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 ).