PMC3815085_01
Clinical picture of the patient that had a bony swelling over the left parietal region (a). A CT scan at regio left parietal reveal bone discontinuity that showed bony destruction (b). On macroscopic examination, reddish mass, size 6 x 5 cm and the temporal muscle, size 2 x 1 cm that had been infiltrated with GCA, were removed (c)
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F1
Physical examination found a swelling that was 6 x 5 cm in size, soft, and without any tenderness [Figure 1a]. Radiological examination of a skull x-ray showed a lytic lesion that involving the left temporoparietal bone, and computed tomography (CT) scan confirmed the presence of extensive bone destruction [Figure 1b], with a well-defined soft tissue lesion expanding into the temporal muscle. Temporal muscle that been infiltrated by the GCA (size 2 x 1 cm) was removed [Figure 1c].
Exposure of the lesion at regio left parietal. (a) Bone discontinuity at regio left parietal, suggested as lytic lesion, as we confirm during operation (b), Postoperative; the bone defect, size 7 x 6 cm was closed with mesh (c-d)
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F2
The tumor mass was approached through a horseshoe scalp incision [Figure 2a and b]. The bone surrounding the tumor mass appeared rarefied and was removed with rongeurs until a normal border was identified [Figure 2c and d].
A giant cell angiofibroma of the scalp presenting as a varying combination of cellular areas composed of bland round to spindle cells, collagenous or myxoid stroma with focal sclerotic areas, medium-sized to small thick-walled vessels, and multinucleated giant cells, often lining angiectoid spaces; arrow giant cell (H and E, stain x100 and x200, respectively) (a-b). The lesion was observed eroded through the bone, as shown that the lysis of the bone without reformation (c). The lesion was highly vascularized with varying caliber of blood vessels and immunohistochemistry showed CD34 positive staining (d)
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F3
Giant cells often lined the pseudovascular spaces [Figure 3a and b]. The pathologic exam also showed bone erosion without any signs of reformation [Figure 3c] and hypervascularization demonstrated by varying calibers of blood vessels. Immunohistochemistry staining showed positive CD34 staining [Figure 3d].