Abstract
BackgroundMultinucleated giant cell-containing tumors and pseudotumors of bone represent a heterogeneous group of benign and malignant lesions. Differential diagnosis can be challenging, particularly in instances of limited sampling. The purpose of this study was to evaluate the contribution of the P63 in the positive and differential diagnosis of giant cell tumor of bone.MethodsThis study includes 48 giant cell-containing tumors and pseudotumors of bone. P63 expression was evaluated by immunohistochemistry. Data analysis was performed using Epi-info software and SPSS software package (version 17).ResultsImmunohistochemical analysis showed a P63 nuclear expression in all giant cell tumors of bone, in 50% of osteoid osteomas, 40% of aneurysmal bone cysts, 37.5% of osteoblastomas, 33.3% of chondromyxoide fibromas, 25% of non ossifiant fibromas and 8.3% of osteosarcomas. Only one case of chondroblastoma was included in this series and expressed p63. No P63 immunoreactivity was detected in any of the cases of central giant cell granulomas or langerhans cells histiocytosis. The sensitivity and negative predictive value (NPV) of P63 immunohistochemistry for the diagnosis of giant cell tumor of bone were 100%. The specificity and positive predictive value (PPV) were 74.42% and 59.26% respectively.ConclusionsThis study found not only that GCTOB expresses the P63 but it also shows that this protein may serve as a biomarker for the differential diagnosis between two morphologically similar lesions particularly in instances of limited sampling. Indeed, P63 expression seems to differentiate between giant cell tumor of bone and central giant cell granuloma since the latter does not express P63. Other benign and malignant giant cell-containing lesions express P63, decreasing its specificity as a diagnostic marker, but a strong staining was seen, except a case of chondroblastoma, only in giant cell tumor of bone. Clinical and radiological confrontation remains essential for an accurate diagnosis.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1838562590777252.
Highlights
Giant cell tumour of bone (GCTOB) is the prototype of giant cell rich neoplasms of the skeleton
It can be a useful tool in distinguishing urothélial carcinoma from prostatic carcinoma [13] and it can be used as a prognosis factor as in adenoid cystic carcinoma [14]
Immunohistochemical analysis showed a P63 nuclear expression in all GCTOB (Figure 4), 2 of 4 osteoid osteomas (50%), 2 of 5 Aneurysmal bone cyst (ABC) (40%) (Figure 5), 3 of 8 osteoblastomas (37.5%), 1 of 3 Chondromyxoid fibroma (CMF) (33.3%), 1 of 4 Non ossifiant fibroma (NOF) (25%), 1 of 12 osteosarcomas (8.3%) and in the single case of chondroblastoma included in this series
Summary
Giant cell tumour of bone (GCTOB) is the prototype of giant cell rich neoplasms of the skeleton. The term giant cell tumour was coined by Bloodgood in 1912 [1] and it was not until 1940 that Jaffe distinguished giant cell tumour of bone from other bone tumours containing many osteoclast-like giant cells [2] This lesion represents 4% to 5% of all primary bone tumors and mainly occurs in skeletally mature patients (peak incidence between ages 20 and 45 years) with a slight female predominance [3,4,5]. It most commonly arises at the epiphyses of long bones like the distal femur, proximal tibia, distal radius and proximal humerus [6]. The purpose of this study was to evaluate the contribution of the P63 in the positive and differential diagnosis of giant cell tumor of bone
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