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Presented by Edward McCarthy, M.D. and prepared by Danielle Wehle, M.D.
Case 4: A 30 year old man had pain in his fingertip for several months.
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Question 1 of 1
1. Question
Week 290: Case 4
A 30 year old man had pain in his fingertip for several months. A radiograph demonstrated a lytic lesion in the distal phalanx.images/case4aP3161643.jpg
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images/case4dImage14.jpgCorrect
Answer: Giant cell reparative granuloma
Histology: none provided
Discussion: This lesion, which contains many of giant cells, shows a distinct zonal pattern which is characteristic of a giant cell reparative granuloma. The giant cells are in clusters surrounded by blood cells and bounded by fibrous tissue and further bounded by reactive bone. This zonal pattern is typical of a giant cell reparative granuloma. This pattern is seen in three main clinical settings. First, it is seen as a bone lesion in hyperparathyroidism where it is known as a “brown tumor.” Second it is seen in the mandible. And third it may be seen, as in this case, as a lytic lesion in the hands and feet (unassociated with hyperparathyroidism.)
The lesion is not a giant cell tumor because of the zonal pattern. Moreover, does not support a diagnosis of giant cell tumor.
Although an enchondroma is the most common tumor in the hand, there is no cartilage in this lesion.
There is no atypia or mitotic activity which would support a diagnosis of malignant fibrous histiocytoma.
Incorrect
Answer: Giant cell reparative granuloma
Histology: none provided
Discussion: This lesion, which contains many of giant cells, shows a distinct zonal pattern which is characteristic of a giant cell reparative granuloma. The giant cells are in clusters surrounded by blood cells and bounded by fibrous tissue and further bounded by reactive bone. This zonal pattern is typical of a giant cell reparative granuloma. This pattern is seen in three main clinical settings. First, it is seen as a bone lesion in hyperparathyroidism where it is known as a “brown tumor.” Second it is seen in the mandible. And third it may be seen, as in this case, as a lytic lesion in the hands and feet (unassociated with hyperparathyroidism.)
The lesion is not a giant cell tumor because of the zonal pattern. Moreover, does not support a diagnosis of giant cell tumor.
Although an enchondroma is the most common tumor in the hand, there is no cartilage in this lesion.
There is no atypia or mitotic activity which would support a diagnosis of malignant fibrous histiocytoma.
