Osteoclastoma of the orbit. Case report.

Abstract

TUMOURS characterized by the presence of giant cells are not uncommonly seen in sections from orbital masses. The histologic appearance of osteoclastoma as first described by N6laton (1860) is of tumours consisting essentially of spindle cells, round cells, and multinucleated giant cells with an abundance of nuclei. It is a rare tumour, which until recently had not been differentiated from other fibrous tumours of bone, and usually occurs at the ends of long bones, although a few have been reported in the orbit and in the region of the sphenoid and the labyrinth. This paper reports a case of osteoclastoma of the orbit.Case Report A boy aged 5 years was admitted to Ein Shams Hospital complaining of progressive right proptosis. Three weeks before admission he had a raised temperature, which was followed by proptosis and later by profuse watering of the right eye.Clinical Examination.-On admission, the right eye showed severe, non-pulsating, irreducible proptosis (27 mm. by simple exophthalmometer) and lagophthalmos. Movement was limited in all directions. No mass was detectable around the orbital margins. Ten days after admission the cornea had turned opaque from exposure. Regional lymph nodes were not enlarged.Investigations.-Radiographs of the orbit were normal. Blood Wassermann was negative and the blood count showed lymphocytosis. Orbitonometry, carried out under general anaesthesia, proved the presence of a solid orbital mass. A clinical diagnosis of a highly malignant tumour was made and exenteration of the orbit was carried out. At operation no bony attachment was revealed and the bones of the orbit were normal. PathologyMacroscopic examination of the exenterated orbital tissue showed an intact globe with a firm rubbery mass involving both the inside and the outside of the muscle cone. This mass appeared nodular and well encapsulated. The exenterated tissue 'was cut vertically through the centre revealing a greyish-white mass with a few areas of haemorrhage. No mass was seen inside the globe, which was slightly compressed by the tumour; the lens was clear and the retina in situ (Fig. 1).Microscopic examination: Sections stained with haematoxylin and eosin show the tumour mass to consist of spindle cells and a large number of giant cells possessing numerous centrally placed nuclei. The cytological picture is fairly uniform with no pleomorphism or active mitosis.

Giant‐cell tumours of soft tissues

“…The term giant-cell tumour is often included in schemes of classification for soft-tissue tumours (Pack and Ariel, 1958;Stout and Lattes, 1967;Enzinger, 1969), but in such a context it is usually regarded as a synonym for pigmented villonodular synovitis, a term used to describe a group of lesions that are not really comparable to giant-cell tumour of bone (see below). In a strict sense the literature contains very few accounts of true giant-cell tumours of soft tissues, although this type of tumour has been reported in the the breast (Dyke, 1926;Fry, 1927;Harvey et al 1940;Rottino and Howley, 1945), the orbit (Abdalla and Hosni, 1966), the heart (Dorney, 1967), and even in the wall of a pseudomucinous cystadenoma of the ovary (Bettinger, 1953). Geschickter and Copeland (1949) used the term giant-cell tumour to describe certain xanthomatous lesions of soft tissues that they regarded as originating in sesamoid bones.…”

Osteoclast-like giant cell tumor of the pancreas associated with mucus-secreting adenocarcinoma

“…They have been noted to occur in the parotid gland [8], thyroid gland [9], skin [10], orbit [11], kidney [12], and breast [13]. However, this lesion seems to have the highest predilection for the pancreas.…”

Orbital osteoclastoma of apparent extraskeletal origin in a pagetic patient: A case report

“…More common primary bone lesions such as fibrous dysplasia, brown tumor of hyperparathyroidism, and giant-cell reparative granuloma have often been inappropriately classified as conventional giant-cell tumors in ophthalmic pathology. 11,12 Giant cell tumor of the tendon sheaths (extraarticular localized pigmented villonodular tenosynovitis) has been occasionally associated with PBD 13,14 and, in view of the present tumor's attachment to an extraocular muscle, has to be considered in the differential diagnosis.…”