Metatarsal giant cell tumors and giant cell reparative granuloma are similar entities

Management of Central Giant Cell Granulomas of the Jaws: An Unusual Case Report with Critical Appraisal of Existing Literature

Central giant cell granuloma (CGCG) is an uncommon, benign but aggressive osteolytic neoplasm of the craniomaxillofacial region, histologically characterized by an abundance of evenly distributed multinucleated giant cells within a sea of spindle-shaped mesenchymal stromal cells, scattered throughout the fibrovascular connective tissue stroma containing areas of hemorrhage. A rapid diagnostic assessment, together with an adequate histopathologic verification, is essential to improve the management and the prognosis of this locally destructive lesion. A rare case of a large destructive CGCG involving the entire right angle of mandible, causing extensive bony resorption, and buccal, medial as well as inferior border cortical expansion with multiple perforations, in a young child is presented. It was treated successfully by enucleation and aggressive curettage followed by peripheral ostectomy preserving the continuity of the mandible. Two adjunctive measures were employed; first, chemical cauterization of the residual bony walls to prevent possible recurrence, for which this tumor is notorious, and second, placement of fresh autologous platelet-rich fibrin within the bony defect to hasten bone fill and reossification, thus obviating the need for a bone graft.

Giant cell reparative granuloma of the hallux following enchondroma

Giant cell reparative granuloma (GCRG) is a rare, benign intra osseous lytic lesion occurring especially in gnathis bone but also seen in feet and hands. It has similar clinical and radiological presentations than giant cell tumor, chondroblastoma, aneurysmal bone cyst, and hyperparathyroidism brown tumors but with specific histological findings We report a case of a GCRG of hallux phalanx in 18 years old patient appearing many years after enchondroma curettage and grafting. Radiographs showed a multiloculated osteolytic lesions involving whole phalanx with cortical thinning and without fluid-fluid levels in CT view. Expected to be an enchondroma recurrence, second biopsy confirmed diagnosis of GCRG with specific histological findings. Although if aetiopathogeny remains unknown, GCRG is reported to be a local non neoplasic reaction to an intraosseous hemorrhage. Our exceptional case claims that this tumor can appear in reaction to cellular disturbance primary or secondary.

Detection of the Epstein-Barr virus and DNA-topoisomerase II- α in recurrent and nonrecurrent giant cell lesion of the jawbones

The aims of this study were to determine whether the expression of Topo II-α correlates with presence of EBV in giant cell lesion of the jawbones and whether it is predictive of clinical biologic behavior of these lesions. Paraffin-embedded tissues from 8 recurrent and 7 nonrecurrent cases of bony GCLs and 9 peripheral giant cell lesions (PGCLs) as a control group were assessed for the expression of EBV and Topo II-α using immunohistochemistry. The results showed positive staining for Topo II-α in mononuclear stromal cells (MSCs) and multinucleated giant cells (MGCs). Student t-test showed that mean Topo II-α labelling index (LI) in recurrent cases was significantly higher than that in non-recurrent cases (P = 0.0001). Moreover, Spearman's correlation coefficients method showed a significant correlation between DNA Topo II-α LI and both of gender and site in these lesions. Moderate EBV expression in relation to the highest Topo II-α LI was observed in two cases of GCT. It was concluded that high Topo II-α LIs could be identified as reliable predicators for the clinical behavior of GCLs. Moreover, EBV has no etiological role in the benign CGCLs in contrast to its role in the pathogenesis of GCTs.

Central giant cell granuloma of the jaws and giant cell tumor of long bones: an immunohistochemical comparative study

OBJECTIVE

This study investigated whether some components of the extracellular matrix and CD68 expression may drive the differences between the central giant cell granuloma (CGCG) of the jaws and giant cell tumor (GCT) of long bones, which present distinct evolution and clinical behavior.

MATERIAL AND METHODS

Eight cases of CGCG and 7 cases of GCT were selected and immunohistochemically analyzed to verify the pattern of expression of CD68, tenascin (Tn) and fibronectin (Fn).

RESULTS

A large number of the mononuclear cells and multinucleated giant cells CD68+ was observed in both of the studied lesions, indicating histiocyte/ macrophage origin. Seven cases of CGCG of the jaws showed intense staining of Fn, with uniform distribution predominantly. In all 7 cases of GCT of long bones the Fn displayed intense expression, with distribution pattern varying from uniform to reticulate/fibrillar. Six cases of CGCG were intensively stained by Tn, presenting focal expression in half of specimens, and reticulate/ fibrillar pattern of expression in 4 cases. All cases of GCT of the long bones presented intense expression of Tn, uniform distribution, and reticulate/fibrillar pattern of expression in four cases.

CONCLUSIONS

The immunoexpression of CD68 in mononuclear cells and multinucleated giant cells and staining patterns of Fn and Tn were similar in both entities. These findings indicate that these proteins could not be used to explain the differences between the CGCG of the jaws and GCT of the long bones.

Computed tomography of the bones of the foot: neoplastic disease

Magnetic resonance imaging is the imaging modality of choice as a conjunctive study to radiography for imaging bone tumors of the foot. However, there will be cases where computed tomography (CT) is performed, and CT is superior in evaluating the bone cortex and identifying pathological fractures, periosteal reaction, or matrix mineralization. This article reviews osseous foot neoplasms. Clinical and imaging findings are discussed, as well as applications where CT provides valuable information.

Giant cell tumour of the triquetrum

We present details of a case of giant cell tumour of bone (GCTOB) involving the triquetrum. GCTOB arising within the carpus is exceedingly rare and, to our knowledge, this is only the second case of monostotic GCTOB of the triquetrum that has been reported.

Giant cell reparative granuloma of the middle phalanx of the foot: a review and case report

Giant cell reparative granuloma is a benign, rare non-neoplastic intraosseous lesion. It is found in various sites throughout the body, including the foot. This uncommon lesion has histological and radiographic features that are similar to other giant cell lytic lesions. Therefore, it is essential to be aware of this lesion to avoid confusion with more aggressive tumors. The purpose of this case report is to present the histological and radiographic findings of a 26-year-old female who had successful surgical excision and resolution of a giant cell reparative granuloma in the middle phalanx third digit left foot.

Primary giant cell tumours of the digital bones of the hand

Primary giant cell tumours involving digital bones of the hand are rare lesions which are generally diagnosed at an advanced stage. Accurate diagnosis requires clinical evaluation, imaging studies and histopathological assessment. Conservative treatment by digit-sparing surgery is associated with high recurrence rates. In a ten year retrospective review, this study identified only four cases. Three cases involved a phalanx and were treated by distal amputation of the involved digit. None recurred. One involved the metacarpal and recurred twice following repeated curettage and bone grafting. No further recurrence has been detected after resection and replacement with a non-vascularised fibular graft and Silastic implant replacement of the metacarpophalangeal joint. Our small series of cases supports a policy of aggressive primary surgery, including amputation or en bloc resection and reconstruction.

Giant cell tumors of the tendon sheath may present radiologically as intrinsic osseous lesions

The purpose of this study was to explain radiographic features of giant cell tumors of the tendon sheath (GCTTS), in particular, osseous extension, by correlating imaging findings with histology in order to increase the accuracy of radiological diagnosis. In a series of 200 consecutive osseous (pseudo) tumors of the hand, on radiography, six patients presented with an intrinsic osseous lesion caused by a histologically confirmed neighboring GCTTS. Available radiographs, computed tomography (CT), and contrast-enhanced magnetic resonance (MR) images were correlated with histology. Radiography showed osseous lesions consisting of well-defined cortical defects in four (one of whom also demonstrated cortical scalloping) and a slightly expansile, well-defined osteolytic lesion in two patients. MR obtained in four patients showed the extraosseous tumor invading/eroding bone and causing cortical scalloping (three and one patients, respectively). Extension depicted on MR was confirmed on the two available resection specimens. All lesions were polylobular (cauliflower or mushroom like) and neighboring tendon sheaths. Dense collagen and hemosiderin-loaded macrophages explained the high CT attenuation and the low MR signal intensity on T2-weighted images that was observed in all four MR and in all two CT scans. The high density of proliferative capillaries explained the marked enhancement observed in all four patients with gadolinium (Gd)-chelate-enhanced MR imaging. GCTTS is a soft tissue (pseudo) tumor that may invade bone and as a consequence mimick an intrinsic osseous lesion on radiographs. In such cases, specific MR and CT features that can be explained by histological findings can be used to suggest the correct diagnosis.

Giant-cell tumours of bone of the hand and wrist: a review of imaging findings and differential diagnoses

Giant-cell tumour of bone (GCTOB) is a benign, locally aggressive, primary bone tumour. Involvement of the distal radius accounts for between 10 and 12% of cases of GCTOB, with the bones of the hand and wrist being rarely affected. GCTOB most commonly affects skeletally mature patients between the ages of 20 and 40 years, with the peak incidence being in the third decade. Women are affected slightly more commonly than men. GCTOB involving the bones of the hand most commonly occurs in a central location, which differs from the usual eccentric location seen in GCTOB at other sites. The radiographic features of GCTOB in the hand and wrist are presented. The role of bone scintigraphy, computed tomography and magnetic resonance imaging is discussed. Evaluation of the postoperative patient is also addressed, including the role of dynamic contrast-enhanced magnetic resonance imaging. A comprehensive review of the potential differential diagnoses that should be considered when GCTOB is suspected in the hand and wrist is also presented.