Abstract
SummaryGiant cell tumor, excluding its prototype in bone, is usually a benign but local aggressive neoplasm originating from tendon sheath or soft tissue. Malignant behavior is uncommon. Visceral organ involvement including urinary bladder is rare. Giant cell tumors in visceral organs usually accompany epithelial tumors and the clinical behavior of giant cell tumor in urinary bladder is similar to its bone counterpart. Here, we report two cases of giant cell tumor located in urinary bladder in comparison with nine reported cases in the English literature. Concurrent noninvasive urothelial carcinoma was also described in all these previous reports and only one patient with follow-up died of disease. One of the two cases we present had no concurrent urothelial tumor at the time of diagnosis but had a history of a low grade noninvasive urothelial carcinoma with three recurrences. The histology of these two cases was similar to the giant cell tumor of bone and composed of oval to spindle mononuclear cells with evenly spaced osteoclast-like giant cells. Immunohistochemically, the giant cells showed staining with osteoclastic markers including CD68, TRAP, and LCA. Immunohistochemical expression of vimentin, CD68, LCA, and smooth muscle actin in mononuclear cells supported a mesenchymal origin with histiocytic lineage. The histologic and immunohistochemical properties in our cases as well as their clinical courses were consistent with a giant cell tumor. Consequently, tumors in urinary bladder showing features of giant cell tumor of bone may also be considered and termed "giant cell tumor".
Highlights
Giant cell tumor (GCT) usually originates from bone, tendon sheath or soft tissue and is composed of oval, plump mononuclear cells and osteoclasts with a slow rate of growth and low incidence of malignant behavior
Recent reports suggest that tumors in visceral organs such as urinary bladder and pancreas should be classified in the undifferentiated carcinoma group considering the common accompaniment of epithelial neoplasms, as well as immunohistochemical expression of epithelial markers and p53, and aggressive course in some cases [12,13]
In addition de novo tumors as well as some soft tissue tumors may express epithelial markers immunohistochemically. These findings indicate that histogenesis of GCT is still controversial and that at least some lesions may be an overdiagnosed as "undifferentiated carcinoma"
Summary
Giant cell tumor (GCT) usually originates from bone, tendon sheath or soft tissue and is composed of oval, plump mononuclear cells and osteoclasts with a slow rate of growth and low incidence of malignant behavior. Recent reports suggest that tumors in visceral organs such as urinary bladder and pancreas should be classified in the undifferentiated carcinoma group considering the common accompaniment of epithelial neoplasms, as well as immunohistochemical expression of epithelial markers and p53, and aggressive course in some cases [12,13]. Except from high grade or invasive neoplasms GCT-like lesions may accompany to those with benign or non-invasive low grade histology or even arise de novo. In addition de novo tumors as well as some soft tissue tumors may express epithelial markers immunohistochemically. These findings indicate that histogenesis of GCT is still controversial and that at least some lesions may be an overdiagnosed as "undifferentiated carcinoma"
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