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Year : 2011  |  Volume : 54  |  Issue : 2  |  Page : 396-397
Giant cell tumor of bone with lymph node metastases: A rare presentation


Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan

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Date of Web Publication27-May-2011
 

How to cite this article:
Aftab K, Umar B. Giant cell tumor of bone with lymph node metastases: A rare presentation. Indian J Pathol Microbiol 2011;54:396-7

How to cite this URL:
Aftab K, Umar B. Giant cell tumor of bone with lymph node metastases: A rare presentation. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Dec 10];54:396-7. Available from: http://www.ijpmonline.org/text.asp?2011/54/2/396/81641


Giant cell tumor (GCT) is a benign but often locally aggressive neoplasm accounting for about 5% of the biopsied primary bone tumors and about 20% of benign bone tumors, making it the sixth most common primary osseous neoplasm. [1] GCTs of bone are known for their unpredictable behavior characterized occasionally even by metastases. Most metastases lodge in the lungs but other rare sites are regional lymph nodes, mediastinum, skin, scalp, and the pelvis. [2]

We received a specimen of a 32-year-old woman with clinical history of severe pain and swelling in the left elbow region over a period of few months with no significant associated medical history. The radiologic films were also received, and the plain radiologic films showed a lytic expansile lesion in the lower end of humerus and upper end of radius and ulna [Figure 1]a. The computed tomography (CT) scans were suggestive of an aggressive lesion [Figure 1]b. The specimen was received in 2 containers. The main specimen consisted of a wide resection of elbow (extending from distal third of humerus to the proximal third of radius and ulna) with the overlying skin measuring 19 × 11 × 8 cm. Cut surface revealed a light brown, firm lesion with hemorrhagic areas measuring 10 × 8 × 7 cm. In the second container, an axillary lymph node was also received comprises a single nodular tissue piece measuring 3 × 2.5 × 1 cm. Light microscopy from the elbow lesion revealed a neoplastic lesion composed of proliferation of round to polygonal cells with vesicular nuclei and prominent nucleoli. Evenly distributed multinucleated giant cells were also seen showing approximately 10-15 nuclei. Areas showing hemorrhage and necrosis were also seen [Figure 2]. Light microscopy from the axillary lymph node revealed clusters of large cells with vesicular nuclei along with scattered multinucleated giant cells predominantly occupying the subcapsular sinuses [Figure 3]. A wide panel of immunohistochemical stains was performed to confirm the nature of these neoplastic cells in the lymph node and these cells were found to be positive only for CD68. Rest of the immunohistochemical stains, including Cytokeratin AE1/AE3, Cytokeratin CAM 5.2, LCA, and ki-1(CD30), were negative in these neoplastic cells.
Figure 1: (a) Plain radiologic film demonstrating a lytic lesion involving the lower end of humerus and upper end of radius and ulna; (b) CT scan demonstrating an aggressive lesion

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Figure 2: Giant cell tumor composed of an admixture of multinucleated giant cells along with polygonal neoplastic stromal cells (H and E, ×40)

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Figure 3: Lymph node showing a metastatic tumor deposit of similar morphology as seen in the primary tumor (H and E, ×100) and inset shows these cells highlighted by CD68 immunohistochemical stain

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GCT is a primary bone neoplasm usually involving the epiphysis of long bones, the sites most commonly affected are the lower end of femur, upper end of tibia, and the lower end of the radius. [3] Most of the patients are in the third and fourth decades of life. [4] Although the lesion had originally been classified as a benign GCT, the potential for metastasis without undergoing sarcomatous transformation was described by Jaffe et al.[5] in 1940. Metastasis from GCT of bone that is histologically benign has become a recognized entity and the lungs are the principal site of metastasis. [6] However, metastases to regional lymph nodes are very unusual. There have been many hypotheses regarding the metastatic potential of GCTs and mechanisms that have been implicated, including the possible vascular and lymphatic invasion and iatrogenic seeding at the time of surgery, but the causes still remain unclear. [7] There have also been reports regarding the spontaneous regression of the metastasis. [4] The early detection and treatment of this tumor is important, because those with complete resection of tumor have the best prognosis. [7] There is currently no definitive method of predicting, based on histologic grounds or flow cytometry, that which GCTs are likely to metastasize. These patients need to be monitored closely for any radiographic or histologic evidence of sarcomatoid transformation, which denotes a significantly worse prognosis. [8] The purpose of this article is to contribute to the accumulated experience related to the GCT of bone and its metastatic potential.

 
   References Top

1.Gamberi G, Serra M, Ragazzini P, Magagnoli G, Pazzaglia L, Ponticelli F, et al. Identification of markers of possible prognostic value in 57 giant cell tumor of bone. Oncol Rep 2003;10:351-6.  Back to cited text no. 1
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2.Qureshi SS, Puri A, Agarwal M, Desai S, Jambhekar N. Recurrent giant cell tumor of bone with simultaneous regional lymph node and pulmonary metastases. Skeletal Radiol 2005;34:225-8.  Back to cited text no. 2
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3.Rosai J, Ackerman LV. Bone and joints. In: Houston M, editor. Text book of surgical Pathology, 9th ed. New Delhi: Elsevier Publishers; 2004. p. 2169-72.  Back to cited text no. 3
    
4.Mendenhall WM, Zlotecki RA, Scarborough MT, Gibbs CP, Mendenhall NP. Giant cell tumor of bone. Am J Clin Oncol 2006;29:96-9.  Back to cited text no. 4
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5.Siebenrock KA, Unni KK, Rock MG. Giant cell tumor of bone metastasizing to lymph nodes. J Bone Joint Surg Br 1998;80:43-7.  Back to cited text no. 5
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6.Rock MG, Pritchard DJ, Unni KK. Metastases from histologically benign giant-cell tumor of bone. J Bone Joint Surg Am 1984;66:269-74.   Back to cited text no. 6
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7.Özkani C, Kalaci A, Özbarlas S. Giant-cell tumor of bone with pulmonary metastases: Treatment by combination of chemotherapy and whole-lung radiotherapy. Fýrat Týp Dergisi 2007;12:306-10.  Back to cited text no. 7
    
8.Kay RM, Eckardt JJ, Seeger LL, Mirra JM, Hak DJ. Pulmonary metastasis of benign giant cell tumor of bone. Clin Orthop Relat Res 1994;302:219-30.  Back to cited text no. 8
    

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Correspondence Address:
Kanwal Aftab
Department of Pathology and Microbiology, Aga khan University Hospital, Stadium Road P.O. Box 3500, Karachi 74800
Pakistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.81641

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