Presence Of Osteoclast-like Giant Cells Research Articles

Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas: a narrative review.

Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas (UCOGCP) is a rare pancreatic tumor that accounts for less than 1% of all pancreatic malignancies. The characteristic pathological manifestation of UCOGCP is the presence of osteoclast-like giant cells (OGCs) distributed among pleomorphic undifferentiated tumor cells. UCOGCP can occur either alone or in association with other types of pancreatic tumors. At present, there is no unified consensus or guideline for the diagnosis and treatment of UCOGCP, and most of the literature are individual case reports. With the accumulation in the number of clinical cases and the development of precision medicine technology, the understanding of UCOGCP is also deepening. Researchers have begun to recognize that UCOGCP is a pancreatic tumor with distinctive clinical and molecular characteristics. In this review, we focus on the latest research status and future exploration directions in the diagnosis, treatment, and prognosis of UCOGCP.

Angiosarcoma with Osteoclast-Like Giant Cells: A Rare Presentation and Review of Literature

Abstract Introduction/Objective Diagnosing angiosarcoma can be challenging, especially in cases with atypical morphology. For the unsuspecting pathologist, some histopathologic features can be misleading, especially when presenting as the predominant component of a tumor or in unusual locations. Herein, we describe an osteoclast-like giant cell-rich angiosarcoma, which initially presented as a groin mass followed by pulmonary metastasis. Methods/Case Report A 54-year-old woman presented with a golf ball size mass near her right groin that she noticed 1 year ago. MRI demonstrated a heterogeneous complex mass with solid and cystic components within the right gracilis muscle. Following the diagnosis of poorly differentiated malignant neoplasm on biopsy, the patient underwent wide excision. Histopathologic examination revealed epithelioid to “rhabdoid-like” cells arranged in a fascicular pattern interspersed with osteoclast-like giant cells. Immunohistochemical stains showed tumor cells are positive for vimentin, CD10, CD31 (focal), CD99 (focal), while negative for Desmin, CD34, SMA, AE1AE3, HMB45, ALK1, CD30, S100, and Melan-A. CD68 highlighted only osteoclast-like giant cells. The lesion was diagnosed as undifferentiated pleomorphic sarcoma (UPS). Nine months later, chest CT showed a 1.3 cm lung nodule. The resected nodule was immunohistochemically and morphologically similar to the groin mass, including the presence of osteoclast-like giant cells. In addition, tumor cells were also diffusely positive for ERG and FLI1. Results (if a Case Study enter NA) NA Conclusion To our knowledge, this is the first report of soft tissue angiosarcoma with osteoclast-like giant cells presenting with lung metastasis. A high index of suspicion for an angiosarcoma in tumors occurring in proximal sites, characterized by epithelioid to “rhabdoid-like” cells, despite the presence of many osteoclast-like giant cells, is crucial to avoid misdiagnosis. Awareness of this histopathologic pattern and diagnostic confirmation with necessary immunohistochemical stains is important to avoid misinterpretation. UPS is essentially a diagnosis of exclusion, which should only be considered following extensive workup to eliminate all other possibilities.

Giant cell Granuloma

Central giant cell granulomas (CGCG) constitute about 10% of benign jawbone lesions. Approximately one-third of CGCG exhibit local aggressive behavior with bone destruction and a tendency to recur.1 Jaffe (1953) was the first to distinguish central giant cell granulomas (CGCG) of the jawbones from other giant cell lesions of bones and originally called them“central giant cell reparative granulomas” since they were believed to be a reactive-reparative process that might heal spontaneously.1 Recently the World Health Organization has defined it as localized benign but sometimes aggressive osteolytic proliferation consisting of fibrous tissue with hemorrhage and haemosiderin depo­sits, presence of osteoclast-like giant cells and reactive bone formation. Many authors have established the differences with other lesions of giant cells. The clinical behavior of CGCG varies from a slowly asymptomatic swelling to an aggressive lesion that manifests with pain, cortical perforation, and root resorption.2 On the other hand the peripheral giant cell granuloma is a reactive exophytic lesion of the gingiva and alveolar ridge that usually occurs as a result of local irritating factors such as plaque, calculus, chronic infection, chronic irritation, tooth extraction, inproperly finished filling, unstable dental prosthesis, and impacted food which originates from the periosteium or periodontal ligament.

"Central giant cell granuloma" - An update.

There are multiple lesions in the jawbones with a common histological character of the presence of osteoclast-like giant cells under one category – giant cell lesions. The central giant cell granuloma (CGCG) is the most common of all and is found to be more prevalent in the Indian population. The pathogenicity still remains an enigma and needs to be differentiated from other look-alike lesions in order to have proper treatment planning. Furthermore, CGCG specifically needs to be differentiated from central giant cell tumor to avoid mutilating surgeries. This article is an attempt to give an outline of the CGCG with updating of the latest information on the perception of this lesion.

Breast carcinoma with osteoclast-like giant cells: A cytological-pathological correlation with a literature review.

Breast carcinoma with osteoclast-like giant cells (OGCs) is a rare disease characterized by the infiltration of OGCs in the tumor; however, cytological aspects of this tumor type remain elusive. We examined the cytological features in fine needle aspiration (FNA) biopsy smears obtained from 5 patients who were histologically diagnosed with breast carcinoma with OGCs. We compared FNA and clinicopathological findings with results from the published literature. Histological assessment of the resected samples showed that all tumors exhibited a histological grade 1 phenotype with a predominant cribriform architecture. Four patients were estrogen receptor positive, and 1 patient showed a triple negative phenotype. All patients survived without tumor recurrence. In the FNA smears, tumor cells were arranged in loosely cohesive clusters, characterized by varying degrees of OGCs infiltration and rare formation of solid tumor nests. Occasionally, 2- or 3-dimensional clusters of tumor cells were found, accompanied by OGCs at the peripheral regions. In all patients, tumor cells were small without severe nuclear atypia. None of the patients showed significant background necrosis. In summary, cytological features of breast carcinoma with OGCs are characterized by loose aggregates of low grade tumor cells, the presence of OGCs, and the absence of necrosis, all of which were consistent with features reported previously. This peculiar form of breast tumors should be included in the differential diagnosis, when physicians encounter FNA findings including low grade ductal carcinoma with the admixture of multinucleated giant cells or OGCs.

A matched-cohort analysis of 192 pancreatic anaplastic carcinomas and 960 pancreatic adenocarcinomas: A 13-year North American experience using the National Cancer Data Base (NCDB)

Anaplastic pancreatic carcinoma (APC) is a rare and poorly characterized disease. We sought to compare the clinical characteristics and outcomes of APC to pancreatic adenocarcinoma (PDAC). The American National Cancer Data Base was queried for patients with resected APC and PDAC using histologic and operative codes. APC cases were matched 1:5 with PDACs based on age, sex, pathologic tumor stage, operative margin status, lymph node positivity ratio, and use of adjuvant chemotherapy. After 1:5 matching, 192 APCs and 960 PDACs were analyzed. When comparing APC vs PDAC the median tumor size was 45mm (interquartile range, 33-60) vs 30mm (interquartile range, 23-40; P<.001), and metastatic nodal disease was present in 40.6% and 38.0% of the cases (P=.25), respectively. APC cases were distributed equally between the head and the body/tail region of the pancreas (50%), while PDAC cases were located mainly in the head of the pancreas (75%; P<.001). Although the resected APC group had a lesser survival during the first year after the diagnosis (51% vs 69%; P=.029), the overall survival was similar in the 2 groups, with 21.6% vs 17.4% alive at 5years, respectively for APC and PDAC (P=.32). Subgroup analysis of patients with APC with (n=18) versus those without (n=80) osteoclastlike giant cells showed a greater 5-year survival (50% versus 15%, P<.001). Patients with resected APC tend to present with large tumors equally distributed between the head and body/tail of the pancreas. While APC is thought to have a more aggressive biology, our matched analysis showed similar overall survival compared with PDAC. The presence of osteoclastlike giant cells portends a significantly better prognosis compared with other histologic features of APCs.

Invasive breast carcinomas of no special type with osteoclast-like giant cells frequently have a luminal phenotype.

Invasive carcinoma of no special type (NST) with osteoclast-like giant cells (OGCs) represents a unique type of breast neoplasm, characterized by the presence of multinucleated OGCs and a vascularized, hemorrhagic stroma. Because of its rarity, the literature regarding this tumor remains limited and a detailed immunophenotype of this tumor has not been established as yet. We report a clinicopathological and immunohistochemical study of 42 patients with invasive carcinoma NST with OGCs. Macroscopically, these tumors presented as a well-delimited red-brown mass. A remarkable feature of the tumor was the presence of OGCs in the fibroblastic or hemorrhagic vascular stroma, as well as in the adjacent tumor nests or glandular lumina. The number of OGCs varied from 8 to 105 per 10 high-power fields with an average of 48. The tumors were well to moderately differentiated. Cribriform architecture was observed in 27 tumors (63%). All of the 36 available tumors were of luminal phenotype, according to the Ki67 labeling index 89% luminal A and 11% luminal B. With a mean follow-up time of 46.4months, lung metastasis was found in 2 patients (5%) at 7 and 11years after the operation, respectively. None of the other cases had presented with evidence of recurrence or metastasis. To the best of our knowledge, this is the largest reported series of invasive carcinoma NST with OGCs as yet. Our study revealed that invasive carcinoma NST with OGCs exhibit a luminal phenotype with luminal A subtype as the major group.

Gastric Carcinoma with Osteoclast-Like Giant Cells Coexisting with Gastrointestinal Spindle Cell Tumor

Reactive multinucleated osteoclast-like giant cells (OGCs) have been described in a variety of neoplasms but rarely in gastric carcinomas. Reported herein is a case of an 81-year-old Caucasian male presented with upper abdominal pain and dysphagia. Esophagogastroscopy revealed an ulcerative mass and a specimen of subtotal gastrectomy and lower esophagectomy was sent for histologic examination. At the gastroesophageal junction an exophytic tumor, measured 2.2 cm in greatest diameter, was observed. Sections from the tumor showed gastric adenocarcinoma, stage pT1bpN0. Diffusely among the neoplastic cells multinucleated giant cells, resembling osteoclasts, were observed, which were positive for CD68, lysozyme, and vimentin and negative for AE1/AE3, CK8/18, hHCG, and LMP1. Moreover, in a random section from the gastric fundus, a spindle cell lesion, sized 0.6 cm, was revealed, which was positive for CD117 and CD34 antigens and was diagnosed as gastrointestinal stromal tumor (GIST). The presence of OGCs is an uncommon finding in gastric carcinomas and by analogy to breast and pancreatic carcinomas it could characterize a rare distinct morphological variant of gastric adenocarcinoma. Due to the limited number of the reported cases, the prognostic value of OGCs is under discussion. Furthermore, pathologists should be aware that incidental GIST may accompany any tumor.

Clinical Outcomes for Anaplastic Pancreatic Cancer: A Population-Based Study

Anaplastic pancreatic cancer (APC) is a rare subtype of pancreatic ductal adenocarcinoma (PDA) that can carry a worse overall survival (OS) when compared with other variants. However, the presence of osteoclast-like giant cells (OCGCs) in APC specimens can predict improved OS. The aim of this study was to evaluate the OS of patients with APC (with and without OCGCs) compared with patients with other subtypes of PDA using a population-based registry. We identified all patients in the Surveillance, Epidemiology and End Results (SEER) database with pathologically confirmed APC and PDA diagnosed between 1988 and 2008. Overall survival was evaluated using Kaplan-Meier and Cox proportional hazard regression. The study cohort included 5,859 (94.3%) patients with PDA and 353 (5.7%) with APC. Overall survival for all patients with APC was significantly worse than for patients with PDA (hazard ratio [HR] = 1.9; 95% CI, 1.7-2.1; p < 0.001); however, in the subgroup of resected patients, APC (n = 81) had similar OS to PDA (n = 3,517) (HR = 0.9; 95% CI, 0.7-1.2; p = 0.37). Patients with APC tumors with OCGCs (n = 11) demonstrated improved OS when compared with all other APC variants without OCGCs (n = 342) (HR = 0.3; 95% CI, 0.1-0.7; p = 0.004), but this survival difference was not observed in the subgroup of resected patients (HR = 0.5; 95% CI, 0.2-1.4; p = 0.18). Anaplastic pancreatic cancer is a rare malignancy with poor OS. The diagnosis of APC with OCGCs is predictive of improved OS compared with other patients with APC. This survival benefit, however, is not observed in patients with resected disease.

Pure reconstruction with bone substitute pellets graft following curettage and high-speed burring for chondroblastoma of the proximal tibia: a case report and review of the literature

. There is a predilectionfor the male sex,with a male to female ratio of 2–3:1.Thediagnosis is confirmed by the presence of osteoclast-likegiant cells, reactive osteoid and mononuclear chondro-blasts,which tend to be scattered individually like pebbles(chicken wire calcification), in contrast to the mono-nuclearcellsof giantcelltumor,whicharespindle-shapedand occur mostly in clusters

A uterine leiomyoma in which a leiomyosarcoma with osteoclast-like giant cells and a metastasis of a ductal breast carcinoma are present

Leiomyosarcoma of the uterus is a rare tumor, and the presence of osteoclast-like giant cells in this tumor is even rarer. A leiomyosarcoma arising in a leiomyoma is also quite unique. Breast cancer metastasizing to the uterus is seldom seen as well. A 70-year-old woman presented with metastasized breast cancer to the bones. An evaluation of the computed tomographic scan was made, which showed an enlarged uterus with a tumor. The tumor was a leiomyoma in which a leiomyosarcoma with osteoclast-like giant cells as well as a metastasis of a ductal breast carcinoma was present. To our knowledge, this is the first report of a leiomyosarcoma containing osteoclast-like giant cells, present in a leiomyoma, in a uterus also containing a ductal breast cancer metastasis present in the leiomyoma and myometrium.

Clear ocell sarcoma-like tumour of the gastrointestinal tract causing small bowel obstruction in a young woman

A 26-year-old woman with a history of Hodgkin's lymphoma in remission, presented with abdominal pain and vomiting. Abdominal CT scan showed signs of small bowel obstruction associated with a localised area of intestinal wall thickening and mesenteric lymphadenopathy. Macroscopic examination of the resected small bowel showed a 2 cm stricturing and ulcerating tumour. Histology revealed a transmurally invasive malignant neoplasm composed of sheets and nests of epithelioid clear cells, with high-grade cytology and dispersed osteoclast-like giant cells. Immunohistochemically, the tumour cells were positive for S100 and negative for Melan-A, HMB45, pancytokeratin, desmin and c-kit. Electron microscopy showed no diagnostic features. Fluorescence in situ hybridisation (FISH) analysis of the tumour confirmed EWSR1 gene rearrangement with t(12,22). These features are consistent with a clear cell sarcoma-like tumour of the gastrointestinal tract (CCSLTGT). Post-operatively, the patient developed adhesions but was otherwise well. CCSLTGT is a recently described new tumour entity that shares some but not all features of clear-cell sarcoma of soft parts. It is exceedingly rare, mainly affects young adults and tends to behave aggressively. The presence of osteoclast-like giant cells and isolated tumoural expression of S100 protein, coupled with EWSR1 translocation, are defining features. Diagnosis of this tumour as a metastatic malignant melanoma is a potential pitfall.

Anaplastic pancreatic cancer: Presentation, surgical management, and outcome

Anaplastic pancreatic cancers are rare neoplasms. The available data are focused on pathologic and molecular features, and little is known about the clinical presentation and management. The outcome of operative exploration and resection is unknown. From a prospective database, all consecutive operations for anaplastic pancreatic cancer performed at our institution were identified. The clinicopathologic details were analyzed and the outcome was compared with a matched group of typical pancreatic ductal adenocarcinomas (nested case-control study). Eighteen patients with anaplastic pancreatic cancer were identified. The patients had a median age of 64 years. The tumors were large (median diameter, 4 cm) and showed peripheral contrast enhancement in radiologic imaging. Fifteen (83%) patients underwent resection, a palliative bypass procedure was performed in 1 (6%) patient, and 2 patients underwent exploration with biopsy only. Perioperative morbidity was 39% and mortality was 6%. The median survival rate in patients with anaplastic pancreatic cancer was 5.7 months and was less than in the control group of patients with pancreatic ductal adenocarcinoma (15.7 months). In anaplastic pancreatic cancer, the median duration of survival was significantly greater after R0/R1 resection, as compared with palliative surgery (7.1 vs 2.3 months). The duration of survival was significantly greater in neoplasms with osteoclast-like giant cells. In 3 (17%) patients, long-term survival of 33, 49, and 161 months was observed. Anaplastic pancreatic cancer is an aggressive type of pancreatic cancer with a short median survival; however, because of the observation of prolonged survival after resection, resection should be performed whenever possible. The presence of osteoclast-like giant cells is associated with a favorable prognosis.

Idiopathic bilateral central giant cell reparative granuloma of jaws: A case report and literature review

Objectives The central giant-cell reparative granuloma has been defined as a localized benign but sometimes aggressive osteolytic proliferation consisting of fibrous tissue with hemorrhage and hemosiderin deposits, presence of osteoclast-like giant cells and reactive bone formation. It is a benign lesion usually appears as solitary, multilocular, radiolucencies, located in the mandible and maxilla. Multiple CGCRGs of the jaw bones is very rare and, if it occurs, it is usually associated with hyperparathyroidism in majority of the cases .This report presents an unusual case of a 12-year-old girl who has idiopatic, bilateral giant cell granulomas of the angulus mandible. Methods A 12 year-old girl was admitted to our department with complain of swelling on both right and left side of her lower jaw. There was no history of trauma, dental problem or neck infection. Blood chemistry, including calcium, alkaline phosphatase and inorganic phosphorus was normal. Patient had not family history, clinical apperiance like cherubism or noonan sydrome and systemic anomalies. MRI showed, in right ramus mandible, 37 × mm × 35 mm × 28 mm size mass and in lenf ramus mandible, an expansile, 30 mm 38 mm × 12 mm size mass. The patient underwent surgical curettage of the lesion through an intraoral approach under general anesthesia. Result The histopathologic examination of the lesion was reported as ‘giant cell reparative granuloma. Conclusion Our patient had multiple CGCRG in her jaw. In literature there is several reports about multiple CGCRG but unlike of that report our patient had no syndromes like Cherubism, Noonan syndrome, neurofibromatosis type-1 and systemic disease like hyperparathyroidism ,fibrous dysplasia. So we define this case as Idiopatic bilaterally central giant cell reparative granuloma of jaw.

Cytology of anaplastic giant cell carcinoma of the thyroid with osteoclast‐like giant cells—A case report

Anaplastic carcinoma of the thyroid is known for its highly aggressive behaviour and rapid spread. While the giant cell variant is a well recognized morphologic pattern, the presence of osteoclast-like giant cells is a rare occurrence. We report a case of anaplastic carcinoma of the thyroid with focal presence of osteoclast-like giant cells occurring in an elderly male patient, diagnosed on aspiration cytology.

Carcinosarcoma (malignant mixed tumor) of the submandibular gland: A case report and review of the literature

A 62-year-old woman was referred with a 3-week history of a tender, rapidly enlarging lump in the left submandibular region. There was associated pain that radiated to the mandible and ipsilateral ear. Examination revealed a firm, mildly tender, approximately 33-cm mobile mass in the region of the submandibular gland. No other neck masses were palpable. Examination of the oral cavity failed to show any mass lesion in the floor of mouth, nor a lesion of the submandibular duct, and the duct papilla was noted to be normal. Full ear, nose, and throat examination was normal. As clinical evidence supported the diagnosis of an inflammatory or infective process, the patient was prescribed a week’s course of oral ciprofloxacin, and routine haematologic investigations and a floor-of-mouth radiograph were organized. This was subsequently reported as normal. Of the blood tests, only the erythrocyte sedimentation rate of 37 mm in 1 hour (normal, 5 to 15) and C-reactive protein of 13 mg/L (normal, 0 to 10) were abnormal. As the mass was unilateral and nonfluctuant, fine-needle biopsy was also arranged. The result of fine-needle assessment showed malignant cells consistent with aspiration from a non–small cell carcinoma. The cytologist was unable to comment on whether this was a primary lesion of the submandibular gland or a lymph node metastasis. Urgent computed tomography (CT) scans of the paranasal sinuses and chest, and magnetic resonance imaging of the neck were performed in an attempt to determine a potential primary site. In addition, the patient was admitted for a left tonsillectomy and panendoscopy, including biopsies of the postnasal space, base of tongue, and left piriform fossa. CT scan of the paranasal sinuses was normal. Negative histology of the biopsy samples and the left tonsil, coupled to the magnetic resonance imaging findings showing replacement of the left submandibular gland by tumor (Fig 1), suggested the left submandibular gland as the primary site. CT scan of the chest did, however, reveal a region of consolidation in the right posterior mid-zone. The remaining lung fields were clear. Following advice from our radiology colleagues as to the infective nature of the lesion, a 2-day of intravenous cefotaxime, followed by 5 days of oral cefadroxil, was prescribed. A chest radiograph 1 week later confirmed complete resolution of the lung lesion. The patient underwent surgical removal of the left submandibular gland and an ipsilateral selective neck dissection including removal of the deep cervical lymph nodes from levels I to IV. The neck dissection was performed to exclude micrometastatic disease in the locoregional cervical lymph nodes. Subsequent histologic examination of the resected specimen revealed a high-grade carcinosarcoma suggested by extension beyond the tumor pseudocapsule and vascular invasion. The epithelial component of the malignancy was adenocarcinomatous with glandular structures and mucus secretion (Fig 2). There was a predominantly sarcomatous component with regions of osteoid formation (Fig 3) and the presence of osteoclastlike giant cells, findings consistent with osteosarcoma. Further immunohistochemical staining showed neurofibrosarcomatous (S100), smooth muscle (smooth muscle actin), and striated muscle (myoglobin) elements, emphasizing the polyclonal histogenicity of these rare lesions. All lymph nodes excised with the specimen were free from malignancy. In light of the histologic findings, specifically the extracapsular spread and vascular invasion, as well as the expected aggressive nature of the tumor, the patient was treated with postoperative radiotherapy of 66 Gy in 33 daily fractions of 2 Gy. She currently remains well and free of disease 12 months after treatment.

Bilateral Infiltrating Lobular Carcinoma of the Breast with Osteoclast-Like Giant Cells

A case of bilateral infiltrating lobular carcinoma of the breast containing osteoclast-like giant cells is presented. Notable pathologic features include prominent tumor-associated angiogenesis and the presence of osteoclast-like giant cells in axillary lymph node metastases. Immunohistologic and ultrastructural examination support a nonepithelial, histiocytic origin for the giant cells, and results are similar to previous reports of osteoclast-like giant cells associated with breast carcinoma. This is the first report of bilateral pure infiltrating lobular carcinoma of the breast with osteoclast-like giant cells and the first case of pure lobular carcinoma with osteoclast-like giant cells present in lymph node metastases.