Pathology: giant cell tumour of bone

Giant cell tumour of bone

• Sheets of spindle-polygonal cells

• Amphophilic cytoplasm

• Monomorphic ovoid nuclei; mitotic activity

• Aggregates of osteoclast-like multinucleated giant cells

• Secondary aneurysmal cyst; prominent osteoid matrix deposition

Giant cell tumour of bone

• Spindle-polygonal cells with storiform pattern

• Amphophilic cytoplasm

• Monomorphic ovoid nuclei; mitotic activity

• Prominent osteoclast-like multinucleated giant cells

• Scant collagenous stroma; sheets of foamy histiocytes

Giant cell tumour of bone

• Sheets of spindle-polygonal cells

• Amphophilic cytoplasm

• Monomorphic ovoid nuclei; mitotic activity

• Prominent osteoclast-like multinucleated giant cells

• Scant collagenous stroma; trabeculae of woven bone with osteoblastic rimming

Giant cell tumour of bone

• Sheets of spindle-polygonal cells

• Amphophilic cytoplasm

• Monomorphic ovoid nuclei; conspicuous mitotic activity

• Prominent osteoclast-like multinucleated giant cells

• Scant collagenous stroma; sheets of foamy histiocytes

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