Aggressive Giant Cell Reparative Granuloma of the Nasal Cavity

Giant cell reparative granuloma (GCRG) is an uncommon and nonneoplastic reactive tumor that involves the maxilla and mandible in the region of the head and neck. It is rare in the nasal cavity, and it might be misdiagnosed. We reported a very aggressive GCRG with intracranial invasion, which was treated surgically via a combined approach of a lateral rhinotomy with a craniotomy by bilateral coronal incision. The pathology was consistent with GCRG. A short literature review about diagnosis, clinical behavior, and treatment of this tumor entity is given. 1. Introduction The term giant cell reparative granuloma (GCRG) was first introduced by Jaffe in 1953 [1] and is an uncommon nonneoplastic reactive tumor that occurs almost exclusively within the mandible and maxilla. The second most common location is in the bone of the hands and feet. The etiology of GCRG is uncertain but may be related to an intraosseous hemorrhage following trauma. In addition, microscopic evidence of hemorrhagic cyst formation resembling an aneurysmal bone cyst frequently is present [2]. GCRGs can be observed at all ages, and they tend to appear more often in children and young adults. Despite their benign nature, they may be locally aggressive. Only a small number of cases have been reported with the involvement of the paranasal sinuses and the orbit [3, 4]. In this paper, we report a new case of GCRG originated from nasal cavity with intracranial invasion. 2. Case Report A 49-year-old women was admitted to the department of otorhinolaryngology in an affiliated hospital with a 2-month history of right-sided nasal obstruction, epistaxis, proptosis, and diplopia. The mass was biopsied endoscopically. Massive bleeding from the tumor was seen at that time. Histopathological diagnosis was reparative giant cell granuloma. Oral steroids (30？mg prednisolone) were administered due to rapid growth of the tumor for two weeks. Since the treatment was not effective, the patient was sent to our hospital. She was a nonsmoker, and there was no history of facial trauma and previous radiation exposure. Her past medical history was unremarkable, and there was no significant family history. Physical examination revealed that the mass completely obstructed the right nasal cavity and partially the left side. The outer surface of the mass was smooth and displaced the right eyeball towards the lateral side, and consequently led to the diplopia. There were no palpable masses or lymphadenopathies in the neck. Routine hematological and biochemical test results including serum calcium, alkaline phosphatase,