Intracranial giant cell tumour—a case report

Background Giant cell tumours (GCT) are rare benign bone tumours that typically occur in the appendicular skeleton. In typical locations, these tumours are relatively simple to diagnose by radiography. However, at atypical locations, these tumours can be confused with other disease pathologies. Here...
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Autor*in:	Hashim, Hilwati [verfasserIn] Bakar, Nor Salmah [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2020

Schlagwörter:	Giant cell tumours Skull CT scan MRI scan Case report

Übergeordnetes Werk:	Enthalten in: The Egyptian Journal of Radiology and Nuclear Medicine - Amsterdam [u.a.] : Elsevier, 2010, 51(2020), 1 vom: 15. Sept.
Übergeordnetes Werk:	volume:51 ; year:2020 ; number:1 ; day:15 ; month:09

Links:	Volltext

DOI / URN:	10.1186/s43055-020-00307-x

Katalog-ID:	SPR040982335

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520			\|a Background Giant cell tumours (GCT) are rare benign bone tumours that typically occur in the appendicular skeleton. In typical locations, these tumours are relatively simple to diagnose by radiography. However, at atypical locations, these tumours can be confused with other disease pathologies. Here, we describe a patient with an intracranial GCT that was initially thought to be a cystic teratoma. Case presentation A 49-year-old man with no previous medical illness was investigated for left-sided hearing impairment and tinnitus associated with a left-sided headache of 2 years’ duration. He did not complain of fever, vertigo, nasal or constitutional symptoms. Examination confirmed a sensory neural hearing loss with no other neurological deficit. Imaging by CT and subsequent MRI revealed an extra axial, multiloculated, and septated mass at the left temporal area with a significant mass effect. A provisional diagnosis of cystic teratoma was made. However, histopathological examination of the resected mass indicated that the lesion was a GCT. The patient required a second excision of the tumour, which he refused. His latest follow-up MRI showed no further progression of the residual tumour. His headaches have resolved and there was no progression of other symptoms. Conclusion This case highlights that GCTs can occur at sites outside the appendicular skeleton and that these tumours may be confused with other diseases that have a similar appearance on imaging.
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allfields	10.1186/s43055-020-00307-x doi (DE-627)SPR040982335 (SPR)s43055-020-00307-x-e DE-627 ger DE-627 rakwb eng 610 ASE Hashim, Hilwati verfasserin aut Intracranial giant cell tumour—a case report 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Giant cell tumours (GCT) are rare benign bone tumours that typically occur in the appendicular skeleton. In typical locations, these tumours are relatively simple to diagnose by radiography. However, at atypical locations, these tumours can be confused with other disease pathologies. Here, we describe a patient with an intracranial GCT that was initially thought to be a cystic teratoma. Case presentation A 49-year-old man with no previous medical illness was investigated for left-sided hearing impairment and tinnitus associated with a left-sided headache of 2 years’ duration. He did not complain of fever, vertigo, nasal or constitutional symptoms. Examination confirmed a sensory neural hearing loss with no other neurological deficit. Imaging by CT and subsequent MRI revealed an extra axial, multiloculated, and septated mass at the left temporal area with a significant mass effect. A provisional diagnosis of cystic teratoma was made. However, histopathological examination of the resected mass indicated that the lesion was a GCT. The patient required a second excision of the tumour, which he refused. His latest follow-up MRI showed no further progression of the residual tumour. His headaches have resolved and there was no progression of other symptoms. Conclusion This case highlights that GCTs can occur at sites outside the appendicular skeleton and that these tumours may be confused with other diseases that have a similar appearance on imaging. Giant cell tumours (dpeaa)DE-He213 Skull (dpeaa)DE-He213 CT scan (dpeaa)DE-He213 MRI scan (dpeaa)DE-He213 Case report (dpeaa)DE-He213 Bakar, Nor Salmah verfasserin aut Enthalten in The Egyptian Journal of Radiology and Nuclear Medicine Amsterdam [u.a.] : Elsevier, 2010 51(2020), 1 vom: 15. Sept. (DE-627)641391862 (DE-600)2583928-7 2090-4762 nnns volume:51 year:2020 number:1 day:15 month:09 https://dx.doi.org/10.1186/s43055-020-00307-x kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 51 2020 1 15 09
spelling	10.1186/s43055-020-00307-x doi (DE-627)SPR040982335 (SPR)s43055-020-00307-x-e DE-627 ger DE-627 rakwb eng 610 ASE Hashim, Hilwati verfasserin aut Intracranial giant cell tumour—a case report 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Giant cell tumours (GCT) are rare benign bone tumours that typically occur in the appendicular skeleton. In typical locations, these tumours are relatively simple to diagnose by radiography. However, at atypical locations, these tumours can be confused with other disease pathologies. Here, we describe a patient with an intracranial GCT that was initially thought to be a cystic teratoma. Case presentation A 49-year-old man with no previous medical illness was investigated for left-sided hearing impairment and tinnitus associated with a left-sided headache of 2 years’ duration. He did not complain of fever, vertigo, nasal or constitutional symptoms. Examination confirmed a sensory neural hearing loss with no other neurological deficit. Imaging by CT and subsequent MRI revealed an extra axial, multiloculated, and septated mass at the left temporal area with a significant mass effect. A provisional diagnosis of cystic teratoma was made. However, histopathological examination of the resected mass indicated that the lesion was a GCT. The patient required a second excision of the tumour, which he refused. His latest follow-up MRI showed no further progression of the residual tumour. His headaches have resolved and there was no progression of other symptoms. Conclusion This case highlights that GCTs can occur at sites outside the appendicular skeleton and that these tumours may be confused with other diseases that have a similar appearance on imaging. Giant cell tumours (dpeaa)DE-He213 Skull (dpeaa)DE-He213 CT scan (dpeaa)DE-He213 MRI scan (dpeaa)DE-He213 Case report (dpeaa)DE-He213 Bakar, Nor Salmah verfasserin aut Enthalten in The Egyptian Journal of Radiology and Nuclear Medicine Amsterdam [u.a.] : Elsevier, 2010 51(2020), 1 vom: 15. Sept. (DE-627)641391862 (DE-600)2583928-7 2090-4762 nnns volume:51 year:2020 number:1 day:15 month:09 https://dx.doi.org/10.1186/s43055-020-00307-x kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 51 2020 1 15 09
allfields_unstemmed	10.1186/s43055-020-00307-x doi (DE-627)SPR040982335 (SPR)s43055-020-00307-x-e DE-627 ger DE-627 rakwb eng 610 ASE Hashim, Hilwati verfasserin aut Intracranial giant cell tumour—a case report 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Giant cell tumours (GCT) are rare benign bone tumours that typically occur in the appendicular skeleton. In typical locations, these tumours are relatively simple to diagnose by radiography. However, at atypical locations, these tumours can be confused with other disease pathologies. Here, we describe a patient with an intracranial GCT that was initially thought to be a cystic teratoma. Case presentation A 49-year-old man with no previous medical illness was investigated for left-sided hearing impairment and tinnitus associated with a left-sided headache of 2 years’ duration. He did not complain of fever, vertigo, nasal or constitutional symptoms. Examination confirmed a sensory neural hearing loss with no other neurological deficit. Imaging by CT and subsequent MRI revealed an extra axial, multiloculated, and septated mass at the left temporal area with a significant mass effect. A provisional diagnosis of cystic teratoma was made. However, histopathological examination of the resected mass indicated that the lesion was a GCT. The patient required a second excision of the tumour, which he refused. His latest follow-up MRI showed no further progression of the residual tumour. His headaches have resolved and there was no progression of other symptoms. Conclusion This case highlights that GCTs can occur at sites outside the appendicular skeleton and that these tumours may be confused with other diseases that have a similar appearance on imaging. Giant cell tumours (dpeaa)DE-He213 Skull (dpeaa)DE-He213 CT scan (dpeaa)DE-He213 MRI scan (dpeaa)DE-He213 Case report (dpeaa)DE-He213 Bakar, Nor Salmah verfasserin aut Enthalten in The Egyptian Journal of Radiology and Nuclear Medicine Amsterdam [u.a.] : Elsevier, 2010 51(2020), 1 vom: 15. Sept. (DE-627)641391862 (DE-600)2583928-7 2090-4762 nnns volume:51 year:2020 number:1 day:15 month:09 https://dx.doi.org/10.1186/s43055-020-00307-x kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 51 2020 1 15 09
allfieldsGer	10.1186/s43055-020-00307-x doi (DE-627)SPR040982335 (SPR)s43055-020-00307-x-e DE-627 ger DE-627 rakwb eng 610 ASE Hashim, Hilwati verfasserin aut Intracranial giant cell tumour—a case report 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Giant cell tumours (GCT) are rare benign bone tumours that typically occur in the appendicular skeleton. In typical locations, these tumours are relatively simple to diagnose by radiography. However, at atypical locations, these tumours can be confused with other disease pathologies. Here, we describe a patient with an intracranial GCT that was initially thought to be a cystic teratoma. Case presentation A 49-year-old man with no previous medical illness was investigated for left-sided hearing impairment and tinnitus associated with a left-sided headache of 2 years’ duration. He did not complain of fever, vertigo, nasal or constitutional symptoms. Examination confirmed a sensory neural hearing loss with no other neurological deficit. Imaging by CT and subsequent MRI revealed an extra axial, multiloculated, and septated mass at the left temporal area with a significant mass effect. A provisional diagnosis of cystic teratoma was made. However, histopathological examination of the resected mass indicated that the lesion was a GCT. The patient required a second excision of the tumour, which he refused. His latest follow-up MRI showed no further progression of the residual tumour. His headaches have resolved and there was no progression of other symptoms. Conclusion This case highlights that GCTs can occur at sites outside the appendicular skeleton and that these tumours may be confused with other diseases that have a similar appearance on imaging. Giant cell tumours (dpeaa)DE-He213 Skull (dpeaa)DE-He213 CT scan (dpeaa)DE-He213 MRI scan (dpeaa)DE-He213 Case report (dpeaa)DE-He213 Bakar, Nor Salmah verfasserin aut Enthalten in The Egyptian Journal of Radiology and Nuclear Medicine Amsterdam [u.a.] : Elsevier, 2010 51(2020), 1 vom: 15. Sept. (DE-627)641391862 (DE-600)2583928-7 2090-4762 nnns volume:51 year:2020 number:1 day:15 month:09 https://dx.doi.org/10.1186/s43055-020-00307-x kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 51 2020 1 15 09
allfieldsSound	10.1186/s43055-020-00307-x doi (DE-627)SPR040982335 (SPR)s43055-020-00307-x-e DE-627 ger DE-627 rakwb eng 610 ASE Hashim, Hilwati verfasserin aut Intracranial giant cell tumour—a case report 2020 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Giant cell tumours (GCT) are rare benign bone tumours that typically occur in the appendicular skeleton. In typical locations, these tumours are relatively simple to diagnose by radiography. However, at atypical locations, these tumours can be confused with other disease pathologies. Here, we describe a patient with an intracranial GCT that was initially thought to be a cystic teratoma. Case presentation A 49-year-old man with no previous medical illness was investigated for left-sided hearing impairment and tinnitus associated with a left-sided headache of 2 years’ duration. He did not complain of fever, vertigo, nasal or constitutional symptoms. Examination confirmed a sensory neural hearing loss with no other neurological deficit. Imaging by CT and subsequent MRI revealed an extra axial, multiloculated, and septated mass at the left temporal area with a significant mass effect. A provisional diagnosis of cystic teratoma was made. However, histopathological examination of the resected mass indicated that the lesion was a GCT. The patient required a second excision of the tumour, which he refused. His latest follow-up MRI showed no further progression of the residual tumour. His headaches have resolved and there was no progression of other symptoms. Conclusion This case highlights that GCTs can occur at sites outside the appendicular skeleton and that these tumours may be confused with other diseases that have a similar appearance on imaging. Giant cell tumours (dpeaa)DE-He213 Skull (dpeaa)DE-He213 CT scan (dpeaa)DE-He213 MRI scan (dpeaa)DE-He213 Case report (dpeaa)DE-He213 Bakar, Nor Salmah verfasserin aut Enthalten in The Egyptian Journal of Radiology and Nuclear Medicine Amsterdam [u.a.] : Elsevier, 2010 51(2020), 1 vom: 15. Sept. (DE-627)641391862 (DE-600)2583928-7 2090-4762 nnns volume:51 year:2020 number:1 day:15 month:09 https://dx.doi.org/10.1186/s43055-020-00307-x kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 51 2020 1 15 09
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In typical locations, these tumours are relatively simple to diagnose by radiography. However, at atypical locations, these tumours can be confused with other disease pathologies. Here, we describe a patient with an intracranial GCT that was initially thought to be a cystic teratoma. Case presentation A 49-year-old man with no previous medical illness was investigated for left-sided hearing impairment and tinnitus associated with a left-sided headache of 2 years’ duration. He did not complain of fever, vertigo, nasal or constitutional symptoms. Examination confirmed a sensory neural hearing loss with no other neurological deficit. Imaging by CT and subsequent MRI revealed an extra axial, multiloculated, and septated mass at the left temporal area with a significant mass effect. A provisional diagnosis of cystic teratoma was made. However, histopathological examination of the resected mass indicated that the lesion was a GCT. The patient required a second excision of the tumour, which he refused. His latest follow-up MRI showed no further progression of the residual tumour. His headaches have resolved and there was no progression of other symptoms. 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author	Hashim, Hilwati
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topic_title	610 ASE Intracranial giant cell tumour—a case report Giant cell tumours (dpeaa)DE-He213 Skull (dpeaa)DE-He213 CT scan (dpeaa)DE-He213 MRI scan (dpeaa)DE-He213 Case report (dpeaa)DE-He213
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title	Intracranial giant cell tumour—a case report
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title_full	Intracranial giant cell tumour—a case report
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title_sort	intracranial giant cell tumour—a case report
title_auth	Intracranial giant cell tumour—a case report
abstract	Background Giant cell tumours (GCT) are rare benign bone tumours that typically occur in the appendicular skeleton. In typical locations, these tumours are relatively simple to diagnose by radiography. However, at atypical locations, these tumours can be confused with other disease pathologies. Here, we describe a patient with an intracranial GCT that was initially thought to be a cystic teratoma. Case presentation A 49-year-old man with no previous medical illness was investigated for left-sided hearing impairment and tinnitus associated with a left-sided headache of 2 years’ duration. He did not complain of fever, vertigo, nasal or constitutional symptoms. Examination confirmed a sensory neural hearing loss with no other neurological deficit. Imaging by CT and subsequent MRI revealed an extra axial, multiloculated, and septated mass at the left temporal area with a significant mass effect. A provisional diagnosis of cystic teratoma was made. However, histopathological examination of the resected mass indicated that the lesion was a GCT. The patient required a second excision of the tumour, which he refused. His latest follow-up MRI showed no further progression of the residual tumour. His headaches have resolved and there was no progression of other symptoms. Conclusion This case highlights that GCTs can occur at sites outside the appendicular skeleton and that these tumours may be confused with other diseases that have a similar appearance on imaging.
abstractGer	Background Giant cell tumours (GCT) are rare benign bone tumours that typically occur in the appendicular skeleton. In typical locations, these tumours are relatively simple to diagnose by radiography. However, at atypical locations, these tumours can be confused with other disease pathologies. Here, we describe a patient with an intracranial GCT that was initially thought to be a cystic teratoma. Case presentation A 49-year-old man with no previous medical illness was investigated for left-sided hearing impairment and tinnitus associated with a left-sided headache of 2 years’ duration. He did not complain of fever, vertigo, nasal or constitutional symptoms. Examination confirmed a sensory neural hearing loss with no other neurological deficit. Imaging by CT and subsequent MRI revealed an extra axial, multiloculated, and septated mass at the left temporal area with a significant mass effect. A provisional diagnosis of cystic teratoma was made. However, histopathological examination of the resected mass indicated that the lesion was a GCT. The patient required a second excision of the tumour, which he refused. His latest follow-up MRI showed no further progression of the residual tumour. His headaches have resolved and there was no progression of other symptoms. Conclusion This case highlights that GCTs can occur at sites outside the appendicular skeleton and that these tumours may be confused with other diseases that have a similar appearance on imaging.
abstract_unstemmed	Background Giant cell tumours (GCT) are rare benign bone tumours that typically occur in the appendicular skeleton. In typical locations, these tumours are relatively simple to diagnose by radiography. However, at atypical locations, these tumours can be confused with other disease pathologies. Here, we describe a patient with an intracranial GCT that was initially thought to be a cystic teratoma. Case presentation A 49-year-old man with no previous medical illness was investigated for left-sided hearing impairment and tinnitus associated with a left-sided headache of 2 years’ duration. He did not complain of fever, vertigo, nasal or constitutional symptoms. Examination confirmed a sensory neural hearing loss with no other neurological deficit. Imaging by CT and subsequent MRI revealed an extra axial, multiloculated, and septated mass at the left temporal area with a significant mass effect. A provisional diagnosis of cystic teratoma was made. However, histopathological examination of the resected mass indicated that the lesion was a GCT. The patient required a second excision of the tumour, which he refused. His latest follow-up MRI showed no further progression of the residual tumour. His headaches have resolved and there was no progression of other symptoms. Conclusion This case highlights that GCTs can occur at sites outside the appendicular skeleton and that these tumours may be confused with other diseases that have a similar appearance on imaging.
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title_short	Intracranial giant cell tumour—a case report
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In typical locations, these tumours are relatively simple to diagnose by radiography. However, at atypical locations, these tumours can be confused with other disease pathologies. Here, we describe a patient with an intracranial GCT that was initially thought to be a cystic teratoma. Case presentation A 49-year-old man with no previous medical illness was investigated for left-sided hearing impairment and tinnitus associated with a left-sided headache of 2 years’ duration. He did not complain of fever, vertigo, nasal or constitutional symptoms. Examination confirmed a sensory neural hearing loss with no other neurological deficit. Imaging by CT and subsequent MRI revealed an extra axial, multiloculated, and septated mass at the left temporal area with a significant mass effect. A provisional diagnosis of cystic teratoma was made. However, histopathological examination of the resected mass indicated that the lesion was a GCT. The patient required a second excision of the tumour, which he refused. His latest follow-up MRI showed no further progression of the residual tumour. His headaches have resolved and there was no progression of other symptoms. 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