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Case Reports

lung nodules showed metastatic deposits of similar nature.Wide excision of the vertebral tumor with metastasectomy ofthe lung nodules was done.Histological examination revealeda tumor composed of osteoclastic type of giant cells lyingdispersed within a cellular stroma (Fig. 2). The stromal cellswere oval to spindle shaped, with a vescicular nucleus and ill-defined, eosinophilic cytoplasm Rare mitotic figures werediscernible. A shell of mature trabecular bone of reactivenature was seen at the periphery. Foci of osteoid formation,hemosiderin pigment and foam cells were seen between thetumor cells. Areas showing features of secondary aneurysmalbone cyst were present (Fig. 3).

Sections from the lung nodules showed deposits ofthe tumor, similar in morphology to the vertebral tumor(Figs. 4, 5).

DISCUSSION

GCT of bone is a common tumor seen in the third to fourthdecade of life, most commonly around the knee and in lowerend of radius. They are locally aggressive tumors; localrecurrence is common and the potential for metastasis withoutundergoing sarcomatous change has been described[1].

Although the term ‘benign metastasizing GCT’ is

GIANT cell tumor (GCT) of the bone is not an uncommonneoplasm. It is a locally aggressive tumor with propensity forrecurrence. Metastasis in GCT is not common; it is almostinvariably seen in recurrent tumors. Metastasis at the time ofinitial presentation is a rare phenomenon. The term benignmetastasizing Giant cell tumor is used, because in spite ofmetastasis, most patients survive; sometimes metastasisregresses or disappears spontaneously. A rare case of benignmetastasizing giant cell tumor of the bone with metastasis atthe time of initial presentation is reported. We have comeacross two large studies in literature, in which out of 28 casesof benign metastasizing giant cell tumors of bone, only threecases presented initially with metastasis.

CASE REPORT

A 28-year-old female presented with bilateral lower limbweakness. CT/MRI showed intense enhancement withmultiple fluid levels in D10 vertebra suggesting a destructivelesion (Fig. 1). Peroperatively, multiple nodules were seenstudded in both lungs. Intraoperative frozen section of thevertebral tumor revealed a giant cell rich tumor and that of the

Fig. 2. H & E, × 40, vertebral tumor, giant cells in a backgroundof spindley and oval stromal cells.Fig. 1. MRI spine.

BENIGN METASTASIZING GIANT CELL TUMOR OF SPINE

Noopur Gupta#, Sumaid Kaul#, Rajendra Prasad* and H.K. Chaturvedi+

From the Departments of Histopathology and Cytopathology# , Neurosurgery* and Surgical Oncology +Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi -110 044, India.

Correspondence to: Dr. Sumaid Kaul, Senior Consultant Histopathology, Department of Histopathology and Cytopathology,Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi - 110 044, India.

E-mail:sumaidkaul53@hotmail.com

Keywords : Benign, metastasizing, giant cell tumor, bone.

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Case Reports

tumor. The mean interval between the onset of the tumor andthe detection of lung metastases was 4.1 years in one largeseries [4]. Our case showed evidence of multiple bilateralpulmonary metastases at the time of presentation which is avery rare phenomenon. We have come across two large studiesin literature in which 127 patients with histologically benignGCT of bone were reviewed. Of these, 28 cases hadpulmonary metastases, out of which only three cases presentedinitially with metastasis [4,5].

Metastases are amenable to surgical resection andmay even regress spontaneously. The mortality rates forpatients with GCT metastasizing to the lungs range from0-35% [2,6-9]. However, multiple bilateral pulmonarymetastases at initial presentation is rare, hence the prognosis isuncertain.

CONCLUSION

GCTs of bone, although termed ‘benign’, are locallyaggressive tumors and are known to recur locally andmetastasize. The incidence of metastasis is low.

Metastases are invariably associated with recurrenttumors. They are usually identified years after the initialresection; metastasis at the time of initial presentation is a rarephenomenon.

REFERENCES

1. Jaffe HL, Lichtenstein L, Portis RB. Giant cell tumor of bone :its pathologic appearance, grading, supposed variants andtreatment. Arch Pathol Lab Med 1940; 30:993-1031.

2. Tubbs WS, Brown LR, Beabout JW, et al. Benign giant celltumor of bone with pulmonary metastases : clinical findingsand radiological appearance of metastases in 13 cases. Am JRoentgenol 1992; 158: 331-334.

3. Kay RM, Eckardt JJ, Seeger LL, et al. Pulmonary metastasisof benign giant cell tumor of bone : six histologically confirmedcases including one of spontaneous regression. Clin Orthop1994; 302: 219 -230.

4. Siebenrock KA, Unni KK, Rock MG. Giant cell tumor of bonemetastasizing to the lungs : a long term follow up. J Bone JointSurg 1998; 80: 43-48.

5. Cheng JC, Johnston JO. Giant cell tumor of bone. Prognosisand treatment of pulmonary metastases. Clin Orthop 1997May; 338: 205-214.

6. Bertoni F, Present D, Enneking WF. Giant cell tumor of bonewith pulmonary metastases. J Bone Joint Surg 1970; 52-A:619-664.

7. Bertoni F, Present D, Sudanese A, et al. Giant cell tumor ofbone with pulmonary metastases: six case reports and areview of literature. Clin Orhtop 1988; 237: 275-285.

8. Rock M. Curettage of giant cell tumor of bone: factorsinfluencing local recurrences and metastasis. Chir OrganiMov 1990; 75(Suppl 1): 204-205.

9. Sanerkin NG. Malignancy, aggressiveness,and recurrence ingiant cell tumor of bone. Cancer 1980; 46: 1641-1649.

inherently contradictory, it serves to emphasize the relativelygood prognosis associated with these tumors.

Metastasis is almost invariably seen in recurrent lesions.The incidence of lung metastasis from a histologically provenGCT ranges from 1-9% [1-3]. Metastatic lesions are generallyidentified years after the initial resection, are solitary or few innumber, and have histological features identical to the primary

Fig. 3. H & E, ×10, vertebral tumor showing secondary aneu-rysmal bone cyst changes.

Fig. 4. H & E, ×10, lung nodule, same tumor, with osteoidformation.

Fig. 5. H & E, ×10, lung nodule, with tumor emboli at periphery.