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Case Report
Asuquo et al., J Clin Exp Oncol 2013, 2:3
http://dx.doi.org/10.4172/2324-9110.1000110 Journal of Clinical &
Experimental Oncology
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Technology and Medicine
Giant Cell Tumour of Soft
Tissue of the Finger: A Case
Report
ME Asuquo1*, VI Nwagbara1, C Agbor1, S Akpan1, G Ebughe2
and T Ugbem2
Abstract
Giant cell tumour of soft tissue resembling osseous giant cell
tumour is a distinct and uncommon entity. Presented is a 52-year-
old man with a 3-year history of swelling located on the dorsum of
the right middle nger diagnosed on histology as giant cell tumour
of soft tissue. The need for high index of suspicion by physicians
is emphasized, as giant cell tumour of soft tissue should be
considered as differential diagnosis of nger lumps.
Keywords
Giant cells; Soft tissue
*Corresponding author: ME Asuquo, Department of Surgery, University of
Calabar Teaching Hospital, Calabar, Nigeria, GPO Box 1891, Calabar, 540001,
Nigeria, E-mail: mauefas@yahoo.com
Received: February 27, 2013 Accepted: April 12, 2013 Published: April 19,
2013
Examination revealed a middle-aged male in relative good health,
afebrile, not pale. On the right hand, there was an irregular nodular
mass on the dorsal surface of the right middle nger measuring
5x3 cm, non-tender, rm, mobile and not attached to the skin and
underlying structures. ere was no regional lymphadenopathy
(Figure 1).
Haemogram and urinalysis were unremarkable. Plain X-ray
of the right hand showed a well-dened unmineralised so tissue
mass around the proximal interphalangeal joint of the middle nger,
with a normal adjoining cortex of the phalanx (Figure 2). A clinical
diagnosis of a broma of the right middle nger was made.
Marginal excision biopsy of the mass was done under a ring block.
It revealed an irregular, lobulated, encapsulated mass (Figure 3).
Histopathology report showed a tumour composed of proliferating
uniform oval mononuclear cells in a myxoid stroma. Scattered
around the background were numerous osteoclast-type giant cells
having many nuclei that resemble the nuclei of mononuclear cells.
No malignancy was seen, Figure 4a and 4b. A diagnosis of giant cell
tumour of so tissue (GCT-ST) of the right middle nger was made.
Follow-up in the SOPD has been satisfactory and patient
informed of the need for follow up.
Discussion
Giant cell tumour of the so tissue is a primary so tissue
neoplasm, it closely resembles GCT of bone cytomorphologically as
the giant cells resemble osteoclast, however both are distinct entities
[5,7], as depicted by our patient. is rare entity rst described by
Salm and Sissons in 1972 [3], was also described by Guccion and
Enzinger later in the same year [6].
e histiogenesis of this tumour is not certain, but it is postulated
that osteoclast-like cells are the result of fusion of circulating monocytes
recruited into the lesion [2,8]. Giant cell tumour of so tissue though
predominantly a benign condition, demonstrates unpredictable
capacity to occasionally recur or evolve into a malignant lesion [2].
Reported recurrence rate is 6.2%, though infrequent, metastasis to the
lungs and parotid glands have been described [4,5]. is underscores
the need to ensure a tumour free margin post excision and follow
up of patients, as the tumour biology of this lesion is not completely
known.
It aects mainly adults of both sexes [2], in keeping with our male
patient aged 52 years. Oliveria et al. reported an age range of 5-80
years (median 43 years), [5], while Tagera-Vaquerizo et al. reported
an age range of 5-84 years [8], both with no predilection for sex.
is lesion, predominantly found in the lower limb with the trunk
and upper limb ranking second and third respectively [5,8]. Kumar
and Carter reported that the hand is rarely involved [1]. However,
Chand et al. reported that the commonest site was the upper limb,
nger being the most common location [2]. Our patient’s lesion was
located on the dorsum of the right middle nger. In keeping with
reported nger lesions, Tejera-Vaquerizo reported a distal phalanx
Introduction
Giant cell tumour of so tissue (GCT-ST) is a rare entity and
has a histopathological semblance of osteoclast like multinucleated
giant cells seen in the osseous counterpart [1,2]. Salm and Sisson rst
coined the term primary GCT-ST in 1972 [3]. It presents as a painless,
rm, mobile, well-delineated mass not attached to muscle, tendon,
or bone [4]. Most of the lesions are seen in the lower limb, the most
common site being the thigh, followed by trunk and upper limb [5]. If
surgically treated by excision with tumour free margin, it is expected
to have a benign clinical course [1]. However, despite being a benign
lesion, it may recur aer excision, has the potential of malignant
transformation, and rarely metastasize [6]. We report a case of GCT-
ST of the dorsum of the middle nger in a 52-year-old man.
Case Summary
A 52-year old businessperson, who had recovered from three
cerebrovascular accidents aecting the le cerebral hemisphere, was
referred from the medical out patient department (MOPD) to the
surgical out patient department (SOPD) with a 3-year history of a
swelling on the right middle nger. e swelling began as a nodule 3
years ago, but gradually increased in size, becoming multilobulated.
ere was no associated history of trauma or arthritis, pain or
limitation of movement of the aected nger and no similar swellings
in other parts of the body. He is a known hypertensive on nifedipine
medication.
Citation: Asuquo ME , Nwagbara VI , Agbor C, Akpan S, Ebughe G, et al. (2013) Giant Cell Tumour of Soft Tissue of the Finger: A Case Report. J Clin Exp
Oncol 2:3.
• Page 2 of 3 •
doi:http://dx.doi.org/10.4172/2324-9110.1000110
Volume 2 • Issue 3 • 1000110
lesion of the right ring nger with a cystic component [8], this was
not a feature in the reported lesion. Mardi and Sharma reported a
case on the dorsum of the right hand over the index nger [9]. Breast
is exceedingly rare site aected by GCT-ST; rst case reported was
fatal [10].
Chand et al. reported that none of the cases they reported was
clinically suspected as GCT-ST in keeping with our experience. ey
present frequently as skin tumour and may be supercial as the case
presented, Figure 1 or may be in deep body tissue [2]. Painless, rm,
mobile, well-demarcated mass, not attached to muscle, tendon, or
bone is the common mode of presentation [4].
ere are no reported gross features that distinguish between
benign and malignant variants. Diagnosis is histologic with
appearance of osteoclast-like giant cells and mononuclear cells
(Figures 4a and 4b). Giant cell tumour of so tissue is required to be
distinguished from giant cell rich tumours of the bone, and GCT of
tendon sheath. Plain radiograph is sensitive in the diagnosis of a bone
lesion or its exclusion as shown in the case presented with a normal
phalanx (Figure 2). e use of cross sectional imaging, magnetic
resonance imaging (MRI), is capable of distinguishing GCT of the
tendon from GCT-ST. However, the location of the lesion mainly on
the dorsolateral part of the anatomical position of the nger, Figure 1,
suggested that the diagnosis of GCT of the tendon sheath is unlikely,
and this conrmed at surgery. e immunohistochemical staining of
GCT-ST is similar to that of GCT of bone; strong positive staining for
CD 68 in multinucleated osteoclast like cells and in mononuclear cells
focal staining for CD6, Ham 56 and smooth muscle actin [9]. Other
so tissue neoplasms are dermatobroma, atypical broxanthomas,
brohistiocytic tumour, giant cell malignant brous histiocytoma.
e treatment of GCT-ST is surgical resection with tumour free
margin. Follow up of these patients is necessary because of possibility
of recurrence and malignant transformation of this tumour [2,8].
e prognosis of GCT-ST varies and the biological aggressive course
for its local recurrence cannot be predicted in view of the wide
clinicopathological spectrum exhibited by this tumour [2].
In conclusion, the need for high index of suspicion by physicians
to consider GCT-ST as dierential diagnosis of lumps of the nger
is emphasised. is lesion with usually a benign course has the
propensity to be malignant with grave consequences.
References
1. Kumar S, Carter LF (2011) Giant cell tumor of soft tissue of hand: simple but
rare diagnosis, which is often missed. Clinics and Practice 1: e54.
2. Chand K, Bhardwaj RK, Rappai TJ (2006) Study of 7 cases of giant cell tumor
of soft tissue. MJAFI 62: 138-140.
3. Salm R, Sissons HA (1972) Giant cell tumors of soft tissue. J Pathol 107: 29-
39.
4. Nguyen V, Garcia C, Haskell H (2010) Giant cell tumor of soft tissue on the
thigh of a 40-year-old woman. Dermatol Online J 16: 2.
5. Oliveira AM, DeiTos AP, Fletcher CD, Nascimento AG (2000) Primary giant
cell tumor of soft tissues: a study of 22 cases. Am J Surg Pathol 24: 248-256.
Figure 1: Clinical photograph giant cell tumour of soft tissue.
Figure 2: Plain X-ray right hand.
Figure 3: Macroscopic photograph of giant cell tumour of soft tissue.
Figure 4a: Giant cell tumour of soft tissue – H&E x 40.
Figure 4b: Giant cell tumour of soft tissue H&E x 100.
Citation: Asuquo ME , Nwagbara VI , Agbor C, Akpan S, Ebughe G, et al. (2013) Giant Cell Tumour of Soft Tissue of the Finger: A Case Report. J Clin Exp
Oncol 2:3.
• Page 3 of 3 •
doi:http://dx.doi.org/10.4172/2324-9110.1000110
Volume 2 • Issue 3 • 1000110
6. Guccion JG, Enzinger FM (1972) Malignant giant cell tumor of soft perts. An
analysis of 32 cases. Cancer 29: 1518-1529.
7. O’Connell JX, Wehrli BM, Nielson GP, Rosenburg AE (2000) Giant cell
tumors of soft tissue: a clinicopathological study of 18 benign and malignant
tumors. Am J Surg Pathol 24: 386-395.
8. Tejera-Vaquerizo A, Ruiz-Molina I, Gonzalez-Serrano T, Solis-Garcia E
(2008) Primary giant cell tumor of soft tissue in the nger. Dermatol Online J
14: 7.
9. Mardi K, Sharma J (2007) Primary giant cell tumour of soft parts- Report of a
case with ne needle aspiration cytology and histology ndings. J Cytol 24:
58-59.
10. May SA, Deavers MT, Resetkova E, Johnson D, Albarracin CT (2007) Giant
cell tumor of soft tissue arising in breast. Ann Diagn Pathol 11: 345-349.
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Author Afliations Top
1Department of Surgery, University of Calabar Teaching Hospital, Calabar,
Nigeria
2Department of Pathology, University of Calabar Teaching Hospital, Calabar,
Nigeria
