在整个基质中，并且没有创伤史有利于GCT的诊断。甲状旁腺功能亢进的褐色肿瘤，由于甲状旁腺激素（PTH）水平升高而引起破骨细胞快速、局部活动，因此必须进行甲状旁腺检查。结论：这些病变的诊断和治疗构成了一个重大挑战，由于其相似的临床表现和放射学表现。准确的诊断对于确定适当的治疗是至关重要的，因为完整的切除是GCT和GCRG的目标，以避免复发，而棕色肿瘤往往屈服于潜在的甲状旁腺功能亢进的治疗。
Background: Giant cell tumors of bone (GCTs) are common in the long bones, but rare in the craniofacial region, with only 1% of cases occurring in the latter. Clinical, radiological, and anatomical diagnosis of this locally aggressive disease, which occurs in response to trauma or neoplastic transformation, poses a major challenge in clinical practice. Methods: The present study describes a series of 4 cases and highlights the main features of the differential diagnosis and treatment of these lesions: GCT, giant cell reparative granuloma (GCRG), and the brown tumor of hyperparathyroidism. Results: GCT presents as a benign neoplasm, most typically affecting the knees, and rarely in the temporal and sphenoid bones. It is radiologically indistinguishable from GCRG due to its lytic, poorly defined appearance. The distinction can only be made microscopically, as the presence of multinucleated giant cells scattered throughout the stroma and the absence of a history of trauma favor a diagnosis of GCT. The brown tumor of hyperparathyroidism occurs with rapid, localized osteoclast activity secondary to the effects of increased parathyroid hormone (PTH) levels; parathyroid examination is indispensable. Conclusion: The diagnosis and treatment of these lesions poses a major challenge due to their similar clinical presentation and radiological appearance. Accurate diagnosis is essential for definition of appropriate management, as complete resection is the goal in GCT and GCRG to avoid recurrence, whereas the brown tumor often yields to treatment of the underlying hyperparathyroidism.