Brain Tumor Res Treat.  2024 Apr;12(2):132-140. 10.14791/btrt.2024.0010.

Treatment of Clival Giant Cell Tumor: A Case Report and Literature Review

• Yang JY
• Kang H
• Kim YH

• KMID: 2555873
• DOI: http://doi.org/10.14791/btrt.2024.0010

Abstract

Giant cell tumors (GCTs) are locally aggressive primary bone tumors of osteoclast-like cells. Most GCTs occur within the long bones, and primary GCTs involving the clivus are extremely rare. We present the case of an 18-year-old boy with binocular horizontal diplopia with an insidious onset who was found to have a hypointense enhancing mass involving the clivus and left side dorsum sellae on magnetic resonance images. The tumor was completely resected via an endoscopic endonasal transclival approach, and histopathologic examination via immunohistochemistry indicated a GCT. The patient’s left abducens nerve palsy improved slightly after surgery. Because of the rarity of GCTs, there is no consensus about the definitive treatment protocol. However, we suggest that gross total resection is the treatment of choice, and denosumab plays a critical role in patients with subtotal resection.

Keyword

Cranial fossa, posterior; Giant cell tumor of bone; H3-3A protein, human; Denosumab

Figure

• 

  Fig. 1 Pre- and postopeartive MR images. A and B: Preoperative sagittal and coronal sections of T1-weighted MR images with contrast revealing a 2.7 cm T2 isointense enhancing mass involving the clivus and left-side dorsum sellae with suspected involvement of the left pituitary gland. C and D: Postoperative MR images showing no residual tumor.

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  Fig. 2 Surgical steps and features. A: The exposed tumor was dark purple and tough. B: A surgical window was created by drilling the cortical bone of the whole clival recess, and the lower clivus was drilled through until the normal bone was secured. C: The dorsum sellae, including the left posterior clinoid process, were resected in an extradural fashion. D: The periosteal layer of the dura surrounding the tumor was also resected due to its severe adhesion to the tumor.

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  Fig. 3 Pathologic speciemen. A: Histopathological examination revealed that the tumor was composed of multinucleated osteoclast-like giant cells and proliferative flaky oval or spindle-shaped mononuclear stromal cells (hematoxylin and eosin stain; magnification, ×40). B: H3F3A (histone 3.3) G34W IHC was positive for the nuclei (magnification, ×40).

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