Giant cell angiofibroma of the scalp: A benign rare neoplasm with bone destruction
A 30-year-old female presented with a bony swelling over her left parietal region that had increased in size over the past 2 years. She had no history of trauma, bone pain, systemic disease, or neurological symptoms. Physical examination found a swelling that was 6 × 5 cm in size, soft, and without any tenderness []. The skin over the swelling area was loosely attached to the underlying soft tissue. There was no venous dilatation, scars, sinuses, or any bruit heard over the swelling. Neurological examination was unremarkable and fundoscopy examination revealed no papilledema.\nRadiological 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 [], with a well-defined soft tissue lesion expanding into the temporal muscle. We were unable to obtain a magnetic resonance imaging (MRI) scan for this patient. On clinical grounds, the decision was made to operate immediately.\nThe tumor mass was approached through a horseshoe scalp incision [Figure and ]. During the operation, the mass appeared to be eroding through the internal tabule of the bone and infiltrating the muscle, but no mass transversed or invaded the dura mater. Temporal muscle that been infiltrated by the GCA (size 2 × 1 cm) was removed []. The bone surrounding the tumor mass appeared rarefied and was removed with rongeurs until a normal border was identified [Figure and ]. The postoperative bone defect was 7 × 6 cm in size and was closed using titanium mesh. The patient's neurological status was intact postoperatively.\nThe histopathological examination showed both cellular areas with especially oval and round- to spindle-shaped cells intermixed with floret-like giant cells in no particular pattern and hypocellular areas. Giant cells often lined the pseudovascular spaces [Figure and ]. The pathologic exam also showed bone erosion without any signs of reformation [] and hypervascularization demonstrated by varying calibers of blood vessels. Immunohistochemistry staining showed positive CD34 staining []. Mitotic activity was inconspicuous. On the basis of these findings, a diagnosis of GCA of the scalp was made.\nShe was discharged from the hospital uneventfully, and no recurrence of the mass was detected at her one-year follow-up.