Giant Cell Reparative Granuloma of the Orbit
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Giant cell reparative granuloma (GCRG) is a rare fibroosseous lesion uncommonly seen in the orbital area. Although benign, it is known to be recurrent and locally destructive. A 37-year-old male presented with proptosis, the fullness of the right upper eyelid, and inferior displacement of the right eye that had progressed gradually over several months. There was no history of pain, loss of visual acuity (VA), or diplopia. Ocular motility examination revealed a slight limitation of motion in supraduction. The patient reported no previous episodes of inflammation, sinus infection, or trauma. Fundus examination was normal. General physical examination and routine blood tests were within normal limits. Contrast-enhanced coronal and sagittal computed tomography (CT) images showed a lytic lesion arising from the roof of the right orbit, with heterogeneous captation, relatively hypocaptant with hypodense areas, and small foci of mineralization within the lesion. The mass had a thinning effect on the superior wall of the roof, without breaking it, and extended over the anterior cranial fossa. It also disrupted the inferior wall of the roof and invaded the orbit, displacing the superior rectus muscle and the globe inferiorly. Magnetic resonance imaging (MRI) revealed a well-defined, heterogeneously enhancing mass, measuring 30mm × 19mm × 27mm, hyperintense on T1-weighted images, and with lobulated, “pseudonodular” appearance on T2-weighted images, with markedly increased signal intensity, reflecting the expansible cystic component.

An orbitotomy was performed via an upper eyelid crease incision, and a red-yellowish friable mass, with evidence of dark coagulated blood, and fragments of bone tissue within the soft tissue was observed. A tissue sample was taken for histopathological study, and then, an ultrasonic aspirator system was used to remove the tumor. The handpiece of this device, with a soft tissue straight tip attached, was used to aspirate and separate the tumor from the surrounding healthy tissue, preventing damage to it. The handpiece is lightweight and ergonomic, allowing it to be inserted into narrow spaces with poor visibility, thus making possible the approach to the cranial fossa through the orbital roof. Moreover, with the Spetzler micro claw tip, the lateral edge of the orbital roof was sculpted to gain visibility and access to the cranial fossa. Once the tumor tissue was removed, we performed a curettage, removing the capsule and the tissue attached to the cortical surface of the bone. During these surgical maneuvers, a leak of cerebral spinal fluid, originating in the innermost part of the cavity, was noted and sealed with human fibrinogen/human thrombin, TachoSil®, Talceda Austria GmbH, Linz, Austria, efficiently. Oral treatment with antibiotics was prescribed for 1 week. Symptoms resolved and there was no evidence of recurrence after 18 months of follow-up.