Giant cell reparative granuloma of ethmoid sinus: A rare case report

Clinical History

13-year-old boy presented with a history of gradually progressive swelling in the periorbital region for three years along with proptosis of the right eye.

Imaging Findings

Axial CT and MR images (Fig. 1, 3) showing fluid fluid level in the right half of the ethmoidal sinus with proptosis of the right eye. Sagittal reformatted CT and MRI (Fig. 3) shows similar findings.

Discussion

Giant cell reparative granuloma was first described by Jaffe. It was thought to be a variant of giant cell tumour. It is not a neoplastic process but is thought to represent a local hyperplastic reparative process after injury. In those without a history of trauma, giant cell reparative granuloma is likely to be a secondary granulomatous lesion developing in the setting of infection or inflammation complicated by haemorrhage. [1]
Giant cell reparative granuloma usually is seen in the first two decades of life. The usual age of onset of giant cell tumours is in the third and fourth decades. Radiographically, the findings are relatively nonspecific. An expansible lesion is seen that may perforate the bony cortex. Occasionally, osteoid is identified within the lesion on computed tomography. [2, 3]
Giant cell tumours, although more common in epiphyseal portions of the long bones, can be seen in the skull, usually affecting the mandible, facial bones, and sphenoidal and ethmoidal sinuses. The treatment of choice for giant cell reparative granuloma is surgical resection, although radiation therapy has been advocated in inoperable cases. Recurrences are rare but have been described; resection is usually performed in these cases. Sarcomatous degeneration after treatment of this lesion with radiation therapy has been described, but de novo malignant transformation is not seen. [4].
Giant cell reparative granuloma is one of the differential diagnoses when an expansile lesion is seen within the paranasal sinuses, bony orbit, or calvaria especially in a patient in the first two decades of life with presence of fluid fluid levels.

Differential Diagnosis List

Final Diagnosis

Giant cell reparative granuloma of ethmoid sinus

URL:	https://www.eurorad.org/case/13094
DOI:	10.1594/EURORAD/CASE.13094
ISSN:	1563-4086