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Malignant tenosynovial giant cell tumor of the leg: a radiologic-pathologic correlation and review of the literature.

Richman DM, Bresler SC, Rosenthal MH, Howard SA - J Clin Imaging Sci (2015)

Bottom Line: Malignant tenosynovial giant cell tumor (TGCT) is a rare clinical entity that can arise as a recurrent lesion or can co-exist with a benign TGCT lesion.Malignant TGCT most commonly arises in the lower extremity and tends to be clinically aggressive, with most patients developing recurrent lesions or dying.Much of the literature describes the histopathologic features and classifies this broad group of tumors, with little description of the imaging characteristics of this disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA ; Harvard Medical School, Boston, Massachusetts, USA.

ABSTRACT
Malignant tenosynovial giant cell tumor (TGCT) is a rare clinical entity that can arise as a recurrent lesion or can co-exist with a benign TGCT lesion. Malignant TGCT most commonly arises in the lower extremity and tends to be clinically aggressive, with most patients developing recurrent lesions or dying. Much of the literature describes the histopathologic features and classifies this broad group of tumors, with little description of the imaging characteristics of this disease. We present the multimodality appearance of a case of malignant diffuse-type TGCT that recurred 2 months after resection with subsequent rapid clinical progression.

No MeSH data available.


Related in: MedlinePlus

55-year-old female with right posterior calf pain initially diagnosed with tenosynovial giant cell tumor with subsequent resection demonstrating malignant tenosynovial giant cell tumor. Pathology of core biopsy and resection specimens is shown. (a) Core biopsy sample of the mass stained with Hematoxylin and eosin, ×400, shows epithelioid cells with round nuclei and a background of lymphocytes, histiocytes, several multinucleated giant cells (thick arrows), and scattered mitoses (thin arrow). Hemosiderin is also present (arrowhead). (b) Although the majority of the resection specimen appears similar to the core biopsy, select areas of the resection stained with Hematoxylin and eosin (×400), display pleomorphic cytology with large, highly atypical cells (arrow) and atypical mitoses (arrowhead), consistent with the diagnosis of malignant diffuse-type TGCT.
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Figure 5: 55-year-old female with right posterior calf pain initially diagnosed with tenosynovial giant cell tumor with subsequent resection demonstrating malignant tenosynovial giant cell tumor. Pathology of core biopsy and resection specimens is shown. (a) Core biopsy sample of the mass stained with Hematoxylin and eosin, ×400, shows epithelioid cells with round nuclei and a background of lymphocytes, histiocytes, several multinucleated giant cells (thick arrows), and scattered mitoses (thin arrow). Hemosiderin is also present (arrowhead). (b) Although the majority of the resection specimen appears similar to the core biopsy, select areas of the resection stained with Hematoxylin and eosin (×400), display pleomorphic cytology with large, highly atypical cells (arrow) and atypical mitoses (arrowhead), consistent with the diagnosis of malignant diffuse-type TGCT.

Mentions: Core needle biopsy of the right calf mass demonstrated diffuse-type giant cell tumor (also known as diffuse-type TGCT) with a heterogeneous cell population consisting of sheets of larger, epithelioid cells with round nuclei and discrete cell borders in a background of histocytes, lymphocytes, and scattered hemosiderin [Figure 5a], the characteristic appearance of diffuse-type TGCT. Numerous giant cells and focal necrosis were also present. Although the cytology of the tumor was atypical with a high mitotic rate of 27 per 10 high-power fields (HPFs), a diagnosis of malignant diffuse-type TGCT was not warranted in this limited sample as the sample did not meet five out of the eight criteria needed for a diagnosis of malignancy (see Discussion). Immunohistochemical stains were negative for smooth muscle actin (SMA), desmin, CD34 (cluster of differentiation protein), Pan-K, and S100 protein in the small amount of tissue present.


Malignant tenosynovial giant cell tumor of the leg: a radiologic-pathologic correlation and review of the literature.

Richman DM, Bresler SC, Rosenthal MH, Howard SA - J Clin Imaging Sci (2015)

55-year-old female with right posterior calf pain initially diagnosed with tenosynovial giant cell tumor with subsequent resection demonstrating malignant tenosynovial giant cell tumor. Pathology of core biopsy and resection specimens is shown. (a) Core biopsy sample of the mass stained with Hematoxylin and eosin, ×400, shows epithelioid cells with round nuclei and a background of lymphocytes, histiocytes, several multinucleated giant cells (thick arrows), and scattered mitoses (thin arrow). Hemosiderin is also present (arrowhead). (b) Although the majority of the resection specimen appears similar to the core biopsy, select areas of the resection stained with Hematoxylin and eosin (×400), display pleomorphic cytology with large, highly atypical cells (arrow) and atypical mitoses (arrowhead), consistent with the diagnosis of malignant diffuse-type TGCT.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374198&req=5

Figure 5: 55-year-old female with right posterior calf pain initially diagnosed with tenosynovial giant cell tumor with subsequent resection demonstrating malignant tenosynovial giant cell tumor. Pathology of core biopsy and resection specimens is shown. (a) Core biopsy sample of the mass stained with Hematoxylin and eosin, ×400, shows epithelioid cells with round nuclei and a background of lymphocytes, histiocytes, several multinucleated giant cells (thick arrows), and scattered mitoses (thin arrow). Hemosiderin is also present (arrowhead). (b) Although the majority of the resection specimen appears similar to the core biopsy, select areas of the resection stained with Hematoxylin and eosin (×400), display pleomorphic cytology with large, highly atypical cells (arrow) and atypical mitoses (arrowhead), consistent with the diagnosis of malignant diffuse-type TGCT.
Mentions: Core needle biopsy of the right calf mass demonstrated diffuse-type giant cell tumor (also known as diffuse-type TGCT) with a heterogeneous cell population consisting of sheets of larger, epithelioid cells with round nuclei and discrete cell borders in a background of histocytes, lymphocytes, and scattered hemosiderin [Figure 5a], the characteristic appearance of diffuse-type TGCT. Numerous giant cells and focal necrosis were also present. Although the cytology of the tumor was atypical with a high mitotic rate of 27 per 10 high-power fields (HPFs), a diagnosis of malignant diffuse-type TGCT was not warranted in this limited sample as the sample did not meet five out of the eight criteria needed for a diagnosis of malignancy (see Discussion). Immunohistochemical stains were negative for smooth muscle actin (SMA), desmin, CD34 (cluster of differentiation protein), Pan-K, and S100 protein in the small amount of tissue present.

Bottom Line: Malignant tenosynovial giant cell tumor (TGCT) is a rare clinical entity that can arise as a recurrent lesion or can co-exist with a benign TGCT lesion.Malignant TGCT most commonly arises in the lower extremity and tends to be clinically aggressive, with most patients developing recurrent lesions or dying.Much of the literature describes the histopathologic features and classifies this broad group of tumors, with little description of the imaging characteristics of this disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA ; Harvard Medical School, Boston, Massachusetts, USA.

ABSTRACT
Malignant tenosynovial giant cell tumor (TGCT) is a rare clinical entity that can arise as a recurrent lesion or can co-exist with a benign TGCT lesion. Malignant TGCT most commonly arises in the lower extremity and tends to be clinically aggressive, with most patients developing recurrent lesions or dying. Much of the literature describes the histopathologic features and classifies this broad group of tumors, with little description of the imaging characteristics of this disease. We present the multimodality appearance of a case of malignant diffuse-type TGCT that recurred 2 months after resection with subsequent rapid clinical progression.

No MeSH data available.


Related in: MedlinePlus