Touch Imprint and Fine Needle Aspiration Cytology of Giant Cell Tumor of Tendon Sheath: A Case Report

Abstract

INTRODUCTIONGiant cell tumors of the tendon sheath (GCTTS) are the second most common lesion of the hand, with simple ganglion cysts being the most common. This tumor was first described by Chassaignac, who referred to it as a "cancer of the tendon sheath". 1 Giant cell tumor of the tendon sheath (GCTTS) is a slowly growing, benign soft tissue tumor. The tumors occur predominantly on the hands and feet. Although the clinical and histopathologic features are well-defined, only a few reports have described the cytologic appearance of this entity. A 26-year-old woman presented with a gradually developing circumscribed soft tissue mass near the proximal phalanx of her left little finger for one year. Imprint and fine needle aspiration (FNA) smears were obtained from the excisional biopsy specimen. The imprint smears were composed of predominantly singly dispersed bland mononuclear cells and several giant cells. The mononuclear cells were polygonal to round, and they showed a histiocyte-like appearance. Osteoclast-type multinucleated giant cells of various sizes were randomly scattered throughout the smears, and these cells contained 3 to 50 nuclei. Nuclear atypia and pleomorphism were absent in both the single and giant cells. Loose aggregates of hemosiderin-laden macrophages and binuclear stromal cells were also seen. The cytologic features of the FNA smears were similar with those of the imprint. Additionally, the FNA smears contained several clumps of densely collagenous stromal tissue that were seldom noted in previously reported cytologic material. The cytologic features were well-correlated with the concurrent histologic findings and the diagnosis of GCTTS was made. When the clinical and radiologic datas are integrated, the diagnosis of GCTTS can be strongly suggested, based on the pre-operative cytologic specimen. CASE Clinical PresentationA 26-year-old woman presented with a soft tissue mass around the little finger of the left hand and intermittent pain for one year. The mass had recently been increasing in size. There was no history of trauma or significant past medical history. On physical examination, there was no discoloration of the overlying skin.The soft tissue mass was located near the proximal phalanx of the little finger, and the mass measured 2 × 1 cm. It was firm, slightly mobile and nontender on palpation. There was no effusion in the joint space. The MRI scan showed a well-circumscribed, extraarticular soft tissue mass with no bony destruction and it suggested giant cell tumor of the tendon sheath (Fig. 1).Excisional biopsy was performed. The specimen was a well-demarcated tan nodule with a lobulated contour, and it measured 2.7×2×0.5 cm. Scanty thick yellowish material was noted on the external surface. The cut surface was gray white and solid with focal yellow flecks at the periphery. Fine needle aspiration was performed on the surgical specimen with using a 10 ml disposable syringe attached to a 22 gauge needle. A number of smears were made. Additionally, touch imprint smears were prepare...

Giant Cell Tumor of Tendon Sheath in Supraclavicular Region: Cytological Aspect of a Common Tumor in an Uncommon Location

“…2,7 First are the stromal cells or histiocyte-like cells that appear round to fusiform, eccentrically placed nuclei, even chromatin distribution, single micronucleoli and a small to moderate amount of cytoplasm with dispersed individual cells or loosely aggregated sheets. 2,[7][8][9] Binucleation, nuclear groove or intranuclear pseudoinclusion may be illustrated in some cases. 2,8,10 Multinucleated giant cells are another main feature of GCTTS.…”

“…They usually contain 3 to more than 50 nuclei in each cell with amphophilic cytoplasm. 2,7,9 Other features, advocating GCTTS diagnosis, are hemosiderin-laden macrophages, xanthoma cells and myxoid background. 2,7,9,11 According to these features in those prior studies, almost all findings could be found in our presented case, comprising stromal cells, multinucleated giant cells and hemosiderin-laden macrophages.…”