CASE REPORT
All procedures performed in this study were in accordance with the ethical standards of the institutional research committee of Adriano Jorge Hospital Foundation (document number 51303221.0.0000.0007) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The patient provided his written consent, and no identifier information is included in this article.
A 33-year-old male patient arrived at the oral and maxillofacial surgery service complaining of painful swelling, obstruction, and bleeding in nasal cavity about 6 months. The physical examination showed a firm mass that obliterated and externalized through the right nasal cavity with intact skin and no ulceration. (figure 1a ). The patient reported medical history of incisional biopsy 4 years ago, in the same region, of a tumor with histopathological diagnosis of the “Suggestive of Nasal Paraganglioma”, however the immunohistochemical study was negative for this tumor and compatible with polypoid tissue presenting an exuberant inflammatory process with numerous multinucleated giant cells in between and with positive markers for AE1/AE3 and CD68(table) (figure 2a, 2b, 2b). Due to the distance, difficult mobility and financial issues to get to the referral hospital, the patient did not return to subsequent appointments, not undergoing the proper treatment for the first lesion. During the Computed Tomography evaluate was observed a hyperdense mass occupying the entire maxillary sinus with no signs of aggressive resorption, perforation or tissue spread. In the Nuclear Magnetic Resonance (NMR) evaluate was showed hypersignal mass occupying the right maxillary sinus, obliterating the right nasal cavity and extending to skull base. (figure 1b,1c ). A bone window was performed in the right maxillary sinus through the Weber-Ferguson incision and an excisional biopsy from the mass was made, the osteotomy was reduced and fixated with plaques and screws of the 2.0mm system and the surgical specimen was sent to anatomopathological analysis. (figure 1d,1e ). The patient has not undergone for any adjuvant therapy, and has been followed for 3 years with no signs of recurrence or complication. Grossly, the surgical specimen had a dark brown-to-reddish appearance that was friable in texture (figure 1f ). Microscopical investigation revealed benign neoplasm characterized by a highly cellular tumor dominated by large numbers of osteoclast-like giant cells. The multinucleated giant cells showed variable number nuclei, some with > 20 per cell, with nuclei arranged disorganized in most giant cells. Otherwise, some areas showed multinucleated giant cells with a ring of nuclei surrounding a central homogeneous cytoplasm similar to Touton giant cells. The cytoplasm surrounded by the nuclei was both amphophilic and eosinophilic, while the cytoplasm near the periphery of the cell was pale and foamy in appearance. The mononuclear cells exhibited a variety of morphological appearances, including round to oval cells and spindled cells in a fibrotic background in most areas. In some fields, it was evident the presence of a large proliferation of xanthoma cells PAS-positives. Proliferation of vascular spaces and hemorrhage completed the analyzed fields. Atypical mitotic figures and necrosis were not observed. The features of malignancy like significant nuclear atypia or necrosis were not seen. Then, the diagnosis was well consistent with GCTB (figure 3a,3b,3c,3d,3e,3f ).