Giant cell tumor of the kidney

A Primary Kidney Giant Cell Tumor of Soft Tissue Caused Peritoneal Dissemination, Considered to Be Malignant Transformation: A Case Report

Giant cell tumor of soft tissue (GCTST) is a defined disease entity that has a morphology similar to giant cell tumor of bone (GCTB). The malignant transformation of GCTST has not been reported, and a kidney primary is extremely rare. We report the case of a 77-year-old Japanese male, who was diagnosed with primary GCTST of the kidney and showed peritoneal dissemination, considered to be a malignant transformation of GCTST, in 4 years and 5 months. Histologically, the primary lesion showed characteristics of round cells with not prominent atypia, multi-nucleated giant cells, and osteoid formation, and carcinoma components were not found. The peritoneal lesion was characterized by osteoid formation and round to spindle-shaped cells, but differed in nuclear atypia, and multi-nucleated giant cells were not detected. Immunohistochemical and cancer genome sequence analysis suggested these tumors were sequential. This is a first report of a case that we could diagnose as primary GCTST of the kidney and could be determined as malignant transformation of GCTST in the clinical course. Analysis of this case will be examined in the future when genetic mutations and the disease concepts of GCTST are established.

Primer malignant giant cell tumour of kidney: a case report

Osteoclast-like giant cell tumours of the kidney are extremely rare and usually accompanied by a conventional urothelial neoplasm such as papillary, transitional renal cell, or sarcomatoid carcinoma. Although they have morphological features similar to those of the giant cell tumours in the skeletal system, their counterparts in the urinary system show highly malignant features. Our case is the third primer malignant giant cell tumour of the kidney in the literature. The patient was a 50-year-old male and underwent nephroureterectomy for a mass of 18×14×13cm in his left kidney. However, the patient died in the second month postoperatively as a result of local recurrences and multiple distant metastases. The general condition of the patient deteriorated progressively; hence, he could not have any adjuvant therapy. Having more information about the pathological and clinical findings of these exceedingly rare tumours can help inform treatment steps.

An expanded immunohistochemical profile of osteoclast-rich undifferentiated carcinoma of the urinary tract

Osteoclast-rich undifferentiated carcinoma of the urinary tract (ORUCUT) is a rare tumor composed of ovoid to spindle-shaped mononuclear cells with intermixed or focally clustered osteoclast-like giant cells. Previous studies have demonstrated that the mononuclear cells are neoplastic cells, while the giant cells are reactive cells of histiocytic lineage. The association between these tumors and classic urothelial carcinomas suggest that the mononuclear cells are derived from urothelial cells; however, no studies have been conducted to assess the immunohistochemical profile of ORUCUT with more specific urothelial markers. This study identified 21 cases of ORUCUT and performed immunohistochemistry for GATA3, uroplakin II, and thrombomodulin along with pancytokeratin (AE1/3) on all cases. Mononuclear cells stained positive in 20 cases (95%) for GATA3 and 19 cases (90%) for thrombomodulin. None of the mononuclear cells were positive for uroplakin II and only three cases showed focal positivity for AE1/3. The osteoclast-like giant cells were negative for GATA3, uroplakin II, thrombomodulin, and AE1/3, providing additional support to a reactive origin for these cells. Additionally, 15 cases (71%) were associated with either in situ or invasive urothelial carcinoma. This study provides an expanded immunohistochemical profile for ORUCUT and more definitively supports a urothelial origin for this tumor.

Osteoclast-rich undifferentiated carcinoma of the urinary bladder: an immunohistochemical study

Osteoclast-rich undifferentiated carcinoma of the urinary tract is a rare tumor which histologically mimicks giant cell tumor of bone. The histogenesis of this tumor has not been clarified yet although its urothelial origin is proposed on the basis of positive reactions of an epithelial marker on mononuclear undifferentiated tumor cells and the existence of foci of a urothelial carcinoma component in some cases. We experienced a case of urinary bladder tumor diagnosed as osteoclastic-rich undifferentiated carcinoma, and performed an immunohistochemical study on the expression of various markers, including stem cell markers to further characterize the tumor properties. Immunohistochemically, CD56, nestin, and Sox2 were expressed in diffusely proliferating mononuclear tumor cells of undifferentiated features, suggesting the stemness properties of these cells. These findings might provide the clue as to the clarification of the pathogenesis of this rare tumor.

Osteoclast-rich undifferentiated carcinoma of the urinary tract: cytologic findings and literature review

The association of urothelial carcinoma with osteoclast-like giant cells is an exceptionally rare event. To our knowledge, there are no published reports of the cytopathologic characteristics of osteoclast-rich undifferentiated carcinoma of the urinary tract. We report herein, the case of a 63-year-old man who was evaluated at The Johns Hopkins Hospital for gross hematuria of 4 months duration. Urinary cytology displayed high-grade malignant cells with scattered osteoclast-like giant cells in a background of acute inflammation and abundant red blood cells. Subsequently, a transurethral tumor resection was performed, which revealed infiltrating undifferentiated carcinoma with osteoclast-like giant cells. The rarity of this neoplasm and its resemblance to other giant cell-rich processes may pose diagnostic difficulties. A review of the important differential diagnoses is also presented.

Osteoclast-rich undifferentiated carcinomas of the urinary tract

Osteoclast-like giant-cell neoplasms of the urinary tract are rare. They are composed of ovoid or spindle-shaped mononuclear cells with evenly spaced osteoclast-like giant cells. Terminology, histogenesis, and biologic behavior of these tumors remain controversial. Six cases of osteoclast-like giant-cell neoplasms of the urinary tract were identified from the consultation files of two of the authors. Patients were all male and elderly (range 65-82), with the exception of one 39-year-old male. In all, 3/6 tumors developed in the bladder and 3/6 in the renal pelvis. Size ranged from 5 to 11 cm. One bladder and three renal pelvis tumors were high stage (pT3) at time of presentation. Adjacent to the osteoclast-like giant-cell neoplasm in the same specimen, all patients had urothelial carcinoma in situ and/or high-grade papillary urothelial carcinoma. Multinucleated cells had identical morphological and immunohistochemical properties of osteoclasts; positive for CD-68, LCA, CD51 and CD54, and negative for cytokeratins and EMA. Varying percentages of mononuclear cells expressed alpha-smooth muscle actin (4/6), desmin (1/6), S-100 (4/6), LCA (2/6) and CD68 (6/6). However, mononuclear cells were also positive for epithelial markers in 4/6 tumors (cytokeratins AE-1/AE-3, Cam 5.2, CK7 and/or EMA). p53 stained mononuclear tumor cells in three cases, paralleling the staining on the accompanying urothelial carcinoma. Ki-67 stained mononuclear tumor cells, but not osteoclast-like giant cells. Follow-up data were available in five cases. One patient developed recurrence of noninvasive urothelial carcinoma and is still alive. Four patients were dead due to disease within 15 months, three with distant metastases. The intimate association of these tumors with urothelial carcinoma along with their immunohistochemical profile supports an epithelial origin for the mononuclear cells and non-neoplastic reactive histiocytic lineage for the osteoclast-like giant cells.

Primary de novo malignant giant cell tumor of kidney: a case report

Background

Osteoclast-like giant cell tumors are usually observed in osseous tissue or as tumors of tendon sheath, characterized by the presence of multinucleated giant cells and mononuclear stromal cells. It has been reported in various extraosseous sites including breast, skin, soft tissue, salivary glands, lung, pancreas, female genital tract, thyroid, larynx and heart. However, extraosseus occurrence of such giant cell tumors in the kidney is extremely rare and is usually found in combination with a conventional malignancy. De-novo primary malignant giant cell tumors of the kidney are unusual lesions and to our knowledge this is the second such case.

Case Presentation

We report a rare case of extraosseous primary denovo malignant giant cell tumor of the renal parenchyma in a 39-year-old Caucasian female to determine the histogenesis of this neoplasm with a detailed literature review.

Conclusion

Primary denovo malignant giant cell tumor of the kidney is extremely rare. The cellular origin of this tumor is favored to be a pluripotential mesenchymal stromal cell of the mononuclear/phagocytic cellular lineage. Awareness of this neoplasm is important in the pathological interpretation of unusual findings at either fine needle aspiration or frozen section of solid renal masses.

Osteoclastoma-like Giant Cell Tumor of the Lung

The main components of an unusual form of lung tumor were osteoclast-like multinucleated giant cells and mononuclear stromal cells. Besides, scattered islands of moderately differentiated squamous cells also appeared. Both the mononuclear and the osteoclast-like giant cells reacted with antibodies against CD68 and vimentin, but did not react with antibodies against cytokeratin, EMA and CEA, or lysozyme and a-1-antitrypsin. The p53 and PCNA antigens were positive only in mononuclear cells and not the osteoclast-like giant cells, suggesting that mononuclear cells represent proliferating elements with histiocytic differentiation while osteoclast-like giant cells are stromal, presumably reactive components of the tumor.

Giant cell tumor of the lung: an autopsy case report with immunohistochemical observations

Tumors resembling giant cell tumor (GCT) of bone are well known to occur in other organs and many cases have been reported to date. While GCT occurring as primary lesions in the lung are extremely rare, the authors experienced such a tumor at an autopsy of a 77 year old woman and subsequently performed histological and immunohistochemical examinations. The clinical and morphologic characteristics of this case are documented, and the literature concerning this type of tumor is reviewed. The present tumor of the lung was histologically characterized by proliferation of benign-looking osteoclast-like giant cells in association with slightly atypical mononuclear cells. The tumor cells were immunohistochemically positive for histiocytic markers but negative for epithelial markers. This case appears to be the first reported benign giant cell tumor of the lung in which histiocytic differentiation of mononuclear cells was suggested by immunohistochemistry.

Renal cell carcinoma with osteoclast-like giant cells

Primary extraskeletal epithelial neoplasms with osteoclast-like giant cells are rare. We describe a case of renal cell carcinoma with a sarcomatoid component and non-neoplastic osteoclast-like giant cells. The giant cells were noted in both the conventional and the sarcomatoid components of the neoplasm. Immunohistochemical studies indicate that these cells are monocyte/histiocyte in origin and most probably a host stromal reaction to the neoplasm.

Osteoclast-like giant cell tumour of the gallbladder

We describe a rare carcinoma of the gallbladder containing osteoclast-like giant cells. Well-differentiated adenocarcinoma was found in the mucosa of the fundus, and osteoclast-like giant cells were present mainly in a haemorrhagic mass protruding from the mucosal surface. The metastatic hepatic tumour was composed chiefly, if not exclusively, of osteoclastoma-like cells, but minute carcinomatous elements were also present. There was an apparent transition between the giant cells and tubular structures in both the gallbladder tumour and hepatic tumour. However, ultrastructural study did not reveal any evidence of epithelial differentiation in the giant cells. Immunohistochemical studies suggested that the mononuclear and giant cells were mesenchymal and histiocytic in nature (vimentin and factor XIIIa positive). A few exceptional giant cells transforming from the fine tubular structure were positive for epithelial membrane antigen. In conclusion, the osteoclast-like giant cell tumour component was thought to represent mesenchymal metaplasia in pre-existent adenocarcinoma.

Giant cell reparative granuloma of the bladder associated with transitional cell carcinoma

We report a case of benign giant cell tumor of the bladder associated with transitional cell carcinoma. This giant cell granuloma represents a reactive reaction that must be distinguished from the giant cell malignant tumor. The morphological, histochemical and immunohistochemical criteria that can aid in the differential diagnosis are discussed.

Malignant osteoclastoma-like giant cell tumour of the renal pelvis

We report the fourth case of an osteoclastoma-like giant cell tumour of the renal pelvis. A special feature was that although thorough sampling of the tumour showed an osteoclastoma-like pattern throughout, it was intimately associated with carcinoma in situ change of the adjacent transitional epithelium and this provides further support for the view that these tumours are of epithelial derivation. However, immunohistological and ultrastructural studies failed to reveal epithelial features within the tumour cells and the possible significance of this finding is discussed.

Giant cell tumor of the bladder associated with transitional cell carcinoma

We report in detail the first giant cell tumor associated with transitional cell carcinoma of the bladder. The giant cell tumor was composed of multinucleated giant and mononuclear stromal cells, and was morphologically indistinguishable from giant cell tumor of the bone. The giant and transitional cell carcinomas showed no evidence of recurrence or metastasis 8 months after transurethral resection. No histogenetic correlation between the cancers was found.