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Presented by Edward McCarthy, M.D. and prepared by Maryam Farinola M.D.
Case 4: A 21 year old man had wrist pain for six months.
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1. Question
Week 214: Case 4
A 21 year old man had wrist pain for six months. A radiograph demonstrated a well defined lytic lesion in the distal radius involving the epiphysis and the metaphysis.images/giant cell tumor 1.jpg
images/giant cell tumor 2.jpg
images/giant cell tumor 3.jpgCorrect
Answer: Giant cell tumor
Histology: The radiographs showing pattern of a well-defined lytic lesion involving both the epiphysis and metaphysis is almost diagnostic of giant cell tumor. The lesion consist of multinucleated giant cells in a mononuclear cell stromal background. Although the lesion is cellular, there are no atypical mitotic figures, and there is no evidence of pleomorphism.
Discussion: The lesion is not a malignant fibrous histiocytoma because of the lack of atypical mitotic figures and cellular pleomorphism.
The lesion is not a non-ossifying fibroma. Non-ossifying fibromas are confined to the metaphyseal portions of bone. Although some non-ossifying fibromas have many multinucleated giant cells, the background stroma of a non-ossifying fibroma is spindly and often shows a storiform pattern.
The lesion is not a chondroblastoma because the background stroma shows no traces of cartilage differentiation. Chondroblastomas almost always have a thin trace of a chondroid matrix with focal calcification.
Incorrect
Answer: Giant cell tumor
Histology: The radiographs showing pattern of a well-defined lytic lesion involving both the epiphysis and metaphysis is almost diagnostic of giant cell tumor. The lesion consist of multinucleated giant cells in a mononuclear cell stromal background. Although the lesion is cellular, there are no atypical mitotic figures, and there is no evidence of pleomorphism.
Discussion: The lesion is not a malignant fibrous histiocytoma because of the lack of atypical mitotic figures and cellular pleomorphism.
The lesion is not a non-ossifying fibroma. Non-ossifying fibromas are confined to the metaphyseal portions of bone. Although some non-ossifying fibromas have many multinucleated giant cells, the background stroma of a non-ossifying fibroma is spindly and often shows a storiform pattern.
The lesion is not a chondroblastoma because the background stroma shows no traces of cartilage differentiation. Chondroblastomas almost always have a thin trace of a chondroid matrix with focal calcification.
