Features of histological differential diagnostics of a tenosynovial giant cell tumor of diffuse type and non-specific inflammatory lesions of the articular capsule

Tenosynovial giant cell-tumor is a benign tumor of the synovial layer of the joints; for a long time to characterize this nosology, the term “villous- nodular synovitis” was used and considered it as a kind of inflammatory post-traumatic process in the joint capsule, and only in-depth studies of the properties of TSGCT at the molecular and cytogenetic levels proved its neoplastic nature. The purpose — to determine the peculiarities of approaches to differential diagnosis of TSGCT with exudative-proliferative syndromes, based on the clinical and morphological studies of biopsy-resection material. The study was performed on 95 cases of TSGCT of diffuse type of different localization, 56 cases of rheumatoid arthritis and 48 cases of non-specific post-traumatic pigmented synovitis. Grades of expressiveness of morphological indicators were evaluated according to the visual-analog scale from low to high with an increase of x100. Hypertrophic, hyperplastic and inflammatory changes in the articular capsule in cases of nonspecific pigmented synovitis are limited to a synovial layer. Hemosiderin is found in the cytoplasm of synovial cells and in siderophages. Nodular and solid proliferators, signs of invasion in adjacent tissues, are absent, which is an important feature in the differential diagnosis of lesions of the joint capsule, rich in clusters of macrophage siderocytes. At histological examination in isolated tissues in patients with rheumatoid arthritis signs of chronic non-specific productive-infiltrative and exudative inflammation of different activity were found — a cluster of mononuclears and plasmacites with the formation of small lymphoid follicles in its own synovial plate, hyperemia of the microcirculatory bed, and fibrin layers. The difference between the described synovitis from TSGCT is the absence of nodular proliferators, infiltrative changes in the deep departments of the capsule, hemorrhages, clumps of hemosiderin and large epithelioid synovitis, which is characteristic of tumors. TSGCT is characterized by polymorphism of histological changes and different degrees of prevalence in joint structures, which in many cases complicates its differential diagnosis.

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CLINICAL AND MORPHOLOGICAL CORRELATIONS AND HISTOPATHOLOGY OF JOINT DAMAGE IN PATIENTS WITH DIFFUSE-TYPE TENOSYNOVIAL GIANT CELL TUMOR

Wiadomości Lekarskie ◽

10.36740/wlek201912102 ◽

2019 ◽

Vol 72 (12) ◽

Author(s):

Olena O Dyadyk ◽

Anastasiia Hryhorovska

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Cell Size ◽

Giant Cells ◽

Cell Tumor ◽

Multinucleated Giant Cells ◽

Diffuse Type ◽

Association Coefficient ◽

Mean Values ◽

Tenosynovial Giant Cell Tumor

Introduction: Tenosynovial giant cell tumor (TSGCT) (synonym – pigmented villonodular synovitis) – is a rare benign proliferative lesion of the synovial sheath, localized in the joint capsule, bursa or tendon sheath and characterized by locally destructive growth. Depending on the prevalence within the joint elements, the presence of a capsule around the tumor, histophotographic features of cell structure and clinical behavior TSGCT can be divided to localized or diffuse type. The aim of the study was researching of histopathological properties of diffuse-type TSGCT, determine the parameters its morphological indicators and to find out the correlation between these morphological and clinical parameters. Materials and methods: The research material was used biopsy (resect) of pathological lesions from 50 patients who were diagnosed and histologically verified diffuse-type TSGCT. Microscopic examinations of the stained sections and their photo archiving were carried out with use of a Olympus-CX 41 light optical microscope. Group measurable parameters (mean values and Pearson tetrachoric index (association coefficient) were calculated in groups of comparison for morphological and clinical indices of TSGCT. The mean values were compared by Student’s test, P value of ≤0.1 was considered statistically significant. Results:Correlation analysis of indicators that accounted for the pairs of cases «clinic – morphology» revealed the relationships, that had the highest parameters of the association coefficient between such indicators: «presence of villous growths» - «severity of hemosiderosis» (if hypertrophied synovial villi available, with vascular injection and pronounced proliferation of synovial cells, there is also a significant accumulation of hemosiderin pigment); «presence of villous growths» - «type of predominant cellular proliferates» (if cells of TSGCT diffuse type consists of monotonous sheets of stromal cells, with uniform, oval to reniform nuclei, the proliferation of villi in synovial layer is non-distinctive); «presence of nodes» - «kind of stroma» (if nodes predominate, their histological structure is mainly represented by polymorphic clusters of synovitis cells in the form of cells, strands, chains, solid formations, among immature connective tissue with low hyalinosis); «cell size (area, cm²)» - «severity of haemosiderosis» and «cell size (area, cm²)» - «the number of multinucleated giant cells» (there is a pronounced deposition of pigment and accumulation of osteoclast-like multinucleated giant cells type, although usually their number is relatively small compared to the localized type of TSGCT). Conclusions: Morphological parameters, that we have identified, characterize pathological changes in the tissues of TSGCT; careful analysis of the frequency of their occurrence in the different comparison groups made it possible to establish intergroup differences and correlations between individual indicators, which were previously unknown or not obvious. Our study was determine to analyze of incidence rates and correlation relationships, revealed some previously unknown differences and dependencies that are important for understanding the pathogenesis, improvement of diagnosis and prognosis of diffuse-type TSGCT.

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Giant Cell Poor Extra-Articular Diffuse-Type Tenosynovial Giant Cell Tumor With Extensive Desmin Expression: A Potential Diagnostic Pitfall With Cytogenetic Confirmation

International Journal of Surgical Pathology ◽

10.1177/1066896918788678 ◽

2018 ◽

Vol 27 (1) ◽

pp. 59-61

Author(s):

Liurka Lopez ◽

Karen Schoedel ◽

Ivy John

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Mononuclear Cells ◽

Giant Cells ◽

Cell Tumor ◽

Diffuse Type ◽

Tenosynovial Giant Cell Tumor ◽

Diagnostic Pitfall

Diffuse-type tenosynovial giant cell tumor can rarely present as an entirely extra-articular mass, which can be misdiagnosed as a sarcoma especially when giant cells are absent, dominated by large dendritic mononuclear cells, and desmin expression is extensive.

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