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Soft Tissue Tumors

Giant cell tumor of soft tissue

 

Author: Nat Pernick, M.D., PathologyOutlines.com, Inc.

Reviewer: David Lucas, M.D., University of Michigan Health Systems (January 2009)

Revised: 26 June 2009, last major update June 2009

 

Definition

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● Soft tissue counterpart of giant cell tumor of bone (Mod Path 1999;12:894)

● Prominent osteoclast-like giant cells and mononuclear cells, but at most mild atypia

 

Terminology

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● Also called soft tissue giant cell tumor of low malignant potential

● See also Bone chapter

 

Epidemiology

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● Rare, usually age 40+ years, in superficial soft tissue of extremities (70%)

 

Clinical images

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http://dermatology.cdlib.org/146/case_presentation/giant_cell/1.jpg

54 year old man

 

Case reports

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● 54 year old man with tumor of finger (Dermatol Online J 2008;14:7)

● 60 year old woman with breast tumor with fatal outcome (Ann Diagn Pathol 2007;11:345)

● Arising in surgical scars (Pathologe 2009 Apr 16 [Epub ahead of print])

● 46 years duration (J Cutan Pathol 2009 Feb 4 [Epub ahead of print])

● Metastatic tumor associated with post-transplant immunosuppression (Virchows Arch 2006;448:847)

 

Treatment and prognosis

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● Complete excision; recurs in 12% (associated with incomplete excision)

● Rare metastases and death

 

Gross description

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● Up to 10 cm, usually dermis or subcutis, 30% are below superficial fascia

● Well circumscribed, nodular, fleshy, red-brown-gray, gritty at periphery due to calcification

 

Micro description

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● Multinodular with fibrous tissue containing siderophages separating nodules

● Nodules contain round/oval mononuclear cells and multinucleated osteoclast-like giant cells with similar nuclei

● Stroma is vascularized; up to 30 mitotic figures/10 HPF

● Often metaplastic bone, blood lakes, vascular invasion

● No/rare atypia, pleomorphism or necrosis

 

Micro images

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Resembles giant cell tumor of bone, with osteoclast-like giant cells but at most mild pleomorphism

 

 

http://dermatology.cdlib.org/146/case_presentation/giant_cell/3.jpg                                                     http://dermatology.cdlib.org/146/case_presentation/giant_cell/4.jpg

Chondroid pattern                                              Osteoid pattern

 

 

Bone tumors

i1543-2165-123-2-163-f02                                     Unfortunately we are unable to provide accessible alternative text for this. If you require assistance to access this image, please contact help@nature.com or the author                              

Giant cells and spindled                                   Numerous osteoclast-like giant cells          

mononuclear cells                                             and surrounding mononuclear cells            

with similar nuclei

 

 

                                  Unfortunately we are unable to provide accessible alternative text for this. If you require assistance to access this image, please contact help@nature.com or the author

Mononuclear cells and                                     Ki-67 staining in mononuclear cells

giant cells

 

Cytology description

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● Numerous osteoclast-like giant cells and mononuclear cells with bland and vesicular nuclei

● Occasional/rare fragment of branching vasculature, mitotic figures (Acta Cytol 2003;47:1103)

 

Positive stains

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● Vimentin, CD68 (strong in multinucleated giant cells), smooth muscle actin

● Also alkaline phosphatase, osteoprotegerin, RANKL, TRAIL and TRAP (Hum Path 2005;36:945)

 

Molecular / cytogenetics

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● Usually no cytogenetic abnormalities

● Case report of telomeric association involving multiple chromosomes (Pediatr Dev Pathol 2005;8:718)

 

Differential diagnosis

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● Giant cell tumor of tendon sheath-localized - near tendons, hyalinized stroma, foam cells and hemosiderin laded macrophages are common, metaplastic bone is uncommon

● Malignant fibrous histiocytoma-giant cell type - infiltrative, moderate to severe atypia of non-giant cells, necrosis, atypical mitotic figures

 

Additional references

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● Stanford University

 

 

End of Soft Tissue Tumors > Giant cell tumor of soft tissue

 

 

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