Diffuse giant cell tumors of the tendon sheath in temporomandibular joint: Two case reports and review of the literature

Giant Cells of Various Lesions Are Characterised by Different Expression Patterns of HLA-Molecules and Molecules Involved in the Cell Cycle, Bone Metabolism, and Lineage Affiliation: An Immunohistochemical Study with a Review of the Literature

Giant cells (GCs) are thought to originate from the fusion of monocytic lineage cells and arise amid multiple backgrounds. To compare GCs of different origins, we immunohistochemically characterised the GCs of reactive and neoplastic lesions (n = 47). We studied the expression of 15 molecules including HLA class II molecules those relevant to the cell cycle, bone metabolism and lineage affiliation. HLA-DR was detectable in the GCs of sarcoidosis, sarcoid-like lesions, tuberculosis, and foreign body granuloma. Cyclin D1 was expressed by the GCs of neoplastic lesions as well as the GCs of bony callus, fibroid epulis, and brown tumours. While cyclin E was detected in the GCs of all lesions, p16 and p21 showed a heterogeneous expression pattern. RANK was expressed by the GCs of all lesions except sarcoid-like lesions and xanthogranuloma. All GCs were RANK-L-negative, and the GCs of all lesions were osteoprotegerin-positive. Osteonectin was limited to the GCs of chondroblastoma. Osteopontin and TRAP were detected in the GCs of all lesions except xanthogranuloma. RUNX2 was heterogeneously expressed in the reactive and neoplastic cohort. The GCs of all lesions except foreign body granuloma expressed CD68, and all GCs were CD163- and langerin-negative. This profiling points to a functional diversity of GCs despite their similar morphology.

Treatment, Survival, and Demographics in Temporal Bone Malignancies: A Pooled Data Analysis

Temporal bone malignancies are relatively uncommon tumors. Their location adjacent to vital structures such as the carotid artery, jugular vein, otic capsule, and temporal lobe can make their treatment potentially challenging. The purpose of this study was to compare outcomes in temporal bone malignancies obtained via pooled literature data. The study sought to examine factors affecting survival in temporal bone malignancies based on the studies in the existing published literature. A systematic search was conducted on the PubMed (Medline), Embase, and Google Scholar databases to identify relevant studies from 1951 to 2022 that described the treatment of temporal bone malignancies. Articles that fulfilled the inclusion criteria were assessed and analyzed by the author. The literature search identified 5875 case series and case reports, and 161 of them contained sufficient data to be included in the pooled data analysis, involving a total of 825 patients. Multivariate analysis of the pooled literature data showed that overall stage, presence of facial palsy, and surgical margin status significantly affected overall survival (OS), while overall stage and presence of facial palsy significantly affected disease-free survival (DFS). To summarize, this study examined pooled survival data on demographics, treatment, and survival of patients with temporal bone malignancies utilizing an extensive literature-based pooled data meta-analysis. Overall stage, facial nerve status, and surgical margin status appeared to most strongly affect survival in patients with temporal bone malignancies.

Diffuse-Type Tenosynovial Giant Cell Tumor Arising in the Temporomandibular Joint Extending to the External Auditory Canal: A Case Report and Literature Review

A 74-year-old Japanese woman with a 1-year history of right preauricular pain and a 2-month history of bleeding from the right ear was admitted to our department. Tumor was observed in the anterior wall in the right external auditory canal. Bony swelling of the right preauricular area was palpated. Computed tomography revealed an ill-defined, osteogenic tumor around the mandibular condyle with a destructive bony lesion involving the temporal bone. Magnetic resonance imaging revealed a 2.0 × 1.5 × 1.3-cm solid tumor around the mandibular condyle, exhibiting a low-intensity signal on T1-weighted imaging and an isointense central area surrounded by low-signal intensity on T2-weighted imaging. Histological examination of biopsy specimens revealed diffuse-type tenosynovial giant cell tumor (D-TGCT). After the feeding arteries for the tumor were embolized, the patient underwent surgery with combined temporal craniotomy and mandibular condylectomy. The soft and cystic tumor with calcification located in the extradural space was totally resected along with the mandibular condyle. No facial paralysis or recurrence was evident as of 6 months postoperatively. To date, only 23 cases of D-TGCT arising in the temporomandibular joint (TMJ) with ear involvement have been reported since 2011. We report successful resection of a rare case of D-TGCT arising in the TMJ.

Chondroid Tenosynovial Giant Cell Tumor: A Rare Case Involving the Infratemporal Fossa

Tenosynovial giant cell tumor (TGCT) is a benign soft-tissue neoplasm that rarely occurs in the craniofacial region. We report a case of a 27-year-old male who presented to our unit in September 2017 with severe temporomandibular joint (TMJ) pain and progressive limitation opening his mouth. Based on clinical and imaging examinations, a well-defined soft tissue lesion was identified within the right infratemporal fossa, causing pressure on the TMJ and the surrounding structures. The lesion was surgically excised through trans-mandibular and endoscopic approaches. Histopathology diagnosis revealed a rare chondroid subset of TGCT. At 18 months follow-up, the patient showed resolution of the jaw pain, good functional and esthetic outcomes, and no evidence of recurrence.

Tenosynovial Giant Cell Tumor in an Infant

In this report, the authors describe a child presenting at 6 months old with a rapidly expanding extracranial left temporal mass concerning for malignancy. The mass was successfully treated at 16 months with radical surgical excision. The patient was found to have a tenosynovial giant cell tumor, diffuse type, completely encased by the temporalis muscle. To our knowledge, this is the first report of a case of diffuse type tenosynovial giant cell tumor in the temporalis muscle, without articular involvement, presenting in an infant.

New Medical Device and Therapeutic Approvals in Otolaryngology: State of the Art Review of 2019

OBJECTIVE

To review new devices and drugs relevant to otolaryngology-head and neck surgery that were approved by the US Food and Drug Administration (FDA) in 2019.

DATA SOURCES

Approval notifications for 2019 were extracted from the ENT (ear, nose, and throat) and general and plastic surgery sections of the FDA's medical devices and therapeutics listings.

REVIEW METHODS

New therapeutics and medical devices identified from the query were analyzed by members of the American Academy of Otolaryngology-Head and Neck Surgery's Medical Devices and Drugs Committee. Technologies were assessed by 2 independent reviewers to ascertain relevance to otolaryngology, prioritized, and classified to subspecialty field with critical review based on extant scientific literature.

CONCLUSIONS

Query of the FDA drug and device database returned 105 ENT devices (50 cleared, 55 with premarket approval, and 0 de novo), 543 general and plastic surgery devices (372 cleared, 170 with premarket approval, and 1 de novo), and 46 new otolaryngology-relevant drug approvals that occurred in 2019. Advances spanned all subspecialty areas with otology predominating, primarily due to hearing-related technologies. While scientific evidence was available for all new devices, there was significant heterogeneity in rigor of supporting scientific data.

IMPLICATIONS FOR PRACTICE

Technological and pharmaceutical innovation is an important catalyst for advances in the surgical specialties. Familiarity with new devices and therapeutics in otolaryngology-head and neck surgery ensures that clinicians keep abreast of developments with potential to improve prevailing standards of care.

Giant cell tumor of tendon sheath in the wrist that damaged the extensor indicis proprius tendon: a case report and literature review

BACKGROUND

Giant cell tumor of the tendon sheath (GCTTS) is a benign soft tissue (synovial membrane) tumor that rarely involves the hands or wrists. And Tendon impairment caused by GCTTS is extremely rare.

CASE PRESENTATION

Here, we reported a case of a 60-year-old female with a 10-year history of gradually increasing mass in her left dorsal wrist. The EIP tendon was partially impaired by the mass.The patient was treated with surgical excision of the mass and reconstruction of the EIP tendon. The histopathological examination suggested the presence of GCTTS. After surgery, the patient had adequate functional recovery and no tumor recurrence after 2 years' follow-up.

CONCLUSION

GCTTS in hands and wrists rarely damages the tendon. Early diagnosis and proactive interventions may likely contribute to good prognostic outcomes.