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Guimarães LM, Bastos VC, Souza MRF, de Castro WH, Gomes CC, Gomez RS. Tenosynovial giant cell tumor: case report and molecular investigation. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 138:e13-e17. [PMID: 38760286 DOI: 10.1016/j.oooo.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/12/2023] [Accepted: 01/25/2024] [Indexed: 05/19/2024]
Abstract
Tenosynovial giant cell tumor is a benign neoplasm arising from the synovium of joints, including the temporomandibular joint (TMJ). Despite its benign nature, these tumors may exhibit aggressive behavior. A 57-year-old woman with a swollen, hardened area in the left TMJ was referred to the university´s clinic. The diagnosis of tenosynovial giant cell tumor was made based on the presence of hyperplastic synovial lining containing mononuclear and giant cells, hemorrhagic areas, hemosiderin deposits, and calcification foci in the biopsy. A low condylectomy was performed, and histopathologic analysis of the surgical piece upheld the diagnosis. Due to histopathologic resemblance with other giant cell-rich lesions (giant cell granuloma of the jaws, brown tumor of hyperparathyroidism, and non-ossifying fibroma) for which signature mutations are known, mutational analysis of KRAS, FGFR1, and TRPV4 genes was conducted. The results revealed wild-type sequences for all the mutations tested, thereby supporting the diagnosis of tenosynovial giant cell tumor.
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Affiliation(s)
- Letícia Martins Guimarães
- Department of Pathology, Biological Science Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Victor Coutinho Bastos
- Department of Pathology, Biological Science Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marina Rocha Fonseca Souza
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Wagner Henriques de Castro
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Carolina Cavaliéri Gomes
- Department of Pathology, Biological Science Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Medical School, Faculdade Ciências Médicas de Minas Gerais, Brazil.
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Chung K, Nawazish A, Chai SM, Bhandari M, Uthamalingam P. Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells arising from an intraductal papillary mucinous neoplasm: report of a rare case highlighting diagnostic difficulties. Pathology 2024; 56:594-597. [PMID: 38160096 DOI: 10.1016/j.pathol.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/03/2023] [Accepted: 09/19/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Kimberley Chung
- Department of Anatomical Pathology, PathWest, Fiona Stanley Hospital, Perth, WA, Australia
| | - Arfa Nawazish
- Department of Anatomical Pathology, PathWest, Fiona Stanley Hospital, Perth, WA, Australia
| | - Siaw Ming Chai
- Department of Anatomical Pathology, PathWest, Fiona Stanley Hospital, Perth, WA, Australia
| | - Mayank Bhandari
- Department of Surgery, Fiona Stanley Hospital, Perth, WA, Australia
| | - Preithy Uthamalingam
- Department of Anatomical Pathology, PathWest, Fiona Stanley Hospital, Perth, WA, Australia.
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Santoso D, Thaha M, Empitu MA, Kadariswantiningsih IN, Suryantoro SD, Haryati MR, Hertanto DM, Pramudya D, Bintoro SUY, Nasronudin N, Alsagaff MY, Susilo H, Wungu CDK, Budhiparama NC, Hogendoorn PCW. Brown Tumour in Chronic Kidney Disease: Revisiting an Old Disease with a New Perspective. Cancers (Basel) 2023; 15:4107. [PMID: 37627135 PMCID: PMC10452999 DOI: 10.3390/cancers15164107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Osteitis fibrosa cystica (OFC) and Brown Tumours are two related but distinct types of bone lesions that result from the overactivity of osteoclasts and are most often associated with chronic kidney disease (CKD). Despite their potential consequences, these conditions are poorly understood because of their rare prevalence and variability in their clinical manifestation. Canonically, OFC and Brown Tumours are caused by secondary hyperparathyroidism in CKD. Recent literature showed that multiple factors, such as hyperactivation of the renin-angiotensin-aldosterone system and chronic inflammation, may also contribute to the occurrence of these diseases through osteoclast activation. Moreover, hotspot KRAS mutations were identified in these lesions, placing them in the spectrum of RAS-MAPK-driven neoplasms, which were until recently thought to be reactive lesions. Some risk factors contributed to the occurrence of OFC and Brown Tumours, such as age, gender, comorbidities, and certain medications. The diagnosis of OFC and Brown Tumours includes clinical symptoms involving chronic bone pain and laboratory findings of hyperparathyroidism. In radiological imaging, the X-ray and Computed tomography (CT) scan could show lytic or multi-lobular cystic alterations. Histologically, both lesions are characterized by clustered osteoclasts in a fibrotic hemorrhagic background. Based on the latest understanding of the mechanism of OFC, this review elaborates on the manifestation, diagnosis, and available therapies that can be leveraged to prevent the occurrence of OFC and Brown Tumours.
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Affiliation(s)
- Djoko Santoso
- Department of Internal Medicine, Dr. Soetomo Hospital, Surabaya 60286, Indonesia; (D.S.); (D.M.H.); (D.P.); (S.U.Y.B.); (N.N.)
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya 60115, Indonesia; (S.D.S.); (M.R.H.)
| | - Mochammad Thaha
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya 60115, Indonesia; (S.D.S.); (M.R.H.)
| | - Maulana A. Empitu
- Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia;
| | | | - Satriyo Dwi Suryantoro
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya 60115, Indonesia; (S.D.S.); (M.R.H.)
| | - Mutiara Rizki Haryati
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya 60115, Indonesia; (S.D.S.); (M.R.H.)
| | - Decsa Medika Hertanto
- Department of Internal Medicine, Dr. Soetomo Hospital, Surabaya 60286, Indonesia; (D.S.); (D.M.H.); (D.P.); (S.U.Y.B.); (N.N.)
| | - Dana Pramudya
- Department of Internal Medicine, Dr. Soetomo Hospital, Surabaya 60286, Indonesia; (D.S.); (D.M.H.); (D.P.); (S.U.Y.B.); (N.N.)
| | | | - Nasronudin Nasronudin
- Department of Internal Medicine, Dr. Soetomo Hospital, Surabaya 60286, Indonesia; (D.S.); (D.M.H.); (D.P.); (S.U.Y.B.); (N.N.)
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya 60115, Indonesia; (S.D.S.); (M.R.H.)
| | - Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya 60115, Indonesia; (M.Y.A.); (H.S.)
| | - Hendri Susilo
- Department of Cardiology and Vascular Medicine, Universitas Airlangga Hospital, Universitas Airlangga, Surabaya 60115, Indonesia; (M.Y.A.); (H.S.)
| | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia;
| | - Nicolaas C. Budhiparama
- Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands;
| | - Pancras C. W. Hogendoorn
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Hild V, Mellert K, Möller P, Barth TFE. Giant Cells of Various Lesions Are Characterised by Different Expression Patterns of HLA-Molecules and Molecules Involved in the Cell Cycle, Bone Metabolism, and Lineage Affiliation: An Immunohistochemical Study with a Review of the Literature. Cancers (Basel) 2023; 15:3702. [PMID: 37509363 PMCID: PMC10377796 DOI: 10.3390/cancers15143702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Giant cells (GCs) are thought to originate from the fusion of monocytic lineage cells and arise amid multiple backgrounds. To compare GCs of different origins, we immunohistochemically characterised the GCs of reactive and neoplastic lesions (n = 47). We studied the expression of 15 molecules including HLA class II molecules those relevant to the cell cycle, bone metabolism and lineage affiliation. HLA-DR was detectable in the GCs of sarcoidosis, sarcoid-like lesions, tuberculosis, and foreign body granuloma. Cyclin D1 was expressed by the GCs of neoplastic lesions as well as the GCs of bony callus, fibroid epulis, and brown tumours. While cyclin E was detected in the GCs of all lesions, p16 and p21 showed a heterogeneous expression pattern. RANK was expressed by the GCs of all lesions except sarcoid-like lesions and xanthogranuloma. All GCs were RANK-L-negative, and the GCs of all lesions were osteoprotegerin-positive. Osteonectin was limited to the GCs of chondroblastoma. Osteopontin and TRAP were detected in the GCs of all lesions except xanthogranuloma. RUNX2 was heterogeneously expressed in the reactive and neoplastic cohort. The GCs of all lesions except foreign body granuloma expressed CD68, and all GCs were CD163- and langerin-negative. This profiling points to a functional diversity of GCs despite their similar morphology.
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Affiliation(s)
- Vivien Hild
- Institute of Pathology, University Hospital Ulm, 89081 Ulm, Germany
| | - Kevin Mellert
- Institute of Pathology, University Hospital Ulm, 89081 Ulm, Germany
| | - Peter Möller
- Institute of Pathology, University Hospital Ulm, 89081 Ulm, Germany
| | - Thomas F E Barth
- Institute of Pathology, University Hospital Ulm, 89081 Ulm, Germany
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Werner J, Grünig H, Loher H, Fischli S, Strobel K, Wicke C. Localization of Brown Tumors With 18F-Fluorocholine PET/CT Imaging in Severe Primary Hyperparathyroidism. Clin Nucl Med 2023; Publish Ahead of Print:00003072-990000000-00579. [PMID: 37256731 DOI: 10.1097/rlu.0000000000004718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
ABSTRACT We present the case of a 68-year-old woman with a painful tibial tumor and fatigue. Histology and laboratory studies were consistent with a brown tumor secondary to initially unrecognized, severe primary hyperparathyroidism. 18F-fluorocholine PET/CT revealed a large hypermetabolic parathyroid mass and multiple bone foci considered as brown tumors. Unilateral neck exploration confirmed a large parathyroid adenoma. Serum calcium and parathyroid hormone levels normalized quickly, and symptoms subsided gradually after parathyroidectomy. Brown tumors are a rare complication of severe hyperparathyroidism. 18F-fluorocholine PET/CT allows the localization of parathyroid adenomas and brown tumors, and can be used as a single imaging modality.
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KRAS codon 12 mutations characterize a subset of de novo proliferating "metaplastic" Warthin tumors. Virchows Arch 2023; 482:839-848. [PMID: 36752878 PMCID: PMC10156774 DOI: 10.1007/s00428-023-03504-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/16/2023] [Accepted: 01/26/2023] [Indexed: 02/09/2023]
Abstract
Warthin tumor (WT; synonym: cystadenolymphoma) represents one of the most frequent salivary gland tumors with a frequency equaling or even outnumbering that of pleomorphic adenomas in some series. Histologically, the tumor displays tall columnar oncocytic cells, arranged into two cell-thick layers lining variably cystic glands within an organoid lymphoid stroma. Tumors with exuberant squamous metaplasia in response to FNA-induced or other types of tissue injury/infarction have been referred to as "metaplastic WTs." However, the same terminology was used for tumors with variable mucinous cell and solid or stratified epidermoid proliferations (occasionally mimicking mucoepidermoid carcinoma), although the "metaplasia concept" has never been proven for the latter. We herein investigated 22 WTs showing prominent mucoepidermoid-like or solid oncocytoma-like proliferations without prior FNA or histological evidence of infarction/ trauma using the TruSight Tumor 15 gene panel and KRAS pyrosequencing. As a control, we tested 11 conventional WTs. No statistically significant differences were observed between the two subcohorts regarding patient's age and tumor size. Six of 22 (27%) proliferating/ metaplastic WTs revealed oncogenic KRAS mutations clustering at codon 12 (exon 2), while all conventional tumors lacked these mutations. Our findings are in line with a neoplastic nature of the epidermoid/ mucoepidermoid proliferations in non-injured "metaplastic" Warthin tumors. We propose the descriptive term "de novo proliferating Warthin tumor" for this variant to distinguish it from infarcted/inflamed genuine metaplastic Warthin tumor.
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