Secondary malignant giant cell tumour of bone--a study of five cases with short review of literature

Secondary malignant giant cell tumour of bone occurs as a result of previous attempts at local control of a benign giant cell tumour of bone (GCT). Out of the total 445 conventional benign GCT of bone, therapeutic irradiation was given in 39 cases as the lesions were located in the vertebrae and pelvic bones where debulking surgery was not possible and the tumours were pressing on the spinal cord. The patients were followed up for 21 years. Out of 39 cases, 5 patients developed sarcomas of which 3 were fibrosarcomas, 1 was malignant fibrous histiocytoma while 1 was an osteosarcoma. All the patients developing post-radiation sarcomas died within a few months due to lung metastasis. In conclusion, all the patients with benign GCT of bone treated with radiation must be followed life long as they are prone to develop sarcomas.     

Primary malignant giant cell tumour of bone--a study of two cases with short review

Primary malignant giant cell tumour of bone is extremely rare. It is distinctly separate from benign metastasising giant cell tumour of bone and secondary malignant giant cell tumour which occurs in response to radiotherapy and repeated curettage of benign giant cell tumor. The tumor has high mortality rate. It usually affects lower end of femur and upper end of tibia. Two usually affects lower end of femur and upper end of tibia. Two cases, on involving upper end of tibia and other in vertebra are discussed. Extreme paucity of literature prompted to publish this article. A short review of radiological appearance, histopathological findings and treatment modalities is highlighted.     

Gynandroblastoma. Report of an unusual ovarian tumour and literature review

Gynandroblastoma is a rare variant of ovarian sex cord stromal tumours that demonstrates morphological evidence of both male and female differentiation. We report a new case of gynandroblastoma in a 22-year-old nulliparous female with a history of menstrual disturbance. Physical examination disclosed a painless pelvic mass measuring 20 cm across with normal secondary sex characteristics, and no signs of virilisation. Histological examination of the surgically resected primary tumour revealed a predominant adult granulosa cell component admixed with a minor Sertoli cell component that did not exceed 20% of the tumour. Immunohistochemical analysis showed positive immunostaining of Sertoli cell areas with inhibin. The final diagnosis was gynandroblastoma. The post-operative course was uneventful and there was no evidence of recurrence during the 9-month follow-up period.     

Idiopathic giant cell myocarditis--a case report and review of literature

Idiopathic giant cell myocarditis (IGCM) is a rare clinicopathological entity which is usually known to cause in more than half the cases sudden death. The histological features are characteristic with a central area of myocardial necrosis and a rich cellular infiltration of lymphocytes with a few eosinophils, plasma cells, macrophages and multinucleated giant cells. We hereby report a case of IGCM in a 72 year old male with history of sudden death. This case is being presented for its rarity and a review of literature is made.     

Squamous differentiation in a sarcomatoid chromophobe renal cell carcinoma: an unusual case report with review of the literature

We describe an extremely rare occurrence of a squamous differentiation in a sarcomatoid chromophobe renal cell carcinoma in a 45-year-old woman with nodal and lung metastasis at presentation. The tumor on histology showed all 3 components intimately admixed with each other, which to the best of our knowledge is the first such case to be reported in the literature. The renal pelvis was smooth walled and uninvolved. Kidney-specific cadherin was positive in the chromophobe renal cell carcinoma areas and negative in the sarcomatoid and squamous areas.     

An unusual epithelial pleomorphic giant cell tumour of the pancreas with osteoclast-type cells.

A case of giant cell tumour of the pancreas with a mixture of pleomorphic giant cells and osteoclast-like cells is described. This association is rare and its histogenesis has been debated. The presence of a small differentiated adenocarcinomatous area at the periphery of the tumour indicates an epithelial origin. Moreover, some pleomorphic cells were positive for keratin (KL1). The osteoclast-like cells strongly expressed CD68 (a marker of histiomonocytic lineage) and did not show proliferative activity. They probably correspond to an unusual reaction of the stroma. Their clinical importance in this type of tumour remains unknown.     

An unusual variant of composite lymphoma: a short case report and review of the literature

We recently encountered an unusual case of composite lymphoma arising in a 73-year-old man with a history of follicular small cleaved cell lymphoma. The neoplasm was composed of follicular small cleaved cell lymphoma and nodular sclerosing Hodgkin disease within a single groin lymph node. In addition to morphologic evidence, the immunologic studies performed in this case demonstrated the simultaneous occurrence of 2 separate lymphocytic proliferations. To the best of our knowledge, only one such histologic type has been reported in the literature.1 Hodgkin lymphoma can develop in patients with non-Hodgkin disease and vice versa, especially after treatment. The simultaneous occurrence of Hodgkin disease and non-Hodgkin lymphoma in a single lymph node is extremely rare. In this article, the relationship between Hodgkin disease and non-Hodgkin lymphoma is explored, possible explanations for the occurrence of composite lymphoma are discussed, and the literature is reviewed.     

Clear cell renal cell carcinoma with syncytial giant cells: a case report and review of the literature

Renal cell carcinoma with syncytial giant cells (SGCs) is rare; to our knowledge, there are only 3 cases reported in the English literature. We report on a case that, unlike previous reports, was associated with higher grade renal cell carcinoma and an aggressive behavior. A 63-year-old man with gross hematuria was found to have a large left renal mass and no evidence of metastasis. The nephrectomy specimen contained a 14.8-cm mass that was confined within the renal capsule. Microscopically, a 1.8-cm area of SGCs was noted in a background of clear cell renal cell carcinoma of Fuhrman nuclear grades 2 to 4. The SGCs had voluminous cytoplasm, multiple large nuclei with prominent nucleoli, and focal emperipolesis. Identical to the background mononuclear tumor cells, the SGCs were positive for AE1/AE3, vimentin, and epithelial membrane antigen and negative for CD68, beta-human chorionic gonadotropin, and mucin. Three months after surgery, the patient developed metastases in the liver, right kidney, and lungs.     

Locally aggressive orbital giant cell reparative granuloma in an infant: case report and literature review

Giant cell reparative granuloma (GCRG) is a non-neoplastic hyperplasia of bones that mostly happens in the mandible and maxilla in any age group but has a predilection for children and young adults. GCRGs that cause bone destruction are of very low frequency. Orbital-involved cases have been rarely reported since 1981, especially in children. We now report a 1-year-old girl with a rapidly enlarging post-traumatic orbital mass. CT scan and surgical resection showed a well-defined mass occupying the upper right orbit, causing bone destruction. Microscopically there was a proliferation of histocytes and some osteoclast-like multinucleated giant cells with hemosiderin, finally confirmed to be GCRG. 22 months’ follow up showed no evidence of recurrence. This case suggests infant orbital GCRG can be locally aggressive.     

Primary malignant giant cell tumour of sacrum--a case report

A rare case of primary malignant GCT of sacrum in a 35-year-old female is reported.     

Hyalinising spindle cell tumour with giant rosettes: report of a case with unusual features including original histological and ultrastructural observations

Hyalinising spindle cell tumour with giant rosettes (HSCTGR) is an uncommon, recently described low-grade sarcoma which shares many histological features with low-grade fibromyxoid sarcoma (LGFMS). We report a case of HSCTGR occurring in the deep soft tissues of the thigh of a 46-year-old woman, that presented as a slowly growing, painless mass. Microscopically the tumour was composed of spindled stromal cells amongst which were scattered so-called collagen rosettes. The distinctive feature of this case was the previously unreported finding of lymphoid cells of T-cell phenotype admixed with fibrohistioctyic cells in the cellular cuff surrounding the collagenous core of the rosettes. The case was further unusual in that it included focal areas of increased cellularity with a mitotic count of up to three per 10 high-power fields. While the latter feature has been associated with increased recurrences and metastases in LGFMS, it is not known whether the significance is similar in HSCTGR. The spindled stromal cells showed ultrastructural features of poorly differentiated fibroblasts, while those at the edges of the rosettes showed features of altered fibroblasts, some with a fibrohistiocytic appearance. These findings support the interpretation that HSCTGR forms part of the spectrum of sarcomas showing fibroblastic differentiation.     

Primary giant cell tumor of soft tissues similar to bone giant cell tumor: A case report and literature review

In this report we describe a primary giant cell tumor (GCT) of soft tissues located in the left dorsal wrist of a 52-year-old man. Plain radiographs did not reveal any lesion in his carpal or hand bones. Although the tumor was clinically considered a ganglion initially, the microscopic features were identical to those found in classic GCT of bone. Light microscopy showed a lesion composed of a homogeneously mixed proliferation of spindle and polygonal mononucleated stromal cells and evenly distributed multinucleated, osteoclast-like giant cells. Whereas most bone tumors have an extraosseous counterpart, only 13 cases of GCT in soft tissues had been published until 1998. Moreover, 64 new cases have been reported in three series. Nevertheless, most major reviews and textbooks do not consider this tumor as a specific entity and regard it as a low grade variant of malignant GCT of soft tissue. We describe the clinical, histologic, and immunohistochemical features of this rare benign neoplasm emphasizing the differential diagnosis with its malignant soft tissue counterpart, an ominous tumor.     

Renal cell carcinoma with intravascular lymphomatosis: a case report of unusual collision tumors with review of the literature

We report the case of a 77-year-old white woman who presented with a left breast mass, lethargy, and weight loss. Pelvic computed tomographic scan revealed a 9.5-cm mass in the right kidney. Surgical pathology demonstrated a diffuse large B-cell lymphoma of the subcutaneous tissue of the breast and renal cell carcinoma with concurrent extensive intravascular lymphomatosis. Systemic dissemination of malignant lymphoma to a concurrent visceral primary neoplasm is rare. To the best of our knowledge, this is the first case illustrating a renal cell carcinoma collision with intravascular lymphomatosis.     

An unusual case of benign thyroid tumour consisting of epithelial and nonepithelial components

An encapsulated tumour consisting of follicular epithelial cells, fat-laden round cells and spindle cells was found in the right lobe of the thyroid gland of a 66-year-old woman. The follicular epithelial cells had oxyphilic cytoplasm in which numerous mitochondria were densely packed. The fat-laden round cells were indistinguishable from mature fat cells by light microscopy. However, they were immunohistochemically negative for S-100 protein and epithelial markers, and lacked a continuous basement membrane. The spindle cells embedded in the collagenous matrix possessed well-developed rough endoplasmic reticulum, most of which contained variably sized, non-membrane-bound lipid droplets. Bundles of thin filaments were occasionally observed in the cytoplasm. Some spindle cells were immunoreactive for PCNA and alpha-smooth muscle actin. There was no striking nuclear atypia of the tumour cells and no capsular or vascular invasion by these components. The tumour can be classified as a benign mixed tumour.