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Objective: The aim of this study was to define histopathological features of giant cell tumor of bone, especially accompanying fibrohistiocytic or aneurysmal bone cyst like components, in the light of our institutions experience. Methods: A total of 120 cases (64 females and 56 males; mean age: 36.2 (12–80)) with ‘GCT’ diagnosed between the years 1...
Citations
... These stromal cells may show rare mitotic figures however atypical mitosis is absent [17]. The well defined histopathologic pattern of GCT is frequently lost by secondary reactive changes such as fibrohistiocytic proliferation, hemorrhage, necrosis and aneurysmal bone cyst formation [18]. In 100% of cases with giant cell bone tumor, strong positive immunohistochemical activity to CD 68 in osteoclast-like giant cells was observed. ...
We present two clinical cases in young patients with the rare pathohistological diagnosis of giant cell bone tumor (GCT) and aneurysmal bone cyst (ABC). Against this background, we discuss the rare indications for intensity modulated radiotherapy (IMRT). We focus on the imaging and pathohistological differences, as well as in terms of biological development in these two osteoclastic tumors with a high risk of recurrence after the inability to perform radical operations due to their localization.
... However, the cases in our study only demonstrated soap bubble hyperintensity, which may imply the hemorrhage in the tumor. The linear hypointense separation in the tumor was not a bony component and might have been a network of small thin-walled sinusoid-like blood vessels or a fibrous separation similar to giant cell tumors [6,24]. Soap bubble hyperintensity and linear hypointense separation could be helpful in diagnosing long bone metastases of ccRCC. ...
Objectives
This article analyzed the imaging features of 18 long bone metastasis (LBM) of renal cell carcinoma (RCC) confirmed by pathology and reviewed the available literature.
Case presentation
Patients who underwent radiographic examinations at our hospital between January 2015 and December 2021 with pathology-confirmed bone metastases were evaluated. The clinical and radiographs and CT, and MR images features of the patients were analyzed. Eighteen patients with pathology-confirmed LBM from RCC were collected. All the patients had X-ray examinations, 15 had computed tomography (CT), 13 had magnetic resonance (MR) imaging, and six had MR enhancement. The clinical and imaging features of the lesions were analyzed, including morphological and signal intensity characteristics. Ten patients were found with metastases after nephrectomy, and eight patients were admitted to the hospital with skeletal-related events (SREs). Eighteen cases originated from clear cell RCC. Fourteen lesions were located in the epiphysis and four in the diaphysis. The height-to-width ratio of the lesions ranged from 1.11 to 3.41 (mean, 1.84). All lesions showed osteolytic destruction, with 16 lesions showing expansile destruction. Seven lesions demonstrated soap bubble hyperintensity and hypointense separation on T2-weighted images. Six lesions demonstrated a flow-void sign, and six showed marked marginal enhancement.
Conclusions
The LBM of RCC mainly occurred in the proximal epiphysis and tended to spread along the long bone axis with expansile osteolytic destruction. In some cases, soap bubble hyperintensity, hypointense separation, and the flow-void sign were seen.
... In ABC, giant cells are of smaller size and are unevenly distributed. In ABC solid type, the stroma is more fibrotic than that of giant cell tumor [14]. ...
Herein, we report the case of a 12-year-old boy diagnosed with multiple aneurysmal bone cysts (ABCs) who had previously undergone surgery on the proximal left tibia, proximal left femur, and distal tibia. During follow-up after the surgery, he developed another lesion on the proximal left humerus. Although rare, the pathological diagnosis was multiple ABCs.
... Secondary changes such as fibrohistiocytic or aneurysmal bone cyst-like components and coagulation necrosis have been noted in conventional GCT of bone and thus tend they to be an important differential diagnosis of each other. 4 Other differentials include fibrous dysplasia, osteosarcoma, and chronic osteomyelitis. The use of bone cement with extended curettage, adjuvant therapy like phenol irrigation and the use of Denosumab or bisphosphonates helps in decreasing the recurrence of aggressive benign bone tumors. ...
... Comunoglu N et al also in their series of 120 specimens had proximal tibia as the most predominant involved site. (7) Up to 15 % of cases have been reported to involve flat bones like pelvis, scapula, ribs and calvaria. Spine, small bones of hand and feet, and patella are atypical sites for GCTB and when involved multi-centric involvement and associated Paget's disease need to be ruled out. ...
Object: The giant cell tumour of bone has a spectrum of clinical-radiological presentation. This study aimed to describe this varied presentation in our institution.
Methods: This retrospective study was conducted on twenty-nine pathologically labelled cases of giant cell tumours of bone. The medical records for clinical presentation and diagnostic imaging studies were studied and evaluated.
Results: Mean age of the patients at presentation was 35.3±12.9 years. Pain, local swelling and restricted joint function were the symptoms seen in 93, 58.6 and 52 % patients respectively.� The cortical breach was seen in 15 (51.7 %) and 22 (75.9 %) lesions on plain radiographs and CT images respectively. 14(48.3 %) cases had soft tissue invasion on MRI at presentation. 26 (89.7 %) of lesions were located within 1 cm from the articular cartilage. The solid tumour component was hypo to iso-intense in signal intensity in 27 (93.1 %) lesions in T1 weighted and 21 (72.4 %) in T2 weighted images. 14 (48.3 %) had hyperintense cystic areas, and fluid-fluid levels, suggestive of aneurysmal bone cysts, were seen in 4 (13.8 %) cases on T2 weighted images. Hypo-echoic nodular areas in solid tumour component, suggestive of hemosiderin deposits, were present in 3 (10.3 %) lesions on T1 and T2 weighted images. Conclusion: The tumour classically presents as an epiphysial-metaphyseal, eccentric, expansile, lytic lesion in a skeletally mature patient. The MRI picture is variable and the surgeon should have a sound knowledge of these variations to obtain a biopsy sample from a proper site of the lesion and to avoid misdiagnosis especially of primary ABC.
... Cancer Cell Int (2020) 20:135 The histological appearance of an increased amount of osteoclast-like giant cells according to Jaffe et al. in 1940 was considered to be the neoplasm of the osteoclast lineage and hence it was given the name "osteoclastoma". With the help of further studies at later stage, it was observed that the neoplastic component was the fibroblast like stromal cell [91]. Recent research studies have confirmed that the osteoblast lineage could consist of stromal cells along-with other sub-cell types. ...
The primary bone tumor is usually observed in adolescence age group which has been shown to be part of nearly 20% of the sarcomas known today. Giant cell tumor of bone (GCTB) can be benign as well as malignant tumor which exhibits localized dynamism and is usually associated with the end point of a long bone. Giant cell tumor (GCT) involves mononuclear stromal cells which proliferate at a high rate, multinucleated giant cells and stromal cells are equally present in this type of tumor. Cancer stem cells (CSCs) have been confirmed to play a potential role in the development of GCT. Cancer stem cell-based microRNAs have been shown to contribute to a greater extent in giant cell tumor of bone. CSCs and microRNAs present in the tumors specifically are a great concern today which need in-depth knowledge as well as advanced techniques to treat the bone cancer effectively. In this review, we attempted to summarize the role played by cancer stem cells involving certain important molecules/factors such as; Mesenchymal Stem Cells (MSCs), miRNAs and signaling mechanism such as; mTOR/PI3K-AKT, towards the formation of giant cell tumor of bone, in order to get an insight regarding various effective strategies and research advancements to obtain adequate knowledge related to CSCs which may help to focus on highly effective treatment procedures for bone tumors.
... On gross pathology, GCT is a soft friable dark tissue with associated areas of cystic and necrotic changes. Histology shows mononuclear stromal cells and characteristic multinucleated giant cells [7]. ...
A 17-year-old female presented to us with pain and swelling in the right heel. Examination revealed the swelling to be tender, hard and fixed to the calcaneus. Radiographs showed an expansile, lytic lesion of the calcaneus with well-defined margins and no extraosseus spread. A core biopsy was done which showed multinucleated giant cells in a sea of mononuclear stromal cells, suggestive of a giant cell tumour (GCT). Curettage and filling up of the defect with bone cement was done under anaesthesia. The patient was fully ambulatory three months after the surgery. At two-year follow-up, the patient continued to be asymptomatic and radiographs revealed no signs of recurrence. It is important to note that GCT can occur in these rare sites and unusual age groups, and hence requires a good level of awareness of the surgeon and adequate preoperative workup, including biopsy, before proceeding to the definitive treatment of the lesion. Considering its potential local aggressiveness, early intervention is necessary. The patient should be kept under regular follow-up to detect any recurrence or metastasis in early stage.
... Osteoclastoma of small bones delineates enhanced tumour reoccurrence, in contrast to tumefaction arising in long bones. As osteoclastoma is uncommonly detected within bones of hands or feet, tumefaction observed within aforesaid sites is possibly a giant cell lesion of small bones whereas jaw is probably involved by a central giant cell granuloma [3,4]. ...
... Receptor activator of nuclear factor kappa-B and its ligand (RANK/ RANKL) signalling pathway is extensively exemplified within osteoblast -like mononuclear stromal cells with consequent transformation of pre-osteoclast cells of monocytic lineage into osteoclast cells. Aforesaid osteoclasts initiate bone absorption with consequent osteolysis discerned within osteoclastoma [4,5]. ...
... RANKL molecules appearing on neoplastic pre-osteoblasts adhere to RANK (receptor activator of nuclear activator kappa-B) situated upon nonneoplastic, macrophage-like, osteoclast precursors, in concurrence with macrophage colony stimulating factor (M-CSF). Aforesaid combination promotes differentiation of osteoclasts with consequent giant cell formation [4,5]. ...
Objective:
To describe the presentation of giant cell tumors (GCT) of the bone in the pediatric population to (1) improve the differential diagnosis of pediatric bone tumors and (2) identify the origin of GCT. Understanding the origin of bone tumors assists in establishing appropriate diagnoses and recommending treatment options. This is particularly important in children, where evaluating the need for invasive procedures is balanced with the desire to avoid overtreatment. GCT have historically been considered epiphyseal lesions with potential metaphyseal extension. Therefore, GCT may be inappropriately excluded from the differential diagnosis of metaphyseal lesions in the skeletally immature.
Materials and methods:
We identified 14 patients from 1981 to 2021 at a single institution who had histologic confirmation of GCT and were less than 18 years old at diagnosis. Patient characteristics, tumor location, surgical treatment, and local recurrence rates were collected.
Results and conclusions:
Ten (71%) patients were female. Eleven (78.6%) were epiphysiometaphyseal (1 epiphyseal, 4 metaphyseal, 6 epiphysiometaphyseal). Five patients had an open adjacent physis, of which three (60%) had tumors confined solely to the metaphysis. Of the five patients with open physis, four (80%) developed local recurrence while only one patient (11%) with a closed physis had local recurrence (p value = 0.0023). Our results illustrate that for the skeletally immature, GCT can (and in our results more commonly did) occur in the metaphyseal location. These findings suggest that GCT should be included in the differential diagnosis of primary metaphyseal-only lesions in the skeletally immature.
Giant cell tumor of bone (GCTB) is a locally aggressive tumor that shows predilection for the metaphysis/epiphysis of long bones, with an incidence of 4–5% of primary bone tumors. GCTB shows two main populations of cells: mononuclear cells and non-neoplastic multi-nucleated giant cells, with or without fibrous background. On the other hand, giant-cell-poor GCTB are rare with only few reports in the literature. These cases offer a diagnostic challenge, given the absence of giant cells and such cases have consistently been shown to harbor the H3F3A gene mutation by sequencing. The H3.3 G34W mutation-specific monoclonal antibody has shown high specificity in the diagnosis of GCTB. Two cases of giant-cell-poor GCTB are presented in this study, in which giant cells were absent or sparse and the diagnosis of GCTB was confirmed by the expression of H3.3 G34W monoclonal antibody in the mononuclear cells by immunohistochemistry. Whether this represents a histologic variant of GCTB or partial involution of GCTB is not yet fully understood; however, an immune response, infectious/inflammatory reaction, and/or anti-tumor cytokine production have been purported to be factors inciting disease regression in GCTB.
