颅骨巨细胞修复性肉芽肿

Giant cell reparative granuloma of the skull

目的 探讨颅骨巨细胞修复性肉芽肿 (giantcellreparativegranuloma,GCRG)的病因、诊断、鉴别诊断以及治疗。方法 回顾性分析 1 987年 6月～ 1 999年 5月收治的 3例颅骨GCRG(颞骨 2例、眶骨 1例 )的临床、组织学和影像学资料。结果 3例病变部位均无外伤史 ,1例因手术未彻底切除病变 ,术后复发。组织学分析 :3例病变均有纤维化 ,成纤维细胞呈椭圆形或梭形 ,并且大量增生 ,基质细胞间混有多核巨细胞 ,大小不一 ,分布不均匀。含有大小不等的出血区以及含铁血黄素沉着 ,有类骨质或新骨形成。CT检查示有溶骨性病变。磁共振成像 (magneticresonanceimaging ,MRI)检查示T1加权、T2加权均为低信号影像。结论 颅骨GCRG罕见 ,且易误诊为骨巨细胞瘤 ,对GCRG应结合临床、组织学、对治疗的反应做出诊断。手术彻底切除是最有效的治疗方法 ,术后应加强随访。

Objective To investigate the clinical course,histologic feature, diagnosis,differential diagnosis and treatment of giant cell reparative granuloma (GCRG) Methods Three cases of GCRG,which arose in the skull,were collected from 1987 to 1999 and analyzed clinicopathologically Results Two patients had the lesion in the temporal bone and one in the orbit One patient with GCRG had a recurrence after incomplete surgical resection Histologically, all of three cases were characterized by fibroblastic proliferation with osteoclast like giant cell rich areas, hemorrage, and newly formed bone or osteoid trabeculae GCRG appeared as a typical bony lytic lesion on computed tomography (CT) and as low signal intensity on both T1 and T2 weighted images on magnetic resonance imaging (MRI) Conclusion GCRG is an uncommon nonneoplastic lesion that typically arises in mandible and maxilla and its involvement in skull is rare Although behaves benignly, GCRG may be locally aggressive It is usually misdiagnosed for a giant cell tumor (GCT) Diagnosis of GCRG is based on typical histologic features as well as clinical information Complete surgical resection is believed to be the most suitable treatment for GCRG and long term follow up by CT scanning is essential