Pathology: giant cell tumour of bone

Giant cell tumour of bone

  • Sheets of polygonal-spindle cells

  • Pale amphophilic cytoplasm

  • Monomorphic ovoid nuclei; mitotic activity

  • Prominent osteoclast-like multinucleated giant cells

  • Occasional areas of interstitial haemorrhage; siderophages, haemosiderin deposition, foamy macrophages; areas of so-called "blue bone"

  • IHC: H3.3 G34W

Giant cell tumour of bone

  • Bands of spindle-polygonal cells

  • Pale amphophilic cytoplasm

  • Monomorphic ovoid nuclei; mitotic activity

  • Aggregates of osteoclast-like multinucleated giant cells

  • Prominent secondary aneurysmal cyst; siderophages and haemosiderin deposition; occasional bands of woven bone

  • IHC: H3.3 G34W

This case shows significant morphologic overlap with primary aneurysmal bone cyst. Accurate classification, in some cases, requires ancillary immunohistochemistry or molecular diagnostic testing

Giant cell tumour of bone

  • Hypocellular; spindle-polygonal cells

  • Pale amphophilic cytoplasm

  • Monomorphic ovoid nuclei; mitotic activity

  • Rare osteoclast-like multinucleated giant cells

  • Secondary aneurysmal cyst; siderophages and haemosiderin deposition; occasional bands of woven bone

  • IHC: H3.3 G34W

This diagnosis in this case would have been challenging without the benefit of immunohistochemistry

Giant cell tumour of bone

  • Sheets of spindle-polygonal cells

  • Amphophilic cytoplasm

  • Monomorphic ovoid nuclei; mitotic activity

  • Aggregates of osteoclast-like multinucleated giant cells

  • Prominent secondary aneurysmal cyst; siderophages and haemosiderin deposition; occasional bands of woven bone

  • IHC: H3.3 G34W

Giant cell tumour of bone

  • Sheets of spindle-polygonal cells

  • Pale amphophilic cytoplasm

  • Monomorphic ovoid nuclei; mitotic activity

  • Prominent osteoclast-like multinucleated giant cells

  • Areas of secondary aneurysmal cyst; interstitial haemorrhage; siderophages and haemosiderin deposition; focal necrosis; occasional bands of woven bone

  • IHC: H3.3 G34W

Giant cell tumour of bone

  • Sheets of spindle-polygonal cells

  • Pale amphophilic cytoplasm

  • Monomorphic ovoid nuclei; mitotic activity

  • Prominent osteoclast-like multinucleated giant cells

  • Areas of interstitial haemorrhage; siderophages and haemosiderin deposition; focal necrosis

Giant cell tumour of bone, post denosumab

Prior biopsy demonstrated a morphologically typical giant cell tumour; curettage following denosumab therapy and resection

  • Fibro-osseous with a zonal pattern

  • Spindle-stellate cells with a storiform pattern; eosinophilic cytoplasm; ovoid nuclei with mild pleomorphism and inconspicuous mitotic activity; myxoid-collagenous stroma

  • Anastomosing trabeculae with variable mineralization; spindle-polygonal osteocytes in lacuna; eosinophilic cytoplasm; round-ovoid nuclei with mild pleomorphism, and inconspicuous mitotic activity

  • IHC: SATB2, H3.3 G34W

  • PMID: 26990281

Giant cell tumour of bone, post denosumab

Prior biopsy demonstrated a morphologically typical giant cell tumour; this is an atypical morphology following neoadjuvant therapy raising the possibility of maligant transformation

  • Cellular; fascicles of spindle-polygonal cells

  • Amphophilic cytoplasm with indistinct cell borders and occasional hyalinization

  • Ovoid-polygonal nuclei with prominent nucleoli and moderate pleomorphism; brisk mitotic activity

  • Clusters of osteoid with variable mineralization

  • IHC: SATB2, H3.3 G34W

Giant cell tumour of bone, malignant

Remote, morphologically typical, giant cell tumour treated by curettage

  • Cellular; fascicles of spindle-epithelioid cells

  • Amphophilic cytoplasm with indistinct cell borders and occasional hyaline globules

  • Ovoid-polygonal nuclei with prominent nucleoli and moderate pleomorphism; brisk mitotic activity

  • Occasional osteoclast-like multinucleated giant cells

  • Delicate bands of osteoid; small ectatic and branching vessels with hyalinized walls; focal necrosis

  • IHC: SATB2, H3.3 G34W

Giant cell tumour of bone, malignant

  • Sheets of spindle-polygonal cells

  • Pale amphophilic cytoplasm

  • Monomorphic ovoid nuclei; mitotic activity

  • Prominent osteoclast-like multinucleated giant cells

  • Scattered siderophages and haemosiderin deposition; occasional woven bone trabeculae

  • IHC: H3.3 G34W

Giant cell tumour of bone, malignant

  • Fascicles of spindle-polygonal cells

  • Pale amphophilic cytoplasm

  • Ovoid nuclei with macronucleoli, frequent multinucleation and moderate pleomorphism; brisk mitotic activity

  • Occasional woven bone trabeculae

  • Original tumour is also shown (curretted eight years prior)

  • IHC: H3.3 G34W