Solitary Giant Cell Research Articles

Multicentric Giant Cell Tumor of Bone.

The typical presentation of giant cell tumor of bone is a solitary lesion involving the meta-epiphyseal region of the long bones. The presence of more than one distinct giant cell tumor in the same patient is rare. This study reports on 7 patients with multicentric giant cell tumor of bone. Clinical and radiologic features were reviewed to evaluate the behavior of multicentric giant cell tumor of bone. Immunohistochemistry and genetic analysis for the H3F3A gene were performed to confirm the diagnosis. The knee was most frequently involved, and most of the lesions were in an ipsilateral extremity. All of the patients received surgical management with curettage or resection. The overall median follow-up was 194 months (interquartile range, 41-336 months). Five of 7 patients had local recurrence (71%), but considering the number of surgically treated lesions, the risk of local recurrence was 33% (5 local recurrences among 15 treated lesions). No lung metastases occurred. Multicentric giant cell tumor of bone tends to exhibit the same aggressive clinical behavior as solitary giant cell tumor of bone. Patients should be monitored for the occurrence of other lesions, especially in the ipsilateral extremity. [Orthopedics. 2023;46(6):e376-e380.].

A solitary giant cell tumor of the tendon sheath of left third finger in a 23-year-old man: a case report

Giant cell tumor of the tendon sheath (GCTTS) is a common condition usually encountered in middle aged men, usually seen on the thumb, index, middle fingers. These benign tumors are known to reoccur. Re-occurrence can be attributed to poor surgical technique, excision of the tumor in toto is considered difficult given the close proximity of the digital nerves, blood vessels, tendons to the tumor. A magnifying loop is usually used in these cases to identify and resect the satellite lesions. In this case report, we are presenting a case of solitary GCTTS of the tendon sheath in a 23-year-old man with history of gradually progressive painless swelling over his left third finger. Musculo-skeletal ultrasound revealed a heterogeneously hypo-echoic well-defined lesion over the ventral aspect of the left third finger. Histopathology showed giant cell morphology. Patient underwent exploration, tumor excision in toto with primary suturing in our institute with an uneventful postoperative period. No loss of range of movements of the PIP, DIP joints was noted in the postoperative period. Good dissection with excision of the tumor in toto gives better outcomes.

Multiple versus solitary giant cell lesions of the jaw: Similar or distinct entities?

The majority of giant cell lesions of the jaw present as a solitary focus of disease in bones of the maxillofacial skeleton. Less frequently they occur as multifocal lesions. This raises the clinical dilemma if these should be considered distinct entities and therefore each need a specific therapeutic approach. Solitary giant cell lesions of the jaw present with a great diversity of symptoms. Recent molecular analysis revealed that these are associated with somatic gain-of-function mutations in KRAS, FGFR1 or TRPV4 in a large component of the mononuclear stromal cells which all act on the RAS/MAPK pathway. For multifocal lesions, a small group of neoplastic multifocal giant cell lesions of the jaw remain after ruling out hyperparathyroidism. Strikingly, most of these patients are diagnosed with jaw lesions before the age of 20years, thus before the completion of dental and jaw development. These multifocal lesions are often accompanied by a diagnosis or strong clinical suspicion of a syndrome. Many of the frequently reported syndromes belong to the so-called RASopathies, with germline or mosaic mutations leading to downstream upregulation of the RAS/MAPK pathway. The other frequently reported syndrome is cherubism, with gain-of-function mutations in the SH3BP2 gene leading through assumed and unknown signaling to an autoinflammatory bone disorder with hyperactive osteoclasts and defective osteoblastogenesis. Based on this extensive literature review, a RAS/MAPK pathway activation is hypothesized in all giant cell lesions of the jaw. The different interaction between and contribution of deregulated signaling in individual cell lineages and crosstalk with other pathways among the different germline- and non-germline-based alterations causing giant cell lesions of the jaw can be explanatory for the characteristic clinical features. As such, this might also aid in the understanding of the age-dependent symptomatology of syndrome associated giant cell lesions of the jaw; hopefully guiding ideal timing when installing treatment strategies in the future.

Intracardiac Giant Cells After Left Ventricular Assist Device Placement

Multinucleated giant cells are seen in the heart in several distinct pathologic conditions, including giant cell myocarditis, sarcoidosis and infectious etiologies. We describe the first report of solitary multinucleated giant cells scattered throughout the heart after placement of a left ventricular assist device (LVAD) and transient Candida glabrata infection. The pathologic findings were noted in the explanted heart of a patient undergoing orthotopic cardiac transplantation 7 months after LVAD surgery. The presence of solitary giant cells without adjacent inflammation was a distinct histologic finding in this case. An awareness of this entity is important to avoid making a diagnosis of a more severe giant cell-related pathologic disease, which may recur in a transplanted heart.

Multiple nail fold nodules in a child

A case is presented of a 5 year old girl, who over 12 months developed multiple asymptomatic yellow‐brown nodules over the distal digits and nail beds, in association with joint stiffness and swelling. Biopsy of a representative nodule showed a nodular non‐encapsulated dermal histiocytic infiltrate. Within this were scattered multinucleate giant cells with a ground glass eosinophilic cytoplasm consistent with multicentric reticulohistiocytosis (MR). This is a rare subgroup of the non‐Langerhans cell histiocytoses which in contrast to solitary giant cell reticulohistiocytomas, is associated with a destructive arthritis. Typically MR affects Caucasian adults, with paediatric cases being rarely reported. Coeliac antibodies, strongly positive in this case, have only once been described in association with this disease, and may support an autoimmune pathogenesis.

Multicentric Giant Cell Tumor of Bone<sbt aid="1121043">Clinicopathologic Analysis of Thirty Cases</sbt>

Giant cell tumor of bone accounts for 4% to 5% of primary bone tumors. Approximately 1% of cases present as multiple synchronous or metachronous lesions. In this study, we describe the clinicopathologic features of thirty cases of multicentric giant cell tumor. Thirty patients who had two or more separate lesions that had been pathologically confirmed to be giant cell tumors were identified. Radiographs were reviewed to evaluate the characteristics and locations of the tumors. Histologic reexamination was performed to document morphologic features. Clinical information and follow-up data were obtained from the medical records. The male:female ratio was 1:2, with an average age at presentation of twenty-one years. Fifty-nine percent of the patients were younger than twenty years of age. There were ninety-four tumors in the series, with an average of three (range, two to nine) per patient. Most tumors had arisen in the long bones. Six patients had synchronous ipsilateral involvement of the distal part of the femur and the proximal part of the tibia. Radiographically, the tumors in long bones manifested as expansive lytic lesions involving the metaphysis and extending into the epiphysis. A minority of the tumors were confined to the metaphysis, had features of a fibro-osseous or bone-forming lesion, or arose in skeletally immature patients. Secondary histopathologic changes including fibrohistiocytic regions, reactive bone formation, or aneurysmal bone cyst-like changes were not uncommon. Most tumors were treated with curettage (64%) or resection (22%). The recurrence rate was similar to that of solitary giant cell tumors. Metastatic disease developed in three patients, and two patients had malignant transformation. Multicentric giant cell tumors occur more often in younger patients than do solitary giant cell tumors, and they frequently present as synchronous lesions around the knee. Some tumors appear as bone-forming or fibro-osseous tumors on imaging studies as a result of fibrohistiocytic regions and reactive bone formation. The risk of recurrence depends on the type of surgery that is performed. Therapeutic Level IV.

Is Ileoscopy With Biopsy Worthwhile in Patients Presenting With Symptoms of Inflammatory Bowel Disease?

To assess the value of adding ileoscopy with biopsy to colonoscopy, hence increasing the indications for ileoscopy in patients presenting with symptoms of inflammatory bowel disease. Two hundred fifty-seven patients with persistent diarrhea and 43 patients with sporadic colonic polyps were studied prospectively. The final diagnosis based on clinical and follow-up data, the histology of multiple ileal biopsies, and endoscopic findings were analyzed. Endoscopic lesions of the terminal ileum were found in 123 of 300 patients. In the 43 patients with colonic polyps, no ileal lesions were seen. Ileal disease without colonic involvement was present in 44 of 123 patients. Microscopic lesions of the ileum were present in 125 of 300, or in 125 of 257 (49%) with symptoms of diarrhea. Two of these had a normal endoscopy. Thirteen patients had a diffuse colitis and 11 had a predominantly left-sided colitis, both originally suggestive of ulcerative colitis. Crohn's disease was diagnosed in 88 patients and infectious disease in 17. Ileal biopsies were essential for the diagnosis in 15 patients and were contributive in 53. Granulomas, solitary giant cells, pseudopyloric gland metaplasia, eosinophils, and a disturbed villous architecture were the most important lesions observed in Crohn's disease and were contributive for this diagnosis. Ileoscopy with biopsy is useful in carefully selected patients presenting with symptoms of inflammatory bowel disease. The main indications are diagnosis of isolated ileal disease in the presence of a normal colon and differential diagnosis in patients with pancolitis and predominantly left-sided colitis. Multiple biopsy specimens show definite pathology in almost half of the patients.

Is ileoscopy with biopsy worthwhile in patients presenting with symptoms of inflammatory bowel disease?

Objective: To assess the value of adding ileoscopy with biopsy to colonoscopy, hence increasing the indications for ileoscopy in patients presenting with symptoms of inflammatory bowel disease. Methods: Two hundred fifty-seven patients with persistent diarrhea and 43 patients with sporadic colonic polyps were studied prospectively. The final diagnosis based on clinical and follow-up data, the histology of multiple ileal biopsies, and endoscopic findings were analyzed. Results: Endoscopic lesions of the terminal ileum were found in 123 of 300 patients. In the 43 patients with colonic polyps, no ileal lesions were seen. Ileal disease without colonic involvement was present in 44 of 123 patients. Microscopic lesions of the ileum were present in 125 of 300, or in 125 of 257 (49%) with symptoms of diarrhea. Two of these had a normal endoscopy. Thirteen patients had a diffuse colitis and 11 had a predominantly left-sided colitis, both originally suggestive of ulcerative colitis. Crohn's disease was diagnosed in 88 patients and infectious disease in 17. Ileal biopsies were essential for the diagnosis in 15 patients and were contributive in 53. Granulomas, solitary giant cells, pseudopyloric gland metaplasia, eosinophils, and a disturbed villous architecture were the most important lesions observed in Crohn's disease and were contributive for this diagnosis. Conclusions: Ileoscopy with biopsy is useful in carefully selected patients presenting with symptoms of inflammatory bowel disease. The main indications are diagnosis of isolated ileal disease in the presence of a normal colon and differential diagnosis in patients with pancolitis and predominantly left-sided colitis. Multiple biopsy specimens show definite pathology in almost half of the patients.

Acute myocardial infarction in a young adult due to solitary giant cell arteritis of the coronary artery diagnosed antemortemly by primary directional coronary atherectomy

It has been reported sporadically that several types of coronary arteritis can result in myocardial infarction. Recently, we treated a 27-year-old with acute anterior myocardial infarction. Primary directional coronary atherectomy was performed in order to recanalize the totally occluded coronary artery. The atherectomized tissue consisted of thrombi and intima infiltrated with inflammatory cells and multinucleated giant cells. Underlying diseases which can result in giant cell arteritis were excluded. This report documents that coronary arteritis can induce acute myocardial infarction, and that directional coronary atherectomy can be an effective tool in the diagnostic method for coronary arteritis.