Breast carcinoma with stromal multinucleated giant cells

Breast carcinomas with osteoclast-like giant cells: a comprehensive clinico-pathological and molecular portrait and evidence of RANK-L expression

Breast carcinomas (BC) with osteoclast-like giant cells (OGC) are rare. Despite their distinct stromal features, their molecular characteristics remain unknown. Here, we report comprehensive clinico-pathological and molecular findings for 27 patients diagnosed with BC-OGC at Institut Curie between 2000 and 2021. Seventeen (63%) cases were invasive carcinomas of no special type (IC NST) with OGC (OGC-IC NST), four (15%) were mixed or multifocal cases with and without OGC (OGC-Mixed), and six (22%) were metaplastic carcinomas with OGC (OGC-MC). All OGC-IC NST and OGC-Mixed cases were ER+ HER2- tumors (most being luminal A based on transcriptomic subtyping, when available), while all OGC-MC were triple-negative. The median age at diagnosis was 46, 45 and 62 years for OGC-IC NST, OGC-Mixed and OGC-MC, respectively. Three patients developed distant metastases (one OGC-IC NST, two OGC-Mixed), one of whom died of metastatic disease (OGC-Mixed), and one other patient died of locally advanced disease (OGC-MC). Histopathological evaluation comparing 13 OGC-IC NST and 19 control IC NST without OGC confirmed that OGC-IC NST showed significantly higher density of vessels (by CD34 immunohistochemistry (IHC)), iron deposits (Perls stain), and CD68 and CD163-positive cell infiltrates. Genomic findings for nine OGC-IC NST and four OGC-MC were consistent with the underlying histologic subtype, including activating alterations of the PI3K/AKT/mTOR pathway in 7/13 cases. Using RNA-seq data, differential gene expression analysis between OGC-IC NST (n = 7) and control IC NST without OGC (n = 7) revealed significant overexpression of TNFSF11 (RANK-L), TNFRSF11A (RANK), CSF1 (M-CSF), CSF1R, and genes encoding osteoclastic enzymes (MMP9, ACP5, CTSK, CTSB) in OGC-IC NST, while OPG (osteoprotegerin) was underexpressed. We also confirmed for the first time RANK-L expression in BC with OGC by IHC (seen in 15 out of 16 cases, and only in 2 of 16 controls without OGC). These findings could offer a rationale for further investigating RANK-L as a therapeutic target in BC with OGC.

Breast Carcinoma with Osteoclast-Like Giant Cells: Immunohistochemical and Ultrastructural Study of a Case and Review of the Literature

We describe an unusual case of infiltrating ductal carcinoma, not otherwise specified, containing numerous benign stromal osteoclast giant cells (OGCs). Macroscopically, the tumor appeared as a well-outlined dark brown mass and was initially interpreted as a benign lesion on the mammograms. OGCs were uniformly distributed in the tumor and were found in vascularized, hemorrhagic stroma often abutted on the nests of tumor cells. Electron microscopy supported a histiocytic origin of the OGCs, but immunohistochemistry failed to confirm the observation. The patient was alive and well 30 months following the operation. A review of the literature concerning breast carcinoma with OGCs is also presented.

Mammary carcinoma with osteoclast-like giant cells: A study of four cases and a review of literature

Mammary carcinoma with osteoclast-like giant cells (OGCs) is an extremely rare tumor. To the best of our knowledge, only 45 cases have been reported in the literature. Here we report four additional cases of this tumor. The fine-needle aspiration cytology was performed in all four cases, showing an abundance of giant cells and mononucleated stromal cells in intimate association with low- or medium-grade malignant epithelial clusters. Histologically, cribriform patterns predominated in three cases. In one case, OGCs were more pronounced in the vicinity of ductal carcinoma in situ accompanied by marked stromal angiogenesis. This study, as well as review of the literature, underlines the characteristic features of this rare histologic type of carcinoma.

Breast carcinoma with osteoclast-like giant cells: morphological and ultrastructural studies of a case with review of the literature

Primary carcinoma with osteoclast-like giant cells is a very rare tumour of the female breast. The clinical course, histological, immunohistochemical and ultrastructural features of 61 cases of invasive duct carcinoma with osteoclast-like multinucleated giant cells (OMGCs) are reviewed and a new case is presented. The median patient age of all patients included in the review was 42 years, the tumour was located in the upper outer quadrant and the mammographic and gross findings were of a well-defined tumour of dark-brown colour, resembling a metastatic melanoma. Follow-up data in the literature have shown that 86% of patients with these tumours are still alive after 5 years. Histologically, these tumours are invasive ductal carcinomas with OMGCs next to the neoplastic glands and within their lumen. Signs of recent and past haemorrhage are ubiquitously present in the highly vascularized stroma. Immunohistochemical and ultrastructural studies have claimed a benign histiocytic nature of the OMGCs; they may represent a special type of polykaryon, distinct from both osteoclasts and inflammatory giant cells.

Bilateral Infiltrating Lobular Carcinoma of the Breast with Osteoclast-Like Giant Cells

A case of bilateral infiltrating lobular carcinoma of the breast containing osteoclast-like giant cells is presented. Notable pathologic features include prominent tumor-associated angiogenesis and the presence of osteoclast-like giant cells in axillary lymph node metastases. Immunohistologic and ultrastructural examination support a nonepithelial, histiocytic origin for the giant cells, and results are similar to previous reports of osteoclast-like giant cells associated with breast carcinoma. This is the first report of bilateral pure infiltrating lobular carcinoma of the breast with osteoclast-like giant cells and the first case of pure lobular carcinoma with osteoclast-like giant cells present in lymph node metastases.

Breast carcinoma with osteoclast-like giant cells

The cytological and histological findings of a case of breast carcinoma with osteoclast-like giant cells are presented. A fine needle aspiration specimen demonstrated the characteristic combination of malignant epithelium and reactive multinucleated cells and enabled identification of this rare variant of breast cancer. Immunocytochemical studies using the monoclonal antibody KP1[CD68] support a histiocytic origin for the osteoclast-like cells.

Peripheral giant cell granuloma: evidence for osteoclastic differentiation

Nine cases of peripheral giant cell granuloma of the oral cavity have been immunohistochemically analyzed to assess the nature of the giant cells. Giant cells were unreactive when tested with antibodies recognizing myelomonocytic and macrophage markers (lysozyme, MAC 387, HAM 56) but showed strong immunoreactivity with MB1, an antibody reactive with osteoclasts. It is concluded that giant cells characterizing giant cell granuloma exhibit a phenotype distinct from other giant cells found in sites of chronic inflammation and may be true osteoclasts.

Alveolar variant of infiltrating lobular carcinoma of the breast with stromal osteoclast-like giant cells

An alveolar variant of infiltrating lobular carcinoma of the breast in which a prominent feature was the presence of numerous osteoclast-like giant cells in a richly vascularized stroma is described. A similar stromal reaction has previously been reported in 46 breast carcinomas of various histologic types, but only once in a pure infiltrating lobular carcinoma. The fine needle aspiration cytological and histological appearances and the immunohistochemical and ultrastructural features of this tumor are reported. Our study confirms the histiocytic nature of the multinucleated giant cells and their similarity to normal osteoclasts.

Immunohistochemical characterization of osteoclasts and osteoclast-like cells with monoclonal antibody MB1 on paraffin-embedded tissues

In this study we provide evidence that MB1, a newly developed monoclonal antibody which reacts with B lymphocytes and a proportion of T cells and monocytes, can be successfully used for the direct immunohistochemical identification of osteoclasts on paraffin-embedded surgical specimens. The antigen(s) recognized by MB1 is present at high density in the cytoplasm of osteoclasts of fetal bone and in the multinucleated cells of human giant cell tumour of bone (osteoclastoma), but is weakly expressed or absent in the giant cells of granulomas. MB1 is thus proposed as a new immunohistochemical marker for osteoclasts on paraffin-embedded material.