Lung tumor
Other carcinoma
Giant cell carcinoma

Author: Roseann Wu, M.D. (see Authors page)

Revised: 2 September 2017, last major update August 2017

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Giant cell carcinoma [title] lung
Cite this page: Wu, R. Giant cell carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/lungtumorgiantcellcarcinoma.html. Accessed October 17th, 2017.
Definition / general
  • Subtype of sarcomatoid carcinoma consisting of purely giant, pleomorphic tumor cells
  • Should not show differentiated non small cell components
  • Tumor stains for cytokeratins
Essential features
  • Giant cell carcinoma is classified as a subtype of sarcomatoid carcinoma that is composed almost entirely of tumor giant cells with no differentiated carcinomatous elements
  • Tumor giant cells may or may not stain for human chorionic gonadotrophin
  • Metastatic sarcoma or germ cell tumor should be excluded
Terminology
ICD-10 coding
  • Use code specific for location of tumor
  • C34.90 malignant neoplasm of unspecified part of unspecified bronchus or lung
Epidemiology
  • Pure giant cell carcinoma is rare, 0.3 - 2% of lung cancers
  • Middle to older age, mainly in male heavy smokers
Sites
  • May show predilection for upper lobes
Pathophysiology
Etiology
Clinical features
  • Cough, chest pain, dyspnea, malaise (varies by location)
Diagnosis
  • Cannot be made on small biopsies or cytology; definite diagnosis only on resected tumor
Radiology images

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CT of lung nodule

Prognostic factors
Case reports
Treatment
  • Not usually surgical since metastatic at diagnosis but resection and radiation may prolong survival
Clinical images

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Endobronchial tumor

Gross description
  • Solid, well demarcated, tan, peripheral mass with areas of necrosis and hemorrhage
Gross images

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8 x 7 cm tumor

Microscopic (histologic) description
  • Dyscohesive, polygonal, mono- and multinucleated giant cells with abundant cytoplasm and prominent nucleoli
  • Neoplastic, highly pleomorphic giant cells, often in inflammatory stroma with emperipolesis (Arch Pathol Lab Med 2010;134:1645)
  • Giant cells are multinucleated, may resemble syncytiotrophoblasts and produce human chorionic gonadotropin but are usually fewer than in primary choriocarcinoma of lung (Histopathology 2000;36:17)
  • Two types of giant cells: β-HCG positive syncytiotrophoblast-like giant cells with smudged nuclei and coarse chromatin with nuclear molding and β-HCG negative giant cells with admixed neutrophils and cell in cell features (Histopathology 2016;68:680)
Microscopic (histologic) images

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Images contributed by Roseann Wu, M.D.
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Giant cell CA lung HE 50X

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Giant cell CA lung HE 200Xb



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8 x 7 cm tumor

Diffuse proliferation of atypical, giant and bizarre cells

Virtual slides

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Rosai collection:
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Giant cell carcinoma


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H&E

Cytology description
  • Pleomorphic cells in flat loose clusters, with abundant, thick, well demarcated cytoplasm, multinucleation (Acta Cytol 2011;55:173)
  • Sharp clear nuclear membranes, acidophilic cytoplasm with finely granular or foamy appearance, irregular coarse chromatin, bizarre mitoses, neutrophil engulfment (Diagn Cytopathol 2007;35:555)
Cytology images

Images contributed by Roseann Wu, M.D.
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Giant cell CA Thin Prep 400X

Positive stains
Differential diagnosis
  • Metastatic germ cell tumor e.g. choriocarcinoma
  • Other subtypes of sarcomatoid carcinoma, particularly pleomorphic carcinoma
  • True sarcomas, such as undifferentiated pleomorphic sarcoma
Board review question #1
    Giant cell carcinoma of the lung is most commonly associated with which epithelial component resembling non small cell carcinoma?

  1. Adenocarcinoma
  2. Adenosquamous carcinoma
  3. Large cell carcinoma
  4. Squamous cell carcinoma
  5. None of the above
Board review answer #1
E. None of the above. Giant cell carcinoma is a subtype of sarcomatoid carcinoma composed almost entirely of tumor giant cells with no differentiated carcinomatous elements