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Presented by Edward McCarthy, M.D. and prepared by Sharon Swierczynski, M.D., Ph.D.
Case 3: A 21 year-old man had a painful swelling in his hand for 6 months.
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1. Question
Week 145: Case 3
A 21 year-old man had a painful swelling in his hand for 6 months. A radiograph demonstrated an expansile lytic lesion in the proximal portion of a metacarpal. This lesion was curetted.images/072803case3fig1.jpg
images/072803case3fig2.jpg
images/072803case3fig3.jpgCorrect
Answer: Giant cell reparative granuloma
Histology: Giant cell reparative granuloma is a benign giant cell containing lesion consisting of giant cells admixed with stromal cells. There is a distinctive zonal pattern of giant cells, fibrous tissue, and reactive bone formation in a pattern that repeats itself over several low power fields.
Discussion: The lesion is not a giant cell tumor because of the zonal pattern of the histologic components. In addition, giant cell tumors involve the epiphyseal end of long bones. In the metacarpal, this would indicate the distal end rather than the proximal end as in the current case.
The lesion is not a malignant fibrous histiocytoma. The cellular pleomorphism and abnormal mitotic figures characteristic of a giant cell-rich malignant fibrous histiocytoma are absent in this case. In addition, the expansile radiographic features indicate a growing, but not rapidly growing, lesion.
Incorrect
Answer: Giant cell reparative granuloma
Histology: Giant cell reparative granuloma is a benign giant cell containing lesion consisting of giant cells admixed with stromal cells. There is a distinctive zonal pattern of giant cells, fibrous tissue, and reactive bone formation in a pattern that repeats itself over several low power fields.
Discussion: The lesion is not a giant cell tumor because of the zonal pattern of the histologic components. In addition, giant cell tumors involve the epiphyseal end of long bones. In the metacarpal, this would indicate the distal end rather than the proximal end as in the current case.
The lesion is not a malignant fibrous histiocytoma. The cellular pleomorphism and abnormal mitotic figures characteristic of a giant cell-rich malignant fibrous histiocytoma are absent in this case. In addition, the expansile radiographic features indicate a growing, but not rapidly growing, lesion.
