Nil ÇOMUNOĞLU, Nuray KEPİL, Sergülen DERVİŞOĞLU

Histopathology of giant cell tumors of the bone: With special emphasis on ﬁbrohistiocytic and aneurysmal bone cyst like components

Objective: The aim of this study was to deﬁne histopathological features of giant cell tumor of bone, especially accompanying ﬁbrohistiocytic or aneurysmal bone cyst like components, in the light of our institutions experience. Methods: A total of 120 cases (64 females and 56 males; mean age: 36.2 (12e80)) with ‘GCT’ diagnosed betweentheyears1996e2016wereincludedinthisretrospectiveanalysis.Caseswereevaluatedaccording to clinical features such as age, gender, localization, recurrence, metastasis and histopathological features. Results: Tumors were localized most frequently at proximal tibia and distal femur, respectively. In 11 cases areas rich in ﬁbrohistiocytic component and in 20 cases aneurysmal bone cyst like component were observed. In 2 cases both components were present. Twenty three cases recurred. In 1 case which was primarily located at calcaneus, tumor metastasized to lung 4 years later during follow-up. Conclusion: GCT can be confused with other tumor or tumor-like lesions involving giant cells. Secondary changes such as ﬁbrohistiocytic or aneurysmal bone cyst-like components and coagulation necrosis were frequently seen in conventional giant cell tumor of bone. For tumors having prominent ﬁbrohistiocytic and/or aneurysmal bone cyst-like components, in order to detect characteristic areas representing GCT, additional sampling is essential. Although secondary histopathological changes do not appear to affect clinical outcome, these features are important in differential diagnosis. Approximately one ﬁfth of GCTcases show recurrence and sacrum and foot bones were the most frequent sites for recurrence.

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Mirra JM. Giant cell tumors. In: Mirra JM, Picci P, Gold RH, eds. Bone Tumors: Clinical, Radiologic, and Pathologic Correlations. Philadelphia: Lea & Febiger; 1989:942e1020.

Unni KK, Inwards CY. Giant cell tumour (Osteoclastoma). In: Unni KK, Inwards CY, eds. Dahlin's Bone Tumors. Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins; 2010:225e242.

Czerniak B. Giant cell lesions. In: Dorfman HD, Czerniak B, eds. Dorfman and Czerniak's Bone Tumors. Philadelphia: Elsevier Saunders; 2016:692e759.

NiuX, Xu H, InwardsCY,et al.Primarybone tumors: epidemiologic comparison of 9200 patients treated at Beijing Ji Shui Tan Hospital, Beijing, China, with 10165 patients at Mayo clinic, Rochester, Minnesota. Arch Pathol Lab Med. 2015;139:1149e1155.

Thomas DM, Skubitz KM. Giant cell tumour of bone. Curr Opin Oncol. 2009;21: 338e344.

Wülling M, Engels C, Jesse N, Werner M, Delling G, Kaiser E. The nature of giant cell tumor of bone. J Cancer Res Clin Oncol. 2001;127:467e474.

Athanasou NA, Bliss E, Gatter KC, Heryet A, Woods CG, McGee JO. An immunohistological study of giant-cell tumour of bone: evidence for an osteoclast origin of the giant cells. J Pathol. 1985;147:153e158.

Chambers TJ, Fuller K, McSheehy PM, Pringle JA. The effects of calcium regulating hormones on bone resorption by isolated human osteoclastoma cells. J Pathol. 1985;145:297e305.

Zheng MH, Robbins P, Xu J, Huang L, Wood DJ, Papadimitriou JM. The histogenesis of giant cell tumour of bone: a model of interaction between neoplastic cells and osteoclasts. Histol Histopathol. 2001;16:297e307.

Kim Y, Nizami S, Goto H, Lee FY. Modern interpretation of giant cell tumor of bone: predominantly osteoclastogenic stromal tumor. Clin Orthop Surg. 2012;4: 107e116.

Wülling M, Delling G, Kaiser E. The origin of the neoplastic stromal cell in giant cell tumor of bone. Hum Pathol. 2003;34:983e993.

Goldring SR, Roelke MS, Petrison KK, Bhan AK. Human giant cell tumors of bone identiﬁcation and characterization of cell types. J Clin Invest. 1987;79: 483e491.

Brecher ME, Franklin WA, Simon MA. Immunohistochemical study of mononuclear phagocyte antigens in giant cell tumor of bone. Am J Pathol. 1986;125: 252e257.

Al-Ibraheemi A, Inwards CY, Zreik RT, et al. Histologic spectrum of giant cell tumor (GCT) of bone in patients 18 Years of age and below: a study of 63 patients. Am J Surg Pathol. 2016;40:1702e1712.

Broehm CJ, Inwards CY, Al-Ibraheemi A, et al. Giant cell tumor of bone in patients 55 Years and older: a study of 34 patients. Am J Clin Pathol. 2018;149: 222e233.

Errani C, Ruggieri P, Asenzio MA, et al. Giant cell tumor of the extremity: a review of 349 cases from a single institution. Cancer Treat Rev. 2010;36: 1e7.

Greenspan A, Jundt G, Remagen W. Miscellaneous tumors and tumor-like lesions. In: Greenspan A, Jundt G, Remagen W, eds. Differential Diagnosis in Orthopedic Pathology. Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins; 2006:387e400.

Gong L, Liu W, Sun X, et al. Histological and clinical characteristics of malignant giant cell tumor of bone. Virchows Arch. 2012;460:327e334.

Bertoni F, Bacchini P, Staals EL. Malignancy in giant cell tumor of bone. Cancer. 2003;97:2520e2529.

Campanacci M. Giant cell tumor. In: Campanacci M, ed. Bone and Soft Tissue Tumors. 2nd ed. Padova-Italy: Piccin Nuova Libraria S.P.A.; 1999:117e151.