Tenosynovial giant cell tumors of the temporomandibular joint and lateral skull base: Review of 11 cases

Objectives To elucidate the clinical behavior, treatment, and outcomes of tenosynovial giant cell tumors (TGCT) involving the temporomandibular joint (TMJ) and adjacent temporal bone. Study Design Retrospective case series with histopathologic review. Methods A retrospective chart review was perform...

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Bibliographic Details
Published in:The Laryngoscope 2017-10, Vol.127 (10), p.2340-2346
Main Authors: Carlson, Matthew L., Osetinsky, L. Mariel, Alon, Eran E., Inwards, Carrie Y., Lane, John I., Moore, Eric J.
Format: Article
Language:English
Subjects:
Adult
Biopsy
chondroblastoma
Combined Modality Therapy
Diagnosis, Differential
Female
Follow-Up Studies
Giant Cell Tumor of Tendon Sheath - diagnosis
Giant Cell Tumor of Tendon Sheath - therapy
Humans
lateral skull base
Magnetic Resonance Imaging
Male
mandible
Middle Aged
NMR
Nuclear magnetic resonance
pigmented villonodular synovitis
Retrospective Studies
Skull Base - diagnostic imaging
Skull Neoplasms - diagnosis
Skull Neoplasms - therapy
temporal bone
temporomandibular joint
Temporomandibular Joint - diagnostic imaging
Temporomandibular Joint Disorders - diagnosis
Temporomandibular Joint Disorders - therapy
Tenosynovial giant cell tumor
Tomography, X-Ray Computed
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Summary:Objectives To elucidate the clinical behavior, treatment, and outcomes of tenosynovial giant cell tumors (TGCT) involving the temporomandibular joint (TMJ) and adjacent temporal bone. Study Design Retrospective case series with histopathologic review. Methods A retrospective chart review was performed identifying and collecting data from all cases of TGCT involving the TMJ and adjacent temporal bone that were treated at the authors' center between January 1960 and December 2015. Results Eleven histopathologically confirmed cases met inclusion criteria. The median age at diagnosis was 49 years, eight patients were men, and the median follow‐up was 116 months. Computed tomographic (CT) imaging revealed a lytic expansile mass centered on the TMJ. Magnetic resonance imaging (MRI) most commonly exhibited hypointense signal on precontrast T1‐ and T2‐weighted sequences and variable postcontrast enhancement. The median delay in diagnosis was 24 months, and the most common presenting symptoms were hearing loss and pain. All patients underwent surgical resection, eight receiving gross total removal, one receiving near total removal, and two patients from early in the series receiving subtotal resection with neoadjuvant or adjuvant radiation. Histopathological review of surgical specimens revealed chondroid metaplasia in seven tumors. Eight of nine cases receiving gross total or near total resection have no evidence of recurrence to date. Conclusions TGCT of the TMJ and temporal bone are rare and locally aggressive tumors that commonly present with nonspecific symptoms. A careful review of CT and MRI followed by early biopsy is critical in establishing an accurate diagnosis and facilitating appropriate treatment. TGCT of the TMJ more commonly contain chondroid metaplasia when compared to TGCT at other anatomic locations. Gross total resection is achievable in most cases and offers long‐term cure. Radiation may be considered for recurrent disease or adjuvant therapy following subtotal resection. Level of Evidence 4. Laryngoscope, 127:2340–2346, 2017
ISSN:0023-852X
1531-4995
DOI:10.1002/lary.26435