Malignant giant cell tumor of toe: A case report and review of literature

INTRODUCTION

A giant cell tumor of soft tissue (GCST) is a benign soft tissue tumor that often occurs subcutaneously in the extremities. Rare cases of malignant GCST have been reported, but its pathogenesis remains unclear.

PATIENTS CONCERNS

We report a case of a 68-year-old man who noticed a painless mass on his second toe one and a half years ago. He visited the Department of Dermatology at our hospital. Magnetic resonance imaging revealed a soft tissue tumor, surrounding the distal aspect of the second toe.

DIAGNOSIS

A biopsy of the tumor was performed by a dermatologist, and it revealed a malignant giant cell tumor of the toe.

INTERVENTIONS

He was referred to our department and underwent lay amputation for wide-margin resection.

OUTCOMES

No recurrence or metastasis was observed 5 years after treatment.

CONCLUSION

: Malignant GCST should be treated with wide-margin resection immediately after its diagnosis.

Trends, Symptoms, and Outcomes of Resectable Giant Mediastinal Tumors

Describing the changes in surgical procedures and factors affecting the surgical outcome of patients who have undergone complete resection of giant mediastinal tumors (GMTs, diameter ≥ 10 centimeters) could improve preoperative decision-making and prognostic evaluations. We accessed data from three sources, which are case reports on surgical treatment of GMTs from PubMed, Web of Science, and EMBASE until June 1, 2019; patients with resected GMT from the Surveillance, Epidemiology, and End Results (SEER) database; and retrospective review of medical records in our institution from 2000 to 2019. The worldwide distribution, clinicopathological characteristics, symptom profile, prognosis of patients with GMT resection, and nomogram for surgical outcome prediction are reported. A total of 242 rare GMT cases from four continents (Asia, North America, South America, and Europe) were included. The median age of the patients was 40 (IQR: 27, range: 13–83) years, and the male-to-female ratio was 1.57:1. Dyspnea, shortness of breath, cough, and chest pain or discomfort were the major symptoms at presentation. The prognosis of benign and low-grade malignant GMTs was superior to that of high-grade malignant GMTs. Tumor malignancy played the most critical role in predicting postoperative survival, followed by longest tumor diameter and a posterior mediastinum location. The findings of this study suggest that the number of successful GMT surgeries has increased over the last decade and describe clinical features of GMTs. Physicians should prioritize tumor malignancy as a leading factor in predicting outcome rather than tumor size.

Mediastinal 99mTc-Methylene Diphosphonate Accumulation in a Patient With Primary Mediastinal Soft Tissue Giant Cell Tumor

Soft tissue giant cell tumor (GCT) is rare. It usually involves the extremities. We report the case of a 37-year-old woman who was suspected of having mediastinal tumor on radiograph. Thoracic CT revealed the tumor had extensive calcification and invaded the adjacent vertebrae and spinal canal. It intensively accumulated Tc-methylene diphosphonate on bone scan. The tumor showed hypointensity on T1-weighted and mixed intensity on T2-weighted fat-saturated sagittal images. Finally, a soft tissue GCT was confirmed by pathology. The case cautions us soft tissue GCT should be in the differential diagnosis spectrum in a calcified posterior mediastinal mass with Tc-methylene diphosphonate accumulation.

Giant Cell Tumor of Soft Tissue: A Rare Entity

Giant cell tumor (GCT) of the soft tissue (GCT-ST) is a rare, unusual primary soft tissue tumor that is completely distinct from, and should not be confused with, any giant cell-rich tumor of bone or soft tissue. Currently, GCT-ST is included in the group of so-called fibrohistiocytic tumors of intermediate (borderline) malignancy. The most common symptom is a painless, slow-growing mass in a superficial location. Computed tomography and magnetic resonance imaging show a solid, nonhomogeneous, frequently hemorrhagic mass. Differential diagnosis is broad and should include benign and malignant entities. The treatment and excision margins of GCT-ST are controversial. Incomplete surgical excision is usually followed by local recurrence. Biological behavior is unpredictable. Giant cell tumor of the soft tissue has shown a lower mean local recurrence rate compared to GCT of bone but has a higher metastatic and death rate. Therefore, close clinical follow-up is recommended. [Orthopedics. 2019; 42(4):e364-e369.].

Recurrent primary mediastinal giant cell tumor of soft tissue with radiological findings: a rare case report and literature review

Background

Giant cell tumor of soft tissue (GCT-ST), which histologically resembles GCT of bone, is a rare tumor. Usually, it is located in the lower extremities and trunk. GCT-ST, occurring in mediastinum, is extremely rare.

Case presentation

We encountered an 18-year-old Chinese woman who had mild dull pain on the left side of back. The following chest computed tomography (CT) showed a heterogeneous mass deeply situated in the posterior mediastinum with compression of the lung and invasion of the adjacent rib. On magnetic resonance imaging (MRI), the tumor exhibited predominantly slight hyperintensity on T2-weighted images and intensely heterogeneous enhancement on contrast-enhanced T1-weighted images. The whole body bone scan showed a mildly increased radiotracer uptake in the proximal portion of the left fifth rib, suggestive of local infiltration by the tumor. Surgical resection of the tumor was performed; subsequently, the tumor was histopathologically proved as GCT-ST. Three months after the operation, the patient developed a local recurrence. A brief discussion about the radiological findings, histopathological features, clinical behavior, and a detailed review of the relevant literature are presented.

Conclusions

To the best of our knowledge, this is the first case about recurrent primary mediastinal GCT-ST, moreover, this is the first report to introduce the MRI findings of primary mediastinal GCT-ST. The present case highlights the ubiquitous distribution of soft tissue giant cell tumor and the importance of considering this tumor in the differential diagnosis of posterior mediastinal neoplasms. Also, a long-term follow-up is required to properly assess the malignant potential of this tumor.

Mesenchymal tumours of the mediastinum--part I

The mediastinum is an anatomically defined space in which organs and major blood vessels reside with surrounding soft tissue elements. The thymus is an important organ in the mediastinum, and many of the masses encountered in the mediastinum are related to this organ. Most neoplasms diagnosed in the mediastinum are epithelial tumours (thymomas and thymic carcinomas), lymphomas or germ cell tumours. In contrast, soft tissue tumours of the mediastinum are rare. In 1963, Pachter and Lattes systematically reviewed soft tissue pathology of the mediastinum, covering the hitherto described [2, 226, 227] In this review, based on the 2013 WHO classification of soft tissue tumours and the 2015 WHO classification of tumours of the lung, pleura, thymus and heart, we provide an updated overview of mesenchymal tumours that may be encountered in the mediastinum.