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Clinical Note |

Congenital Giant Cell Granuloma of the Temporal Bone

Austin B. Wiles, MD; Joseph F. Dilustro, MD; Stephanie A. Moody Antonio, MD
Arch Otolaryngol Head Neck Surg. 2011;137(9):942-946. doi:10.1001/archoto.2011.145.
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Giant cell reparative granuloma (GCRG), which is an uncommon, benign, granulomatous lesion of bone, was first described by Jaffe1 in 1953. It is most commonly found in the mandible but has been reported to occur in many other sites, including the axial skeleton, orbit, sinuses, and cranial vault.1,2 Approximately 35 cases of GCRG originating in the temporal bone have been reported. The lesion has been described in patients ranging in age from 2 months to 72 years.2 The youngest documented patient to date presented with a small palpable mass at the age of 2 months.3 To our knowledge, there are no previous reports of a congenital lesion. Our patient presented with a 4 × 4-cm mass at the age of 5 days, suggesting that the lesion had developed in utero.

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Figure 1. Axial computed tomogram (bone window) of temporal bone showing an erosive mass lesion involving the mastoid, external auditory canal, middle ear, and labyrinth. The vestibule and semicircular canals appeared to be demineralized or eroded. In cuts not shown herein, there appeared to be substantial erosion of the bony external auditory canal and the mastoid segment of the facial canal, while the ossicles, internal auditory canal, and cochlea appeared to be intact.

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Figure 2. T1-weighted postcontrast magnetic resonance image showing a homogeneous mass that was isointense to the cerebellum and enhanced at the periphery and along septations. The 3.5 × 3.3 × 3.7-cm (anteroposterior × transverse × craniocaudal) mass pushed into the posterior and middle cranial fossae, compressed the right cerebellar hemisphere and peduncle, and shifted the lateral ventricle but did not seem to invade beyond the dura.

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Figure 3. Axial computed tomogram (bone window) at 15 months after surgery showing remineralization of the bony vestibule and lateral semicircular canal. The lateral semicircular canal had indistinct margins and irregular mineralization, suggesting that it might not be patent. T2-weighted magnetic resonance image (not shown) demonstrated attenuation of the fluid signal of the semicircular canals, while there was a normal signal in the vestibule and cochlea.

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Figure 4. Axial T1-weighted postcontrast fat-suppressed magnetic resonance image at 30 months after surgery showing nonenhancing soft tissue filling the right mastoid cavity. There were no areas of enhancement that would suggest residual disease.

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