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peripheral giant cell reparative granuloma

Thursday 23 November 2006

Digital slides

- Case 86 (HPC:86): Peripheral giant cell reparative granuloma of the second metacarpal

Definition: Peripheral giant cell granulomas are giant cell reparative granulomas of extragnathic sites.

Peripheral giant cell reparative granulomas are uncommon lesions that predominantly involve the short tubular bones of the hands and feet.

A subset of GCRGs may be neoplastic and that these lesions differ cytogenetically from classic giant cell tumors of bone or solid ABC, although the latter entity is otherwise indistinguishable from reparative granuloma. (17527082)

Synopsis

- intact or ulcerated surface epithelium cover
- benign proliferation of granulation-like tissue that supports numerous benign multinucleated giant cells
- abundant extravasated deposits of hemosiderin
- spicules of woven or lamellar bone (35%)

Associations

-  Noonan syndrome (9660063, /16860226/)

Cytogenetics

- t(X;4)(q22;q31.3) (10565307, 17527082)
- inv(2)(p13q21), t(inv2;11)(q21;q13) (17527082)
- t(2;10)(q23;q24) (17527082)

Differential diagnosis

- osseous giant cell reactions
- osseous giant cell lesions (giant cell-rich lesions of bone)
- osseous giant cell tumors

Peripheral giant cell reparative granuloma can be differentiated from osteoblastic osteosarcoma by the uniformity of the stromal cells and by the lack of dysplasia in these cells. In young persons, however, numerous mitotic figures and active proliferation of stromal cells may make this distinction difficult.

Peripheral giant cell reparative granuloma may be indistinguishable from the rare extraosseous brown tumor of hyperparathyroidism.

Nota bene: Giant cell-rich lesions of bone, including giant cell tumor of bone, giant cell reparative granuloma (GCRG), and aneurysmal bone cyst (ABC), may have overlapping clinical, radiologic, and histopathologic features. In fact, GCRG and solid ABC are currently differentiated solely based on skeletal location.

See also

- giant cell reparative granuloma (GCRG)

References

- Novel karyotypes in giant cell-rich lesions of bone. Gleason BC, Kleinman PK, Debelenko LV, Rahbar R, Gebhardt MC, Perez-Atayde AR. Am J Surg Pathol. 2007 Jun;31(6):926-32. PMID: 17527082

- Wold LE, Dobyns JH, Swee RG, Dahlin DC. Giant cell reaction (giant cell reparative granuloma) of the small bones of the hands and feet. Am J Surg Pathol. 1986 Jul;10(7):491-6. PMID: 3728789

- Lorenzo JC, Dorfman HD. Giant-cell reparative granuloma of short tubular bones of the hands and feet. Am J Surg Pathol. 1980 Dec;4(6):551-63. PMID: 7212148

- Hirschl S, Katz A. Giant cell reparative granuloma outside the jaw bone. Diagnostic criteria and review of the literature with the first case described in the temporal bone. Hum Pathol. 1974 Mar;5(2):171-81. PMID: 4590573

- Giant cell reparative granuloma of the distal skeletal bones. A report of five cases with immunohistochemical findings. Panico L, Passeretti U, De Rosa N, D’Antonio A, De Rosa G. Virchows Arch. 1994;425(3):315-20. PMID: 7812518