Fine‐needle aspiration diagnosis of giant cell tumour of bone presenting at unusual sites

Jain, Manjula; Aiyer, Hema Malini; Singh, Monu; Narula, MK

doi:10.1002/dc.10188

Cited by 21 publications

(12 citation statements)

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“…7,8 And, with the exception of scattered case reports or distal extremity cases reported within larger series, FNAB of the foot and ankle region has been largely neglected. [11][12][13][14][15][16][17] The purpose of this study is to report our experience with FNAB of the upper and lower distal extremities.…”

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confidence: 99%

Fine-Needle Aspiration Biopsy of the Distal Extremities

2010

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We reviewed our cytopathology databases for an 11-year period to identify all fine-needle aspiration biopsy (FNAB) cases of palpable masses of the hand, wrist, ankle, or foot. Cases were included only if there was a subsequent tissue biopsy or a minimum 1-year clinical follow-up. Of 141 aspirates, 41, 23, 34, and 43 were from the hand, wrist, ankle, and foot, respectively. Specific benign or malignant diagnoses were achievable in 71.6% of cases, whereas the remaining cases were given a descriptive diagnosis (26.2%) or, infrequently, a "suspicious for" diagnosis (2.1%). Overall sensitivity and specificity for distinguishing a benign from malignant entity from all 4 sites were 100% and 96%, respectively, whereas positive and negative predictive values were 88% and 100%, respectively. The most common lesion was a ganglion. Of the benign neoplasms, giant cell tumor of tendon sheath (17) and desmoid-type fibromatosis (7) were most common. Of 31 malignancies, 24 were sarcomas: sarcoma not otherwise specified (6), high-grade pleomorphic sarcoma (5), and Ewing sarcoma (3) were most common. Seven nonsarcomas included melanoma (3), metastatic squamous carcinoma (2), and malignant lymphoma (2). An FNAB-procured cytopathologic diagnosis is clinically reliable in a high percentage of distal extremity mass lesions.

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confidence: 99%

Fine-Needle Aspiration Biopsy of the Distal Extremities

2010

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“…These tumors are known to regress after correction of hyperparathyroidism. Pathologic differentiation of brown tumors from other giant cell-containing bone lesions can be challenging (6). In addition to multiple osteolytic brown tumors, our patient also had the characteristic radiographic findings of hyperparathyroidism, including erosions and subperiosteal bone resorption on the radial aspect of the mid phalanx of the left middle finger, the latter incidentally seen in her initial radiograph (Fig.…”

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confidence: 90%

Primary Hyperparathyroidism-Related Brown Tumors Mimicking Other Giant Cell-Containing Skeletal Tumors: Role of Correlative Imaging in Diagnosis

Manzil

Bhambhvani

Vattoth

et al. 2013

Journal of Nuclear Medicine Technology

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A patient initially suspected of having a giant cell granuloma was subsequently found-through additional imaging with 99m Tc-sestamibi and ultrasound-to have osteolytic brown tumors caused by a parathyroid adenoma. Brown tumors that relate to primary hyperparathyroidism may mimic other skeletal tumors that contain giant cells, presenting difficulty with accurate diagnosis. Correlative imaging can have a valuable role in such cases, potentially avoiding the extensive work-up usually done for suspected bone metastases. Wepresentacaseofayoungwomanwi th an osteolytic femur and maxillary brown tumors from primary hyperparathyroidism who was misdiagnosed as having giant cell-rich tumors including aneurysmal bone cyst and giant cell granuloma. Correlation between biochemical and multimodality imaging findings eventually led to the accurate diagnosis of brown tumors. CASE REPORTA 23-y-old woman presented with a pathologic fracture of the right femoral neck secondary to osteolytic lesions seen on CT (Fig. 1A). The fracture required hip hemiarthroplasty. On pathologic examination, an aneurysmal bone cyst was found to correlate with the CT findings. The patient's work-up included a skeletal survey that was notable for hypercalcemia and multiple osteolytic lesions, several of which were hot on a whole-body bone scan obtained 3 h after intravenous injection of 740 MBq (20 mCi) of 99m Tcmethylene diphosphonate (Fig. 1B). Contrast-enhanced maxillofacial CT (iopamidol [Isovue; Bracco], 85 mL; 120 kVp; 160 mA; 180-mm field of view) was also performed for evaluation of a left mandibular mass and numbness and revealed multiple osteolytic facial lesions ( Figs. 2A and 2B). Biopsy of the left mandibular mass was consistent with a giant cell granuloma. Further work-up demonstrated an elevated level of serum parathyroid hormone (1,492 pg/mL; reference range, 10-90 pg/mL) and calcium (14.9 mg/dL; reference range, 8.4-10.2 mg/dL), consistent with primary hyperparathyroidism. These findings led to additional imaging, including a parathyroid scan with early (15 min) and delayed (2 h) planar images obtained after intravenous injection of 740 MBq (20 mCi) of 99m Tc-sestamibi (Fig. 3A) and neck ultrasound (Fig. 3B), both of which showed a left inferior parathyroid adenoma, which was later confirmed on pathologic examination after surgical excision. The right hip, left mandible, and numerous other osteolytic skeletal lesions were thus attributed to primary hyperparathyroidism-related multifocal brown tumors. After left inferior parathyroidectomy, the levels of serum parathyroid hormone (32 pg/mL) and calcium (9.3 mg/dL) returned to normal, indicating cure. Follow-up maxillofacial CT revealed regression and sclerosis of the various osteolytic facial lesions (Fig. 2C) after correction of hyperparathyroidism. DISCUSSIONGiant cells can be seen in many bone tumors, including giant cell tumors, aneurysmal bone cysts, giant cell granulomas, giant cell-rich osteosarcomas, chondrosarcomas, and brown tumors associated with hyperparathyroidism (1). Beca...

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“…Radiologically, it is usually lytic and expansile without prominent peripheral sclerosis and periosteal reaction [9]. The histopathological findings are often a mixture of all components, and the differential diagnosis of GCTB, not surprisingly, would include central giant cell granuloma, aneurismal bone cyst (ABC), and osteitis fibrosa cystica (brown tumor) [10]. Fine needle aspiration cytology (FNAC) brings out a large number of giant cells as well as stromal cells.…”

Section: Discussionmentioning

confidence: 99%

Rare presentation of giant cell tumor of bone in the lateral end of the clavicle

Khera

2013

Am J Case Rep

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Patient: Male, 30Final Diagnosis: Giant cell bone tumorSymptoms: Bone swelling • painMedication: —Clinical Procedure: —Specialty: OncologyObjective:Unusual clinical courseBackground:Cooper first reported giant cell tumors (GCT) in the 18th century. The clavicle is a rare site for tumors. Metastatic tumors are more common than benign. This is the first case of GCT lateral end of clavicle to be reported in the literature.Case Reports:A 30-year-man was admitted with a 1-year history of progressively increasing swelling and pain over the left lateral end of the clavicle.The plain radiograph and PET scan revealed an expansile radiolucent lesion in the lateral end of the clavicle. Swelling was epiphsio-metaphyseal in location. It demonstrated geographical type of destruction with a narrow zone of transition. There was no periosteal reaction or soft-tissue component. The mitotic activity was found to be 0–1/10 HPF. Diagnosis was confirmed histopathologically. A wide excision of the mass, including 3 cm of healthy tissue of the clavicle, was performed.Conclusions:The presence of an expansile lytic lesion of the lateral end of the clavicle should be taken seriously and complete radiological and histopathological investigation should be done and giant cell tumor of the bone should be kept in mind despite its rarity.

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Fine‐needle aspiration diagnosis of giant cell tumour of bone presenting at unusual sites

Cited by 21 publications

References 5 publications

Fine-Needle Aspiration Biopsy of the Distal Extremities

Fine-Needle Aspiration Biopsy of the Distal Extremities

Primary Hyperparathyroidism-Related Brown Tumors Mimicking Other Giant Cell-Containing Skeletal Tumors: Role of Correlative Imaging in Diagnosis

Rare presentation of giant cell tumor of bone in the lateral end of the clavicle

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