Journal of Cytology
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Year : 2007  |  Volume : 24  |  Issue : 1  |  Page : 58-59
Primary giant cell tumour of soft parts - Report of a case with fine needle aspiration cytology and histology findings


Department of Pathology, Indira Gandhi Medical College, Shimla, India

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   Abstract 

A cytohistopathological study of a rare case of giant cell tumour of soft tissues in a 30-year-old male patient is presented. The cytological features when evaluated in conjunction with clinical and radiological features are sufficiently diagnostic. The primary knowledge of its existence and knowledge of its cytological features are important for a correct preoperative cytologic diagnosis.

Keywords: Giant cell tumour of the soft parts, FNAC

How to cite this article:
Mardi K, Sharma J. Primary giant cell tumour of soft parts - Report of a case with fine needle aspiration cytology and histology findings. J Cytol 2007;24:58-9

How to cite this URL:
Mardi K, Sharma J. Primary giant cell tumour of soft parts - Report of a case with fine needle aspiration cytology and histology findings. J Cytol [serial online] 2007 [cited 2020 Sep 18];24:58-9. Available from: http://www.jcytol.org/text.asp?2007/24/1/58/42094



   Introduction Top


Primary giant cell tumours of soft tissues (GCT-ST) resembling osseous giant cell tumours are extremely rare soft tissue tumours, located in both superficial and deep soft tissues. They can be seen in all age groups and most of the reported cases have been in extremities, with thigh being the most common site.[1] These tumours have unpredictable behaviour. Some patients are cured with simple surgical excision whereas others develop metastatic disease within a relatively short interval. To date, there are no consistently reliable criteria, either clinical or pathological to separate the benign from more aggressive lesions. We describe the cytological and histopathological features of a case of GCT-ST.


   Case Report Top


A 30 year old patient presented with a fungating skin and soft tissue mass on the dorsum of right hand over index finger. Plain radiograph revealed a soft tissue density over the middle and terminal phalanges of the right index finger. Underlying bones were within normal limits. Fine needle aspiration (FNA) of the tumour was done. The aspirates were cellular and contained a dual population of cells, consisting of mononuclear spindle cells and multinucleated osteoclast type of giant cells. The tumour cells were arranged as cohesive clusters, sheets as well as single cells. The attachment of osteoclastic giant cells to the periphery of cohesive groups of tumour cells was a prominent feature [Figure 1]. These cells were round to elongated exhibiting single bland nuclei and second group of multinucleated osteoclast type giant cells showed dozens of round nuclei with occasional micronucleoli. Strands of collagen or basement membrane material were discernible in tissue fragments. Keeping in view cytologic findings as well as radiological findings, a diagnosis of giant cell tumour of soft tissues was made. The tumour was excised and sent for histopathological examination. Microscopic examination of the sections taken from the soft tissue mass showed a cellular tumour comprising of spindle to oval cells admixed with numerous multinucleated giant cells [Figure 2]. These giant cells were scattered uniformly and appeared to have a similar nucleus to that of the surrounding spindle cells. Mitotic rate was 1 per high power field and mostly in the stromal cells. There were areas of haemorrhage and haemosiderin deposition. Thus the histological findings were consistent with the cytodiagnosis of giant cell tumour of soft tissue.


   Discussion Top


Giant cell tumour of soft tissue is a rare tumour first described in 1972 by Salm and Sissons,2 followed shortly by Gruccion and Enzinger.[1] Although "giant cell tumours of the soft parts" has traditionally been considered a single entity as reflected in the original term "malignant giant cell tumour of soft parts" and later by the term "malignant fibrous histiocytoma of giant cell type", the degree of atypia and mitotic activity varies in this group, suggesting biologic heterogeneity.[3] Folpe et al[3] propose that these tumours should be termed "giant cell tumours of low malignant potential" and regarded as the soft tissue analogue of giant cell tumour of bone.

Giant cell tumour of soft parts can occur in patients ranging in age from 1 to 87 years. Approximately 80­90 % of the giant cell tumours are located in the extremities with about 80% of these in the lower extremity, the thigh being the most common site. Other sites include the face, abdominal wall, shoulder, neck and retroperitoneum. [2]

Kim et al [4] described cytological features of giant cell tumour of soft tissue in a 58-year-old woman with a well-demarcated dermal tumour. Their case showed numerous osteoclast like giant cells and mononuclear cells with a bland nucleus. They concluded that primary giant cell tumour of soft tissues should be considered in the differential diagnosis of bland looking giant cell rich lesions. Galed-Placed et al [5] have described cytodiagnosis of giant cell tumour in soft parts in a patient with osseous Pagets disease. In their case, in addition to the two population of cells, numerous capillary structures surrounded by tumour cells was a prominent feature. Cytological features of malignant giant cell tumour of soft tissues have also been described by Angervall et al [6] in their five cases. They found histiocytic cells, fibroblast like cell and multinucleated giant cells of both osteoclast like benign and pleomorphic malignant type in varying proportions. They concluded that finding of phagocytosing pleomorphic malignant cells and giant cells of osteoclast type in aspirated cytologic material strongly favour the diagnosis of malignant giant tumour of soft tissues. Giant cell tumours of soft tissues demonstrate a similar inmunohistochemical staining profile as GCT of bone, exhibiting strong positive staining for CD 68 within multinucleated osteoclast like cells and focal staining of mononuclear cells for CD6, Ham 56 and smooth muscle actin.

Thus, primary giant cell tumour should be considered in the differential diagnosis of a number of other neoplastic and reactive lesions in which giant cells might be abundant. The cytologic features of GCT- ST appear to be characteristic enough to allow a suggestive diagnosis. FNAC can be used as a diagnostic tool for an early and accurate detection of giant cell rich lesions since the cytological features when evaluated in conjunction with clinical and radiological features are sufficiently diagnostic. The primary knowledge of its existence and knowledge of its cytologic features are important for a correct preoperative cytologic diagnosis.

 
   References Top

1.Gruccion JG, Enzinger FM. Malignant giant cell tumours of soft parts, an analysis of 32 cases. Cancer 1972; 29: 1518-29.  Back to cited text no. 1    
2.Salm R and Sissons HA. Giant cell tumour of soft tissue. J Pathol 1972; 107 : 27-9.  Back to cited text no. 2    
3.Folpe Al, Morris RJ, Weiss SW. Soft tissue giant cell tissue of low malignant potential : a proposal for the reclassification of malignant giant cell tumour of soft parts. Mod Pathol 1999; 12 : 894-902.  Back to cited text no. 3  [PUBMED]  
4.Kim NR, Han J. Primary giant cell tumour of soft tissue. Report of a case with fine needle aspiration cytologic and histologic findings. Acta Cytol 2003; 47: 1103-6.  Back to cited text no. 4    
5.Galed-Placed I, Garcia- Ureta E, Sanchez-Blas M, Lago-Novoa M. Giant cell tumour in soft parts in a patient with osseous Pagets disease: diagnosis by fine needle aspiration. Diagn Cytopathol 1998 ; 19 : 352-4.  Back to cited text no. 5    
6.Angervall L, Hagmar B, Kindblom LG, Merk C. Malignant giant cell tumour of soft tissues : a clincopathologic, cytologic, ultrastructural, angiographic and micro-angiographic study. Cancer 1981; 47 : 736-47.  Back to cited text no. 6    

Top
Correspondence Address:
K Mardi
12-A, Type V Quarters, GAD Colony, Kasumpti, Shimla, Himachal Pradesh 171 009.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.42094

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    Figures

  [Figure 1], [Figure 2]

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    Abstract
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