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Pseudosarcomatous Spindle Cell Proliferation With Osteoid Matrix Mimicking Osteosarcoma: A Distinct Histologic Phenotype in Giant Cell Tumor of Bone Following Denosumab Therapy

Pseudosarcomatous Spindle Cell Proliferation With Osteoid Matrix Mimicking Osteosarcoma: A... Giant cell tumor of bone (GCTB) is a distinct benign locally aggressive neoplasm of bone composed of multinucleated osteoclast-type giant cells and round to oval or spindled mononuclear cells. It comprises 4% to 5% of all primary bone tumors and 18% to 20% of all benign bone tumors, and usually presents as osteolytic lesion of the bone with predilection for the epiphyses of long bones, often in skeletally mature individuals between 20 and 50 years of age. Radiographically, it presents as an eccentric radiolucent lesion frequently involving the epiphyseal region of long bone. The prototypic histopathology includes a dense population of round to oval or spindled mononuclear cells admixed with fairly uniform large numbers of osteoclast-type multinucleate giant cells. Even though GCTB is considered as benign, it can be very aggressive at times and can also metastasize to lungs as implants. For decades the treatment options for GCTB has remained the same, ranging from surgical curettage to radical resection depending upon the tumor extent. Regardless, a recurrence rate of up to 15% to 25% is noted after surgical treatment. 1–3 Recently, receptor activator of nuclear factor κ-B ligand (RANKL) pathway has been thought to be involved in the http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Applied Immunohistochemistry & Molecular Morphology Wolters Kluwer Health

Pseudosarcomatous Spindle Cell Proliferation With Osteoid Matrix Mimicking Osteosarcoma: A Distinct Histologic Phenotype in Giant Cell Tumor of Bone Following Denosumab Therapy

Pseudosarcomatous Spindle Cell Proliferation With Osteoid Matrix Mimicking Osteosarcoma: A Distinct Histologic Phenotype in Giant Cell Tumor of Bone Following Denosumab Therapy


Giant cell tumor of bone (GCTB) is a distinct benign locally aggressive neoplasm of bone composed of multinucleated osteoclast-type giant cells and round to oval or spindled mononuclear cells. It comprises 4% to 5% of all primary bone tumors and 18% to 20% of all benign bone tumors, and usually presents as osteolytic lesion of the bone with predilection for the epiphyses of long bones, often in skeletally mature individuals between 20 and 50 years of age. Radiographically, it presents as an eccentric radiolucent lesion frequently involving the epiphyseal region of long bone. The prototypic histopathology includes a dense population of round to oval or spindled mononuclear cells admixed with fairly uniform large numbers of osteoclast-type multinucleate giant cells. Even though GCTB is considered as benign, it can be very aggressive at times and can also metastasize to lungs as implants. For decades the treatment options for GCTB has remained the same, ranging from surgical curettage to radical resection depending upon the tumor extent. Regardless, a recurrence rate of up to 15% to 25% is noted after surgical treatment. 1–3 Recently, receptor activator of nuclear factor κ-B ligand (RANKL) pathway has been thought to be involved in the pathogenesis of GCTB. 4 Denosumab is a monoclonal antibody against RANKL thereby inhibiting the maturation of osteoclasts and has been proposed to treat unresectable GCTB. 5 There is very scant precedent literature on the histomorphology of GCTB following denosumab therapy, with a recent report by Hakozaki et al 6 on a benign fibrous histiocytoma-like pattern of GCTB after treatment with denosumab. We report herein a distinctive pseudosarcomatous spindle cell proliferation with matrix production and paucity of giant cells and mitosis, mimicking osteogenic sarcoma in GCTB post-denosumab therapy. A 68-year-old female presented with a 3-month history of a painful soft-tissue mass on her left wrist. There was increase in the...
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Copyright
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Subject
Online Articles: Letters to the Editor
ISSN
1541-2016
eISSN
1533-4058
DOI
10.1097/PAI.0000000000000165
pmid
25789537
Publisher site
See Article on Publisher Site

Abstract

Giant cell tumor of bone (GCTB) is a distinct benign locally aggressive neoplasm of bone composed of multinucleated osteoclast-type giant cells and round to oval or spindled mononuclear cells. It comprises 4% to 5% of all primary bone tumors and 18% to 20% of all benign bone tumors, and usually presents as osteolytic lesion of the bone with predilection for the epiphyses of long bones, often in skeletally mature individuals between 20 and 50 years of age. Radiographically, it presents as an eccentric radiolucent lesion frequently involving the epiphyseal region of long bone. The prototypic histopathology includes a dense population of round to oval or spindled mononuclear cells admixed with fairly uniform large numbers of osteoclast-type multinucleate giant cells. Even though GCTB is considered as benign, it can be very aggressive at times and can also metastasize to lungs as implants. For decades the treatment options for GCTB has remained the same, ranging from surgical curettage to radical resection depending upon the tumor extent. Regardless, a recurrence rate of up to 15% to 25% is noted after surgical treatment. 1–3 Recently, receptor activator of nuclear factor κ-B ligand (RANKL) pathway has been thought to be involved in the

Journal

Applied Immunohistochemistry & Molecular MorphologyWolters Kluwer Health

Published: Mar 1, 2016

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