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Surgical Pathology Criteria
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Soft Tissue Giant Cell Tumor of Low Malignant Potential

Definition

  • Soft tissue tumor with a prominent population of osteoclast-like giant cells throughout, but lacking significant cytologic atypia

Alternate/historical Names

  • Giant cell tumor of soft tissue
  • Osteoclastoma of soft tissue

Diagnostic Criteria

  • Multinodular infiltrative soft tissue tumor
    • May be superficial or deep
  • Three cell populations throughout
    • Bland mononuclear cells
    • Short spindled cells
    • Osteoclast-like multinucleated giant cells
  • More than mild atypia is not permitted
    • Vesicular round to oval nuclei in all three cell populations
  • Frequent mitotic figures, but none are atypical
  • Necrosis is not permitted
  • Frequent findings
    • Vascular invasion
    • Rim of reactive bone
    • Angiectatic spaces
    • Hemorrhage
    • Hemosiderin laden macrophages
    • Foamy macrophages
  • Histologically resembles giant cell tumor of bone
    • A bone primary must be ruled out radiographically
  • Richard L Kempson MD
    Robert V Rouse MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting: August 10, 2008

 

Supplemental studies

Immunohistology

  Mononuclear cells Multinucleated cells
CD68 focal positive positive
Smooth muscle actin focal positive negative
S100 negative negative
CD45 negative negative
Lysozyme negative negative
Desmin negative negative

Differential diagnosis

  • Giant cells may be seen in leiomyosarcoma, epithelioid sarcoma and other sarcomas, carcinomas and melanomas
    • These can be distinguished by recognizing areas of the tumor with the classic appearance or immunophenotype of the other neoplasm
Giant Cell Malignant Fibrous Histiocytoma Soft Tissue Giant Cell Tumor of Low Malignant Potential
Marked cytologic atypia in mononuclear cell component Mild atypia at most
Coagulative tumor cell necrosis frequently present Coagulative necrosis not permitted
Atypical mitotic figures frequently found Atypical mitotic figures not permitted

 

Tenosynovial Giant Cell Tumor Soft Tissue Giant Cell Tumor of Low Malignant Potential
Usually located near joints Wide variety of locations
Usually low mitotic rate Frequently high mitotic rate
Usually polymorphous with siderophages, foam cells and lymphocytes Usually lacks siderophages, foam cells and lymphocytes
Metaplastic bone not seen Metaplastic bone frequent
Usually has hyalinization of stroma Lacks hyaline stroma

 

Soft Tissue Giant Cell Tumor of Low Malignant Potential Plexifiorm Fibrohistiocytic Tumor
Mixed giant and spindled cells but not distinctly biphasic Biphasic with nodules of histiocyte-like cells with giant cells and spindled fibroblastic areas
Infiltrating nodules Plexiform infiltrative pattern
Frequent mitotic figures Mitotic figures rare

 

Extraskeletal Osteosarcoma Soft Tissue Giant Cell Tumor of Low Malignant Potential
Malignant cytologic features Mild atypia at most
Osteoid in a lace-like pattern formed by malignant cells Frequently a rim of metaplastic bone

 

Giant Cell Rich Nodular Fasciitis Soft Tissue Giant Cell Tumor of Low Malignant Potential
Areas of typical nodular fasciitis usually present with loose myxoid stroma and C and S shaped fascicles Lacks areas with appearance of nodular fasciitis
Giant cells frequent in intravascular fasciitis Vascular invasion is frequent but main lesion is not intravascular

Clinical

  • Mean age 40 years
  • May involve superficial and deep soft tissue
  • Most frequent on extremities
    • May be seen in other sites
  • May recur
  • Metastasis very rare

Bibliography

  • Kempson RL, Fletcher CDM, Evans HL, Henrickson MR, Sibley RS. Tumors of the Soft Tissues, Atlas of Tumor Pathology, AFIP Third Series, Fascicle 30, 2001
  • Fletcher CDM, Unni KK, Mertens F. Pathology and Genetics of Tumours of Soft Tissue and Bone, World Health Organization Classification of Tumours 2002
  • Weiss SW, Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors, 5th edition, 2008
  • Salm R, Sissons HA. Giant-cell tumours of soft tissues.J Pathol. 1972 May;107(1):27-39.
  • Guccion JG, Enzinger FM. Malignant giant cell tumor of soft parts. An analysis of 32 cases. Cancer. 1972 Jun;29(6):1518-29.
  • Oliveira AM, Dei Tos AP, Fletcher CD, Nascimento AG. Primary giant cell tumor of soft tissues: a study of 22 cases. Am J Surg Pathol. 2000 Feb;24(2):248-56.
  • Folpe AL, Morris RJ, Weiss SW. Soft tissue giant cell tumor of low malignant potential: a proposal for the reclassification of malignant giant cell tumor of soft parts. Mod Pathol. 1999 Sep;12(9):894-902.
  • O'Connell JX, Wehrli BM, Nielsen GP, Rosenberg AE. Giant cell tumors of soft tissue: a clinicopathologic study of 18 benign and malignant tumors. Am J Surg Pathol. 2000 Mar;24(3):386-95.
  • Billings SD, Folpe AL. Cutaneous and subcutaneous fibrohistiocytic tumors of intermediate malignancy: an update. Am J Dermatopathol. 2004 Apr;26(2):141-55.
 
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