reverberisandro at gmail
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Mar 30, 2008, 3:45 PM
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[Orthopod] Re: Giant cell tumour
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Dear Alexander,
I spent my early orthopaedic surgical experience at an Italian bone tumor
center. I have seen many GCTs of the bone, but none is similar to that you
presented. I hope that this is a my error, but
it, in my opinion, appears aggressive and strange in diaphyseal
localization. It seems in some aspects similar to a teleangectatic
osteosarcoma, a variant of osteosarcoma (characteristic gross appearance of
telangiectatic osteosarcoma is a multi-cystic "bag of blood".
Microscopically, telangiectatic osteosarcoma has large blood filled spaces
and thin septation. Within the septa there is scanty osteoid production by
the pleomorphic malignant cells. Giant cells are not rare)
See also : *
*
*http://www.emedicine.com/orthoped/TOPIC566.HTM
*
that says
**
*"Microscopic features (of teleangiectatic osteosarcoma):
*
Malignant cells are noted in a background of blood and necrotic debris.
Because the pleomorphic hyperchromatic malignant cells may be diluted in the
necrotic and hemorrhagic background, a careful examination to recognize
these elements is imperative. Blood lakes, rather than endothelium-lined
spaces, are present. In some cases, an osteoid matrix may not be visualized
except within the septal walls, which may be thin and difficult to find. In
such cases, a characteristic radiographic appearance, when correlated with a
careful microscopic search for features suggestive of malignancy, helps in
the correct interpretation of the
findings.25<http://www.emedicine.com/orthoped/TOPIC566.HTM#ref25>In
some cases, low-power examination reveals a morphologic pattern that
is
reminiscent of an aneurysmal bone cyst (see Image
1<http://www.emedicine.com/orthoped/TOPIC566.HTM#Multimediamedia1>
).
A potential trap is created by a radiologic impression of an aneurysmal bone
cyst and the characteristic gross features of that cyst. However,
examination of the cyst lining reveals overt malignant cells, often with
increased mitotic activity (see Image
2<http://www.emedicine.com/orthoped/TOPIC566.HTM#Multimediamedia2>).
These cells may lie adjacent to the benign osteoclastic giant cells. In some
cases, these giant cells are numerous, and the tumor mimics a giant,
cell-rich osteosarcoma (see Image
3<http://www.emedicine.com/orthoped/TOPIC566.HTM#Multimediamedia3>).
Unlike an aneurysmal bone cyst, telangiectatic osteosarcoma has an osteoid
matrix that is delicate and lacelike in appearance. Also, the stroma between
the dilated vascular spaces often contains malignant cells."
But what were anamnesis and clinical signs? had she pain?
This is an interesting case ; I thank you if you post next results.
2008/3/29, Alexander Chelnokov <alex61mobile@mail.ru>:
>
>
> Dear Sandro
>
> reverberi wrote 27 §Þ§Ñ§â§ä§Ñ 2008 §Ô., 18:16:21:
>
> > your solution is brilliant.
>
> It was my first experience with the technique and technically it
> is very attractive. At least much time saving than thorough curettage ;-)
>
>
> > I have some doubt about the diagnosis. Are you sure that this is a
> > benign lesion? Has she pain? The age of the patient, specimen and
>
>
> Yesterday our pathologist presented a preliminary conclusion - lytic
> GCT. Will pass specimens to colleagues from other facilities.
>
>
> --
>
> Best regards,
> Alexander N. Chelnokov
> Ural Scientific Research Institute
> of Traumatology and Orthopaedics
> 7, Bankovsky str. Ekaterinburg 620014 Russia
>
>
> >
>
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