Journal of Cytology
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CASE REPORT  
Year : 2016  |  Volume : 33  |  Issue : 2  |  Page : 106-108
Giant cell tumor of soft tissues of low malignant potential: A rare diagnosis on fine needle aspiration cytology


Department of Pathology, Shrimati Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India

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Date of Web Publication16-May-2016
 

   Abstract 

Primary giant cell tumors of soft tissues (GCT-ST) are extremely rare soft tissue tumors, located in both superficial and deep soft tissues. They resemble osseous giant cell tumors morphologically and immunohistochemically. The tumor exhibits strong positive immunoreactivity for cluster of differentiation 68 (CD68) within multinucleated osteoclast-like giant cells and focal staining of mononuclear cells. Case reports describing the cytohistological features of this entity are very few. We report a case of GCT-ST of low malignant potential diagnosed on fine needle aspiration (FNA) and confirmed on histological and immunohistochemical studies.

Keywords: Cytology, giant cell tumor, soft tissue

How to cite this article:
Kulkarni MM, Joshi AR, Patil V, Ansari T. Giant cell tumor of soft tissues of low malignant potential: A rare diagnosis on fine needle aspiration cytology. J Cytol 2016;33:106-8

How to cite this URL:
Kulkarni MM, Joshi AR, Patil V, Ansari T. Giant cell tumor of soft tissues of low malignant potential: A rare diagnosis on fine needle aspiration cytology. J Cytol [serial online] 2016 [cited 2019 Jun 26];33:106-8. Available from: http://www.jcytol.org/text.asp?2016/33/2/106/177144



   Introduction Top


Primary giant cell tumors of soft tissues (GCT-ST) are extremely rare soft tissue tumors, located in both superficial and deep soft tissues. Morphologically and immunohistochemically, they resemble osseous giant cell tumors. 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] The term, giant cell tumor of soft tissue of low malignant potential, has been proposed. The term malignant giant cell tumor of soft tissue is restricted to histologically high grade lesions. [2] The tumor exhibited strong positive immunoreactivity for cluster of differentiation 68 (CD68) within multinucleated osteoclast-like giant cells and focal staining of mononuclear cells. [3] Provided that GCT-ST is treated adequately by complete excision; a benign clinical course is expected because episodes of distant metastasis and tumor-associated death seem to be exceedingly rare. [4] Case reports describing the cytohistological features of this entity are very few. We report a case of GCT-ST of low malignant potential diagnosed on fine needle aspiration (FNA) and confirmed histologically.


   Case Report Top


A 33-year-old female came to the surgical outpatient department with swelling over the right thigh since 2 months. The swelling was gradually increasing in size. The overlying skin showed puckering. The swelling was nontender and hard on palpation. Systemic examination was noncontributory. Magnetic resonance imaging (MRI) of the right thigh was done that showed 3 cm × 2.5 cm × 1.5 cm T1 and T2 hypointense mass lesion with significant postcontrast enhancement noted in the posterolateral aspect of the upper third of the thigh. The lesion was extending up to the vastus lateralis. There was no bone erosion. The provisional diagnosis of soft tissue sarcoma was given. The patient was referred to the cytology department. FNA was done. Smears were prepared and stained with leishman and hematoxylin and eosin stain. The smears were cellular and showed bimodal population. There were clusters of spindle cells with bland nuclei [Figure 1]a. These were traversed by fibrovascular septae. Additionally seen were few multinucleate giant cells with oval nuclei [Figure 1]b, inset. The nuclei resembled the nuclei of the spindle cells. The background was hemorrhagic. Mitotic figures were absent. Considering clinical history, radiological finding, and cytomorphology, the diagnosis of giant cell tumor of low malignant potential was suggested. The tumor was excised and sent for histopathological examination. We received a soft tissue mass measuring 8 cm × 6 cm × 3 cm. Subcutaneous tissue showed a tumor measuring 2.5 cm × 2.2 cm × 2 cm. The tumor was grayish white, nodular, and hard in consistency. Microscopically an ill-circumscribed tumor composed of short fascicles of spindle cells with ovoid nuclei was seen. Multinucleated giant cells were dispersed uniformly among these tumor cells. Mitotic count was 3 to 5/10 high-power fields (HPF). There were focal areas of osseous metaplasia. Base and resection margins were free of tumor.
Figure 1: (a) Cytophotomicrograph showing bland spindle cells in groups mixed with blood (H and E, ×400) (b) Cytophotomicrograph showing spindle cells arranged in small fascicles (H and E, ×400) Inset — Giant cell (H and E, ×400)

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Immunohistochemical study was done with CD68 (clone 514 H12) and Ki 67 (clone MM1, Novacastra). CD68 showed diffuse and strong immunoreactivity in the multinucleated giant cells and focal immunoreactivity in the mononuclear cells. Ki 67 index was 12-15%. The diagnosis of giant cell tumor of low malignant potential was confirmed. The patient remained well and asymptomatic after tumor removal.


   Discussion Top


GCT-ST is a rare tumor first described in 1972 by Salm and Sisson and followed shortly by Gruccion and Enzinger. [5] The histogenesis is unclear and the behavior is dependent upon the location, size, and microscopic appearance. Low- and high-grade forms have been separated from each other on the basis of the atypia, pleomorphism, and mitotic activity of the mononuclear neoplastic component. [2]

Case reports describing cytomorphological features of GCT-ST of low malignant potential are rare. Cytological features of GCT-ST in a 58-year-old woman with a well-demarcated dermal tumor has been described. [6] Their case showed numerous osteoclast-like giant cells and mononuclear cells with a bland nucleus. They concluded that primary GCT-ST should be considered in a differential diagnosis of bland-looking giant cell lesion. A case of superficial thigh mass diagnosed on cytology is reported. [7] Differential diagnosis of GCT-ST includes soft tissue mesenchymal tumors rich in giant cells. [8] These include tenosynovial giant cell tumor and malignant giant cell tumor of soft parts. Apart from significant difference in location, tenosynovial giant cell tumor contains heterogeneous population of cells including xanthoma cells, siderophages, and lymphocytes. Giant cell form of malignant fibrous histiocytoma by definition contains mononuclear and giant cells with significant levels of atypia. Atypical mitotic figures and necrosis are present. GCT-ST is differentiated from fibrohistiocytic tumor by the bimodal population of cells. [9] In our case, the tumor did not show any pleomorphism or cellular atypia and proliferation index was 3-5%, which suggests a slightly raised proliferative activity. [10] Ki67 labelling index can be used as an indicator of low malignant potential. Epithelioid sarcoma is differentiated by the presence of prominent nucleoli, cellular trails, and keratin that are absent in GCT-ST.


   Conclusion Top


In conclusion, GCT-ST occurs as a primary, soft tissue neoplasm, and it is identical clinically, morphologically, and immunohistochemically to giant cell tumor of bone. Complete excision of the GCT-ST results in a benign clinical course because episodes of distant metastasis and tumor-associated death seem to be exceedingly rare. GCT-ST should be considered in a differential diagnosis of a giant cell rich spindle cell lesion of soft tissue. Our case highlights that GCT-ST can be diagnosed cytologically in an appropriate clinical setting.

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There are no conflicts of interest.

 
   References Top

1.
Guccion JG, Enzinger FM. Malignant giant cell tumor of soft parts. An analysis of 32 cases. Cancer 1972;29:1518-29.  Back to cited text no. 1
    
2.
Folpe AL, Morris RJ, Weiss SW. Soft tissue giant cell tissue of low malignant potential: A proposal for the reclassification of malignant giant cell tumor of soft parts. Mod Pathol 1999;12:894-902.  Back to cited text no. 2
    
3.
O′Connell JX, Wehrli BM, Nielsen GP, Rosenberg AE. Giant cell tumors of soft tissue: A clinicopathologic study of 18 benign and malignant tumors. Am J Surg Pathol 2000;24:386-95.  Back to cited text no. 3
    
4.
Oliveira AM, Dei Tos AP, Fletcher CD, Nascimento AG. Primary giant cell tumor of soft tissue: A study of 22 cases. Am J Surg Pathol 2000;24:248-56.   Back to cited text no. 4
    
5.
Mardi K, Sharma J. Primary giant cell tumors of soft parts. Report of a case with fine needle aspiration cytology and histology findings. J Cytol 2007;24:58-9.   Back to cited text no. 5
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6.
Kim NR, Han J. Primary giant cell tumor 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. 6
    
7.
Angervall L, Hagmar B, Kindblom LG, Merck C. Malignant giant cell tumor of soft tissues: A clincopathologic, cytologic, ultrastructural, angiographic and microangiographic study. Cancer 1981;47:736-47.  Back to cited text no. 7
    
8.
Asotra S, Sharma S. Giant cell tumor of soft tissue: Cytological diagnosis of a case. J Cytol 2009;26:33-5.  Back to cited text no. 8
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9.
Weiss SW, Goldblum JR. Fibrohistiocytic tumors of intermediate malignancy. In: Weiss SW, Goldblum JR, editors. Enzinger and Weisss Soft Tissue Tumors. 5 th ed. Philadelphia: Mosby; 2008. p. 398-401.   Back to cited text no. 9
    
10.
Swanson SA, Brooks JJ. Proliferation markers Ki-67 and p105 in soft-tissue lesions. Correlation with DNA flow cytometric characteristics. Am J Pathol 1990;137:1491-500.  Back to cited text no. 10
    

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Correspondence Address:
Maithili M Kulkarni
Department of Pathology, Shrimati Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.177144

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