Osteoclast-type giant cell neoplasms of the parotid gland

The "Forgotten" Subtypes of Breast Carcinoma: A Systematic Review of Selected Histological Variants Not Included or Not Recognized as Distinct Entities in the Current World Health Organization Classification of Breast Tumors

Breast carcinoma is the most common cancer in women. Nineteen different subtypes of breast carcinomas are recognized in the current WHO classification of breast tumors. Except for these subtypes, there are a number of carcinomas with special morphologic and immunohistochemical features that are not included in the 5th WHO classification, while others are considered special morphologic patterns of invasive breast carcinoma of no special type. In this manuscript, we systematically review the literature on four different subtypes of invasive breast carcinoma, namely lymphoepithelioma-like breast carcinoma, breast carcinoma with osteoclast-like giant cells, signet-ring breast carcinoma, and metaplastic breast carcinoma with melanocytic differentiation. We describe their clinicopathological characteristics, focusing on the differential diagnosis, treatment, and prognosis.

An osteoclast-like giant cell tumor embedded in the mural nodule of a pancreatic mucinous cystic neoplasm: A case report and literature review

RATIONALE

Mucinous cystic neoplasms (MCNs) are relatively rare lesions, accounting for 2%-5% of all exocrine pancreatic neoplasms. MCNs mainly occur in women (female:male ratio = 20:1), with a peak incidence in the 5th decade of life. Osteoclast-like giant cell tumors (OGCTs) are rare and relatively aggressive neoplasms, comprising <1% of all pancreatic carcinomas. Herein, we present a rare "combination tumor" case and discuss the impact of mural nodules in pancreatic MCNs considering malignant transformation.

PATIENT CONCERNS

A 54-year-old Mongolian man, without vomiting, nausea or jaundice, presented with abdominal distention since 3 months. He had a 7-year history of diabetes. Physical examinations indicated slight middle abdominal tenderness without rebound tenderness or rigidity. Laboratory results revealed that the level of carcinoembryonic antigen (CEA) was 1.16 ng/ml (normal: <5 ng/ml); CA-199: 30.02 U/ml (normal: <27 U/ml); hemoglobin: 143 g/L; fasting glucose: 7.71 mmol/L; and albumin: 43 g/L. Abdominal enhanced computed tomography revealed a 7 × 6 cm solid neoplasm in the pancreatic body with partial enhancement and heterogeneity. Endoscopic ultrasound revealed a solid-cystic space-occupying lesion in the pancreatic body.

DIAGNOSIS

The preoperative preliminary diagnosis was pancreatic solid-cystic tumor, possibly a solid pseudopapillary tumor. Postoperative pathological findings revealed a pancreatic borderline MCN with an OGCT embedded in a mural nodule of the capsule. Immunohistochemical results indicated a simultaneous dual origin from the epithelium and stroma.

INTERVENTIONS

The patient underwent open distal pancreatectomy and splenectomy. Postoperative blood glucose levels were closely monitored and regulated. We intravenously administered single-agent gemcitabine (1400 mg on day 1) as the first-time chemotherapy, 1 month after surgery. After the first chemotherapy, the patient refused to receive further treatment owing to personal reasons.

OUTCOMES

The patient showed uneventful recovery and was discharged 13 days after the initial surgery. Follow-up was performed 1, 3 and 6 months after surgery. At 6 months, abdominal computed tomography scan showed no signs of recurrence, regional lymphadenopathy, or other abnormalities. And laboratory tests showed a platelet count of 301 × 10/L, postprandial blood glucose of 12.9 mmol/L and CA-199 level of 20 U/ml. The patient had no obvious discomfort.

LESSONS

Although pancreatic MCNs are widely accepted as borderline tumors, malignant transformations may occur due to various risk factors (cyst size, mural nodules, septations, and tumor location). The combination tumor in this case was more likely to increase the possibility of malignant biological behavior, thereby worsening overall prognosis. Therefore, long-term follow-up must be maintained with strict monitoring.

Primary osteoclast-like giant cell tumor of parotid gland: A rare extraskeletal presentation with diagnostic challenges

Primary osteoclast-like giant cell tumor (OC-GCT) has been rarely described in extraskeletal sites. The diagnosis primarily hinges on the detection of giant cells. However, these giant cells are also seen in many giant cell lesions, thus creating diagnostic confusion and dilemma. Here, we describe a rare case of a 24-year-old male with primary extraskeletal, OC-GCT presenting as a swelling in the right parotid region and highlight its cytological, histological and immunohistochemical characteristics with diagnostic challenges.

Features of a giant cell tumour of the parotid gland: A case report

A giant cell tumour (GCT) is a benign tumour that commonly arises in the distal end of the long bones. Extraosseous GCTs have been reported in a number of organs, but it is rare for a GCT to present in the parotid gland. Therefore, primary GCTs of the parotid gland (GCTPs) are extremely rare. Although GCTPs have been identified as benign soft-tissue tumours, they have a highly malignant potential and poor prognosis. In the present case, we report a 58-year-old male patient presenting with non-tender mass over the left preauricular area for 11 months. The final pathology report revealed a rare case of a GCTP that was treated by parotidectomy and adjuvant radiation therapy. The patient had no recurrence after 2 years of follow-up.

Osteoclast-like Giant Cell Tumor of Parotid Gland with a Carcinomatous Component: A Case Report

The giant cell tumor of the salivary gland is very rare, and 20 cases have been reported in the English-language literature. We report an additional case. A 57-year old man had noticed a mass in the right parotid area for several weeks. The diagnosis using aspiration cytology was a giant cell tumor possibly with a carcinomatous component. Superficial parotidectomy was carried out. The resected parotid gland contained a 1.8 cm-sized well-circumscribed brownish tumor. Histologically the tumor consisted of evenly distributed osteoclast-like giant cells, mononuclear cells and two small foci of a carcinomatous component. The osteoclast-like giant cells and mononuclear cells were positive for vimentin and CD68, and the carcinomatous component was positive for cytokeratin and epithelial membrane antigen. There was no metastatic lesion in the cervical lymph nodes. We believe this is the first case in Korea of an osteoclast-like giant cell tumor of the parotid gland.

Fine needle aspiration of pigmented villonodular synovitis of the temporomandibular joint

Temporomandibular joint (TMJ) problems are usually the result of functional disorders. Tumors of the TMJ are rarer entities, the diagnosis of which may be delayed due to a clinical impression of a functional ailment. We report a case of a patient with a recurrent TMJ area lesion diagnosed cytologically as pigmented villonodular synovitis (PVNS), an entity that very rarely involves the TMJ and is usually diagnosed by histology. The differential diagnosis of PVNS in the context of its location in and around the TMJ is also discussed.

A case of osteoclast-like giant cell tumor of the pancreas associated with borderline mucinous cystic neoplasm

A 34-year-old, previously healthy female presented with severe acute upper quadrant abdominal pain and an 11-cm cystic mass in the tail of the pancreas. The patient underwent distal pancreatectomy with total gross excision of the mass. Grossly, the mass consisted of a multiloculated cystic lesion measuring 11.7 cm in its greatest dimension. An irregular solid lobulation at the lateral aspect of the cyst was visible, measuring 3 cm in the largest dimension. Histologically, there were two distinct components: a mucinous, neoplastic epithelial cyst with few foci of moderate atypia, and nodular spindle cell areas containing multinucleated tumor giant cells. Immunohistochemically, the multinucleated giant cells were positive for vimentin, CD68 and CD45, and negative for cytokeratin and epithelial membrane antigen (EMA). The spindle cells of hypercellular stroma were stained for vimentin, but not for EMA or carcinoembryonic antigen (CEA). Neuron-specific enolase (NSE), S100 and Ki-67 showed no reactivity. The histological diagnosis "osteoclast-like giant cell tumor of the pancreas associated with borderline mucinous cystic neoplasm" was made. The patient recovered and is free of disease 4 years after the diagnosis.

Osteoclastlike giant cell tumor of the salivary gland

Giant cell tumor of the salivary gland is extremely rare, with only 15 cases published in the English literature. The tumor characteristically contains a mixture of multinucleated giant cells, resembling osteoclasts of bone, and neoplastic mononuclear cells. In about half of the reported cases, there is an associated carcinomatous component. We are reporting an additional case of giant cell tumor of the parotid gland that was initially misinterpreted as an extraosseous osteosarcoma in the biopsy specimen. The histologic and immunohistochemical findings as well as a review of the literature with discussion of the histogenesis of this unusual neoplasm are presented.

Osteoclast-Like Giant-Cell Tumor of the Parotid with Salivary Duct Carcinoma: Case Report and Cytologic, Histologic, and Immunohistochemical Findings

Primary giant-cell tumor of the salivary gland is a rare lesion with an incompletely characterized histogenesis. To the best of our knowledge, only 16 cases have been previously documented in the English-language literature. We report a new case, which occurred in a 75-year-old man who presented with a parotid mass and cervical lymphadenopathy. The patient underwent a left total parotidectomy and cervical lymph node dissection. As far as we know, ours is the only reported case of a primary giant-cell tumor of the salivary gland in which the patient presented with lymph node metastasis. Because so little is known about giant-cell tumor of the salivary gland, we use the occasion of this case report to describe the cytologic, histologic, and immunohistochemical characteristics that we observed.

Osteoclast-like giant cell tumor of the pancreas associated with mucus-secreting adenocarcinoma. Case report and discussion of the histogenesis

BACKGROUND/AIMS

The osteoclast-like giant cell tumor of the pancreas is a rare entity that closely resembles giant cell tumor of the bone, which has also been observed in many other organs. Some tumors also contain areas of ductal adenocarcinoma. Conflicting opinions exist regarding the tumor origin, whether it is mesenchymal or epithelial, neoplastic or reactive.

METHODS

We report the case of a 69-year-old Brazilian man with a mass in the head of the pancreas, the histological examination of which revealed a predominant component of osteoclast-like giant cells within a background of pleomorphic mononuclear cells with osteoid formation and other areas composed of conventional mucus-secreting adenocarcinoma.

RESULTS

Immunohistochemistry showed that carcinoma cells of the usual type expressed epithelial antigens (EMA and cytokeratin) and lysozyme; the giant cells expressed vimentin, CD45, CD68, and lysozyme; and the mononuclear cells expressed macrophage marker (HAM56), vimentin, and lysozyme, and only some of them expressed epithelial markers, CD45, and CD68.

CONCLUSION

Our immunohistochemical findings reveal that the giant cells in this case are of mesenchymal origin may be from the bone marrow cells. We believe that it is important to determine the histogenesis in each case to carry out the pertinent adjuvant therapy.

[Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas. A case report]

Undifferentiated carcinoma with osteoclast-like giant cells is a rare pancreatic neoplasm, with a possible cystic pattern, includes an adenocarcinoma component and giant cell mimicking osteoclastic bone tumor. We report the case of a 72-year woman admitted for jaundice and epigastric pain. Abdominal ultrasound and computed tomography scan revealed a 6 x 5 cm cystic and solid tumor of the pancreatic head with both bile duct and pancreatic duct dilatation. A pancreaticoduodenectomy was performed and pathologic examination revealed an undifferentiated carcinoma with osteoclast-like giant cells of the pancreatic head. The patient was alive and disease-free with a 18-month follow-up.

Osteoclast-type Giant Cell Neoplasm of Salivary Gland. A Microdissection-based Comparative Genotyping Assay and Literature Review

Primary salivary gland tumors resembling giant cell tumor of bone are very rare and have unsettled histogenesis. Both mesenchymal and epithelial origins have been suggested. We review 14 cases in the English-language literature and report another case, the first of which to be studied by microdissection-based microsatellite analysis. One-half of the tumors have been associated with a carcinoma, usually salivary duct carcinoma and carcinoma ex pleomorphic adenoma. Significant differences between this tumor and giant cell tumor of bone were observed. Unlike giant cell tumor of bone, in which the nuclei of the mononuclear and giant cells are similar, those of salivary gland show obvious differences between the nuclei of mononuclear cells and osteoclastic giant cells. In addition and in contrast to giant cell tumor of bone, the mononuclear cells of giant cell tumor of salivary gland express epithelial markers (epithelial membrane antigen, EMA; carcinoembryonic antigen, CEA) and androgen receptor. Genotypically, the microsatellite pattern of the giant cell component is more akin to the carcinomatous component and does not resemble giant cell tumor of bone. Biologically, giant cell tumor of salivary gland tends to be more aggressive than giant cell tumor of bone. We conclude that giant cell tumor of salivary gland is an unusual carcinoma that is not related to giant cell tumor of bone.

Osteoclastic giant cell tumor of the pancreas: case report and literature review

An unusual case of a 40-year-old woman seeking treatment for a 10-cm cystic neoplasm of the pancreas is described. Imaging revealed a large proteinaceous, fluid-filled cyst with a mural nodule. Laparotomy was successful with en bloc resection. Pathologic examination revealed a neoplastic mucinous epithelial tumor with an abundance of multinucleated tumor giant cells. This presentation is consistent with literature reports of an osteoclastic-type giant-cell tumor of the pancreas. The natural history, pathologic evaluation, and clinical implications of this rare neoplasm are discussed with reference to published reports.

The spectrum of giant cells in tumours of the salivary glands: an analysis of 11 cases

In view of the different terminology for salivary gland tumours with giant cells, eleven cases were analysed by histopathology and immunocytochemistry. Four cases (three pleomorphic adenomas, one carcinosarcoma in a pleomorphic adenoma) were classified as having a foreign-body giant cell reaction, and five cases (two mucoepidermoid carcinomas, one acinic cell carcinoma, two carcinomas in pleomorphic adenomas) as having a sarcomatoid osteoclast-like giant cell reaction. In two further cases a giant cell tumour and a giant cell granuloma were associated with carcinomas in pleomorphic adenomas. All giant cells showed characteristic expression of CD68 as a typical marker for histiocytes and macrophages with their origin in mononuclear haematopoetic stem cells. There was no evidence for an epithelial origin of the giant cells because all those examined had a negative reaction to cytokeratin. Foreign-body cells were characterized by cytoplasmic vacuoles and irregularly dispersed nuclei. They showed a focally circumscribed reaction mostly outside the connective tissue pseudocapsule of the tumours. The sarcomatoid osteoclast-like giant cell reactions in carcinomas were distinctly intermingled with the carcinomatous patterns. In contrast, the associated osteoclast-like giant cell tumour was distinctly separate from the salivary gland tumour tissue and was composed of numerous larger osteoclast-like giant cells with a greater number of nuclei (more than 20); these giant cells were uniformly distributed throughout the tumour tissue. The giant cell granuloma was also separate from the carcinoma and was composed of nests of smaller, more irregularly distributed giant cells.

Fine-needle aspiration of pigmented villonodular synovitis of the temporomandibular joint masquerading as a primary parotid gland lesion

The fine-needle aspiration findings in a case of pigmented villonodular synovitis of the temporomandibular joint are presented. The characteristic cytomorphologic and clinical features of this uncommon, benign fibrohistiocytic lesion are discussed. In addition, due to the initial clinical impression of a primary parotid gland lesion, the differential diagnosis for the cytomorphologic features observed (histiocytoid cells admixed with osteoclast-like giant cells) are discussed within the context of a primary salivary gland mass.

Hybrid tumours of salivary glands. Definition and classification of five rare cases

Hybrid tumours are very rare tumour entities which are composed of two different tumour entities, each of which conforms with an exactly defined tumour category. The tumour entities of a hybrid tumour are not separated but have an identical origin within the same topographical area. In contrast, biphasically differentiated tumours are a mixture of two cellular patterns with a corresponding term in the tumour classification. Examples of a biphasic differentiation are: basaloid-squamous carcinoma, adeno-squamous carcinoma or sarcomatoid carcinoma, and epithelial-myoepithelial carcinoma, mucoepidermoid carcinoma or adenoid cystic carcinoma. Hybrid tumours must also be distinguished from the multiple occurrence of salivary gland tumours which can develop syn- or metachronously. In the tissue samples of more than 6600 salivary gland tumours covered by the Salivary Gland Register (Institute of Pathology, University of Hamburg, Germany) only 5 cases of hybrid tumours were recorded between 1965 and 1994. This means less than 0.1% of all registered tumours. Case 1 was a very rare example of a hybrid adenoma with differentiation as a basal cell adenoma and a canalicular adenoma of the parotid gland. The similar cellular origin of both types of adenoma may be an explanation for its development in a hybrid adenoma. Case 2 is a hybrid tumour with a composition of basal cell adenoma and a glandular type of adenoid cystic carcinoma. In both types of tumours the two cell types (duct-lining cells and modified myoepithelial cells) have a similar histogenetic origin. Therefore, the development of the both cell types in a hybrid tumour with two trends of differentiation is possible. Case 3 represents a hybrid adenoma as a mixture of a Warthin tumour and a sebaceous adenoma. Although inclusions of sebaceous cells are observed in Warthin tumours, this hybrid tumour shows a composition of two different epithelial structures in a varied mixture. Case 4 is a very rare and unique hybrid carcinoma with two absolutely different components: acinic cell carcinoma and salivary duct carcinoma. The poor prognosis of this hybrid carcinoma is determined by the salivary duct carcinoma. Case 5 represents a hybrid carcinoma whose two components have a similar histogenetical basis: epithelial-myoepithelial carcinoma and a glandular type of adenoid cystic carcinoma. Both carcinomas are composed of variable proportions of ductlining cells and myoepithelial cells.

Multiple tumours of the salivary glands--terminology and nomenclature

Multiple tumours of the salivary glands are very rare and their combinations according to histological classification of the tumours, localisation and origin (origin in independent topographical areas or in the same tissue) are diverse. The following two categories can be distinguished: common occurrence of multiple salivary gland tumours with identical histology, or with different histology. In either group the tumours can be unilateral or bilateral, synchronous or metachronous. The most common multiple tumours with an identical histology are Warthin tumours and pleomorphic adenomas. Bilateral occurrence has been observed especially in oncocytomas, acinic cell carcinomas and basal cell adenomas. In the group of multiple tumours with differing histology, Warthin tumours and pleomorphic adenomas show a number of combinations with other adenomas or carcinomas of the salivary glands. Notable also is the simultaneous occurrence of salivary gland tumours with other oral tumours or extraglandular tumours, especially thyroid carcinomas and breast carcinomas. Multiple salivary gland tumours must be distinguished by nomenclature from tumours with biphasic differentiation and hybrid tumours. Tumours with biphasic differentiation are defined as regular, recurring mixtures of two cellular components in the same tumour and have a corresponding term in the tumour classification. Hybrid tumours are very rare and are composed of two different tumour entities within the same topographical area. Each of the tumour entities conforms with an exactly defined tumour category.

Renal cell carcinoma with osteoclast-like giant cells

Primary extraskeletal epithelial neoplasms with osteoclast-like giant cells are rare. We describe a case of renal cell carcinoma with a sarcomatoid component and non-neoplastic osteoclast-like giant cells. The giant cells were noted in both the conventional and the sarcomatoid components of the neoplasm. Immunohistochemical studies indicate that these cells are monocyte/histiocyte in origin and most probably a host stromal reaction to the neoplasm.

Carcinosarcoma of the submandibular salivary gland. Immunohistochemical findings

Carcinosarcomas of the salivary glands are rare lesions that generally have been associated with benign mixed tumors. The authors report a case of a submandibular gland lesion, which occurred in a 64-year-old man, that was composed of intermingled ductal type adenocarcinoma and osteogenic sarcoma with a large component of osteoclast-like giant cells. The local recurrence of the tumor was entirely sarcomatous with no epithelial component observed. There was no histologic evidence of a preexisting or coexisting pleomorphic adenoma. Immunohistochemical studies confirmed two separate populations of tumor cells, corresponding to the histologic growth pattern. The authors review the literature and discuss histogenetic implications of distinction between de novo carcinosarcoma and carcinosarcoma in association with pleomorphic adenoma.

Osteoclast-like giant cell tumor of the pancreas: immunophenotypic similarity to giant cell tumor of bone

An immunophenotype was performed on an osteoclast-like giant cell tumor of the pancreas using a panel of antibodies to epithelial and leukocyte antigens. Several antibodies to cytokeratin and carcinoembryonic antigen were negative in the tumor. Osteoclast-like cells were positive for CD4, CD13, CD45, CD68, CD71, and vimentin, but negative for lysozyme and HLA-DR. Mononuclear tumor cells were positive for CD4, CD11c, CD13, CD14, CD45, CD68, CD71, HLA-DR, and vimentin, but negative for lysozyme. The phenotype is similar to that previously described for giant cell tumor of bone. The osteoclast-like cell phenotype is also similar to that reported for normal osteoclasts. The findings support a nonepithelial origin for osteoclast-like giant cell tumor of the pancreas, and suggest a derivation similar to giant cell tumor of bone.