ARTIGO DE REVISÃO O tumor de células gigantes (TGC) é uma neoplasia óssea benigna agressiva de comportamento biológico incerto, constituído histologicamente por células gigantes multinucleadas dispersas pelo tecido tumoral, cujo núcleo apresenta as mesmas características das células ovóides e fusiformes que formam o seu estroma. A graduação anatomopatológica é dada pelo seu estroma e não pelas células gigantes, que podem estar presentes também em outras lesões tumorais e pseudotumorais como o tumor marrom do hiperparatireoidismo, o cisto ósseo aneurismático, o condroblastoma epifisário, o osteoblastoma e o fibroma não osteogênico. Os aspectos radiográficos clássicos do TGC o definem como uma lesão epifisiometafisária, lítica, insuflativa, excêntrica, com afinamento ou erosão da cortical, em adulto jovem na faixa dos 20 aos 35 anos de idade, localizado mais freqüentemente no fêmur distal e na tíbia proximal, podendo ocorrer em outras patologias, destacando-se pela sua gravidade o osteossarcoma telangectásico e o fibrohistiocitoma ósseo maligno. Dentre as lesões benignas, notadamente o cisto ósseo aneurismático e o condroblastoma epifisário fazem o diagnóstico diferencial com o TGC. Com menor freqüência, pode estar localizado no úmero proximal, rádio distal, fêmur proximal, coluna dorsal e sacro.Clinicamente, seu comportamento é agressivo (estadiamento B3 de ENNEKING), com crescimento rápido, às vezes em semanas, apesar de oligossintomático, levando ao afinamento e ruptura da cortical óssea, com invasão das partes moles adjacentes, sem entretanto invadir e ulcerar a pele e o tecido celular subcutâneo. A princípio pode ser confundido como uma lesão intrínseca do joelho, principalmente se a radiografia não for atualizada e bem feita, já que alterações nítidas podem ser notadas com intervalo de 10-15 dias. A nossa própria experiência mostra que, em alguns casos encaminhados Giant Cells Tumor (GCT) is an aggressive benign bone neoplasia, with an uncertain biological behavior. It is histologically constituted of giant multinuclear cells spread over tumoral tissue with a nucleus presenting the same features of the ovoid and fusiform cells forming its stroma.The anatomopathological rate is given by its stroma and not by the giant cells that can also be present in other tumoral and pseudo-tumoral lesions such as the hyperparatireoidism brown tumor, the aneurismatic bone cyst, the epiphysial condroblastoma, the osteoblastoma and the non-osteogenic fibroma.Classic radiologic features of GCT: lytic, pumping, eccentric, with thinning or erosion of cortical bone, epiphysial-metaphyseal lesion, found in young adults from 20 to 35 years old, more frequently located in distal femur or proximal tibia, can be found in other pathologies, deserving emphasis for its severity the teleangectasic osteosarcoma and malignant bone fibrohystiocitoma. Among benign lesions, aneurismatic bone cyst and epiphysial condroblastoma are differential diagnosis from GCT. Less frequently it can be located in proximal humerus, distal radius, proximal femu...

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PURPOSE:To evaluate 20 cases of nonmetastatic synovial sarcoma of the extremities regarding prognostic factors, and to propose a histologic grading system with prognostic significance. METHODS:The cases of 20 patients (14 females and 6 males) with nonmetastatic synovial sarcomas of the extremities treated between 1985 and 1998, were retrospectively evaluated regarding prognostic factors. A histologic grading system with prognostic significance is proposed. RESULTS: The mean follow-up period was 48.4 months (range, 16-116 months). There was local recurrence in 3 cases (15%), microscopic surgical margin being the only prognostic factor identified. Seven patients (35%) died of the disease in a mean postoperative period of 31.7 months (range, 16-53 months), all with pulmonary or brain metastasis. The survival rate was 65% in 48.4 months of follow-up. CONCLUSION: The unfavorable prognostic factors identified regarding survival were high histologic grade, tumors proximal to the knee or elbow, and spontaneous tumor necrosis over 25%. Local recurrence did not have influence on survival in this study. The presence of mast cells appears to have a positive influence on survival, although statistical significance was not reached (P = 0.07). The oncologic and functional result was good in 6 cases (30%), regular in 7 (35%), and poor in 7 cases (35%).

The distinction between benign and malignant papilloma of the breast through percutaneous needle biopsy can be difficult because of limited samples; the underestimation rate can be up to 25%. The aim of this study is to identify clinical and histological factors associated with underestimation, invasive ductal carcinoma, or ductal in-situ carcinoma (DCIS) of the breast found in surgical specimens from papillary lesions. This may contribute toward selection of patients for a follow-up strategy without the need for surgical excision. From a database of 3563 patients, we identified 85 with intraductal papilloma between 2007 and 2013 who had undergone breast-imaging studies, percutaneous needle biopsy, and surgical resection of the lesion. Central papillomas normally present with a palpable mass, whereas peripheral papillomas generally do not have clinical manifestations (microcalcifications); both central and peripheral papillomas were related to atypical lesions, 13.5 and 15.4%, respectively. Among the 59 cases of central papillomas, there were four cases of underestimation, three DCIS and one invasive ductal carcinoma (6.8%). Among the 26 cases of peripheral papillomas, there was one case of DCIS (3.8%), with a total underestimation rate of 5.8%; all underestimated lesions measured more than 1 cm. The median size was 11 mm at mammography and 19 mm at ultrasound. Our data suggest that lesions less than 1 cm in size, without atypia and concordant imaging and clinical findings, may not require surgical resection.