First Case Report of a Huge Giant Cell Tumor of Soft Tissue Originating from the Retroperitoneum

Abstract

Patient: Male, 78Final Diagnosis: Giant cell tumor of soft tissueSymptoms: Fatigue • weight lossMedication: —Clinical Procedure: Surgical resectionSpecialty: SurgeryObjective:Rare diseaseBackground:Giant cell tumor of soft tissue (GCT-ST) is a rare disease generally generated from superficial tissue. We report an extremely rare case of giant cell tumor of soft tissue arising from retroperitoneal tissue.Case Report:A 78-year-old man visited our medical center with the chief complaint of fatigue and weight loss for 1 month. He had a hard and immobilized mass without pain in the left upper quadrant. Contrast-enhanced CT showed a huge tumor (22×20×16 cm) in the retroperitoneal space, and it invaded into the stomach, colon, pancreas, spleen, and left kidney. MRI demonstrated the tumor had a serous cystic component as T1 was low, T2 was high, and DWI was slightly high. We diagnosed the retroperitoneal malignant tumor, and tumor resection was performed with total gastrectomy, partial colectomy, distal pancreatectomy, left nephrectomy, and left adrenal-ectomy for complete resection, without any postoperative complications. The tumor predominantly consisted of a solid mass, and had necrotic lesions, cystic lesions, and calcification. The histological exam showed it was composed of spindle and multinucleated giant cells; however, there was no cellular atypia or pleomorphism. Immunohistochemical staining characterized the tumor with CD68+, SMA+, CD34–, Desmin–, and S-100–. We finally diagnosed it as GCT-ST with the intermediate group of malignancy, according to WHO criteria. Thereafter, the patient had no recurrence at 1 year after resection.Conclusions:The huge GCT-ST arising from the retroperitoneal space, which has never before been reported, was successfully resected. We report it with pathological findings to add to the relevant literature.

A Pilot Evaluation of Magnetic Resonance Imaging Characteristics Seen With Primary Soft Tissue Giant Cell Tumor in 2 patients

“…In previous reports, Aoki et al [3] and Murphey et al [4] have indicated that MR images of GCT of bone may suggest a presence of solid components with hypointensity to isointensity for T 1 -and T 2 -weighted images, caused by hemosiderin deposition or high collagen content, which is consistent with our findings. On contrast images, the solid regions are intensely slowly enhanced, reflecting the hypervascular tissue in accordance with IHC performance (like the bone GCT), and are in line with findings in other benign soft tissue tumors [2][3][4] , unlike the GCT-ST tumors with diffuse cystic components located in the subcutaneous tissue or malignant soft tissue tumors [8][9][10][11] .…”

“…Histologically, GCT-ST lesions bear a close resemblance to their bony counterparts, giant cell tumor of bone. Most of the existing reports are pathological and clinical studies, while the imaging aspects have only been reported in the cases of adjacent bone or with atypical cystic degeneration [2][3][4][5][6][7][8][9][10][11] . With regard to MR or ultrasonography imaging features, superficial masses can be further identified based on facial edema, skin thickening, skin contact, internal hemorrhage or necrosis and lobulation of the mass [12][13][14][15] .…”

A Pilot Evaluation of Magnetic Resonance Imaging Characteristics Seen With Primary Soft Tissue Giant Cell Tumor in 2 patients

“…In the present study, all lesions were significantly big (maximum lesion size ranged from 4.0 cm to 6.0cm) and were located in the superficial areas of extremities or trunk. This type of lesion is commonly observed in GCT-ST, but it can also be found in the deep soft tissues of head, neck and retroperitomeum region [2][3][4][5][6][7][8][9][10] . Unlike deep-seated masses, size criteria (i.e.…”

“…Clinically, primary GCT-ST mainly affects young to middle-age adults [4][5][6][7][8][9][10][11]16] . Here we reported two cases with GCT-ST: the first was an elder man who was asymptomatic and had a benign clinical course; the other one was a young woman who presented with ill-circumscribed multinodular mass were included in the differential diagnosis.…”

“…Histologically, GCT-ST lesions bear a close resemblance to their bony counterparts, giant cell tumor of bone. Most of the existing reports are pathological and clinical studies, while the imaging aspects have only been reported in the cases of adjacent bone or with atypical cystic degeneration [2][3][4][5][6][7][8][9][10] . There is only one case report on intravoxel incoherent motion (IVIM) DWI of juxtacortical mass [2] .…”