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Background
This rare soft tissue tumor was originally described as Giant Cell Angiofibroma of the Orbit, based upon its unique localization and distinctive histopathologic appearance. Since the initial report, additional sites have been identified.
OUTLINE
GROSS APPEARANCE/
CLINICAL VARIANTSCHARACTERIZATION General Giant cell angiofibroma. A distinctive orbital tumor in adults.
Dei Tos AP, Seregard S, Calonje E, Chan JK, Fletcher CD.
Department of Histopathology, St. Thomas's Hospital (U.M.D.S.), London, England.
Am J Surg Pathol 1995 Nov;19(11):1286-93 Abstract quote
A series of seven cases of a previously unrecognized potentially recurrent tumor occurring in the orbit of adult patients is reported.
This lesion shows histologic appearances intermediate between, but distinct from, solitary fibrous tumor and giant cell fibroblastoma of soft tissue. Morphologically it is characterised by a richly vascularized, patternless spindle-cell proliferation containing pseudovascular spaces. Multinucleate giant cells (often of floret type) and cells with large, rounded nuclei are present both in the cellular areas and also lining the pseudovascular spaces. The stroma is variably collagenized or sometimes myxoid. Immunohistochemically, the tumor cells exhibit positivity for vimentin and CD34. Follow-up in five cases (median duration 24 months) revealed local recurrence in one patient and persistent tumor in another.
The clinical and morphologic features enable distinction of this lesion from both solitary fibrous tumor and giant cell fibroblastoma, and we suggest the designation "giant cell angiofibroma of the orbit".
VARIANTS
- Extraorbital giant cell angiofibroma.
Husek K, Vesely K.
Department of Pathology, St. Anne's University Hospital Brno, Czech Republic.
Cesk Patol. 2002 Jul;38(3):117-20. Abstract quote
We describe a case of giant cell angiofibroma (GCA) in extraorbital location. A 47-year-old man developed a subcutaneous tumor on the forearm, which measured 6 cm in diameter and was well demarcated.
Histologically, small-sized vessels similar to arterioles, sometimes with a hyalinized wall, were regularly distributed throughout the tumor tissue. Lesional cells were oval and spindle in shape with pale eosinophilic cytoplasm and plump nuclei with clumped chromatin. In addition, larger bizarre cells with lobulated hyperchromatic nucleus were randomly admixed. Areas with a sieve-like pattern contained small slit-like spaces or larger pseudocystic spaces lined by tumor cells with an admixture of bizarre cells.
Both mononuclear and bizarre lesional cells expressed strongly and diffusely vimentin and CD34. Negative reactions were with cytokeratins, bcl-2, desmin, actin, VWF, S100, alpha-1-antitrypsin, CD99, lysozyme and FXIIIa. Our finding confirms that GCA is a benign neoplasm not necessarily confined to orbital location. The patient did well without recurrence after 13 months of follow-up.
- Giant cell angiofibroma of the nasolacrimal duct.
Yazici B, Setzen G, Meyer DR, Williams EF, McKenna BJ.
Department of Ophthalmology, Albany Medical Center, New York, USA.
Ophthal Plast Reconstr Surg. 2001 May;17(3):202-6. Abstract quote
PURPOSE: To describe clinical and histologic features of the first case, to our knowledge, of giant cell angiofibroma located in the nasolacrimal duct region in a 28-year-old woman.
METHODS: Interventional case report. A left nasolacrimal duct tumor was excised en bloc by lateral rhinotomy. Histopathologic examination was performed with the use of light microscopy. Immunohistochemical staining included S-100 protein, muscle-specific actin, desmin, myoglobin, vimentin, and CD34.
RESULTS: The lesion was characterized by haphazardly arranged oval to spindled cells, a myxoid and collagenous stroma, multinucleated giant cells, prominent blood vessels, and pseudovascular spaces. Tumor cells were strongly positive for vimentin and CD34 and were negative for other antigens. After excision, there has been no recurrence over 4 years of follow-up.
CONCLUSIONS: Originally described as an orbital tumor, giant cell angiofibroma also may occur in the nasolacrimal duct and lacrimal sac region. This mesenchymal neoplasm should be included in the differential diagnosis of lacrimal drainage system tumors.Extraorbital giant cell angiofibromas.
Mikami Y, Shimizu M, Hirokawa M, Manabe T.
Department of Pathology, Kawasaki Medical School, Kurashiki-city, Okayama, Japan.
Mod Pathol 1997 Nov;10(11):1082-7 Abstract quote
We herein describe two unusual neoplasms showing histopathologic features consistent with those of giant cell angiofibroma, which was originally described as a neoplasm arising in the orbit in adults: one of them arose in the right submandibular region of a 48-year-old woman and the other in the right parascapular region of a 49-year-old woman.
Macroscopically, although the latter was characterized by a lymphangioma-like cystic appearance, both tumors were well circumscribed and encapsulated.
Microscopically, in both cases, pseudovascular spaces lined by a discontinuous row of multinucleated cells were seen against a background of spindle-shaped fibroblastic cell proliferation. In the second case, the tumor presented increased cellularity and plump and somewhat atypical nuclei of proliferating fibroblastic cells, compared with the tumor in the first case. Immunohistochemically, the mononuclear and multinucleated cells within these tumors were positive for vimentin and CD 34 but negative for any other antigens, including Factor VIII-related antigen, desmin, alpha smooth muscle actin, myoglobin, S-100 protein, LeuM1, lysozyme, alpha-1-antitrypsin, and cytokeratins (AE1/AE3 and CAM5.2).
The features in these cases indicate that giant cell angiofibroma can arise in an extraorbital site in middle-aged patients and presents some histopathologic diversity.
A cutaneous case of giant cell angiofibroma occurring with dermatofibrosarcoma protuberans and showing bimodal CD34+ fibroblastic and FXIIIa+ histiocytic immunophenotype.
Silverman JS, Tamsen A.
Department of Pathology and Laboratory Medicine, Southampton Hospital, New York
J Cutan Pathol 1998 May;25(5):265-70 Abstract quote
Dei Tos and colleagues in 1995 reported a series of seven distinctive orbital tumors in adults which they named giant cell angiofibroma (GCA). The morphologic features are intermediate between giant cell fibroblastoma and solitary fibrous tumor with a richly vascularized, patternless spindle cell proliferation forming a collagenous or myxoid stroma with pseudovascular angiectoid spaces. The spindled tumor cells have large, rounded nuclei, sometimes with complex folded shape and pseudoinclusions. There also are multi- or mononuclear giant cells, and these tumor cells partly line so-called angiectoid spaces. Cells express human progenitor cell antigen CD34 and vimentin. One case in the buccinator fascia was also noted by the authors, but similar cutaneous lesions are thus far unknown.
We report our experience with a polypoid tumor that ocurred on the thigh of a 49-year-old woman that conforms to the description of GCA. The tumor has variegated vessels admixed with patternless spindle and giant cell stroma with angiectoid spaces as well as areas of dermatofibrosarcoma protuberans (DFSP). Most tumor cells express vimentin and CD34, including giant and spindle cells lining angiectoid spaces. Focally up to 40% of the lesional cells express coagulation factor XIIIa with histiocytoid to highly dendritic cytosomes. The DFSP component is composed of admixed CD34+ and FXIIIa+ dendritic cells arranged in a storiform pattern. Tumor cells are negative for actin, desmin, S-100, and cytokeratin. The Ki67 proliferation index is 1% in GCA areas and 3% in DFSP areas; Ki 67 stains mainly fibroblasts.
We conclude that this cutaneous GCA is a fibrohistiocytic tumor closely related to and representing a more organoid angioformative analog of GCF, with both being related histogenetically also to DFSP.
These lesions represent part of a greater spectrum of fibrovascular tissue patterns, all probably derived from proliferations of interactive microvascular CD34+ fibroblasts and FXIIIa+ histiocytes.
Orbital and Extraorbital Giant Cell Angiofibroma: A Giant Cell-Rich Variant of Solitary Fibrous Tumor? Clinicopathologic and Immunohistochemical Analysis of a Series in Favor of a Unifying Concept
Louis Guillou, M.D.; Sandra Gebhard, M.D.; Jean-Michel Coindre, M.D.
From the University Institute of Pathology, Lausanne, Switzerland (L.G., S.G.), and Bergonié Institute and University of Bordeaux II, Bordeaux, France (J.-M.C.).
Am J Surg Pathol 2000;24:971-979 Abstract quote
The clinicopathologic and immunohistochemical features of one orbital and nine extraorbital soft tissue lesions, the morphology of which overlaps with giant cell angiofibroma and solitary fibrous tumor, are presented.
There were 3 male and 7 female patients. Age at diagnosis ranged from 18 to 81 years (median: 45 yrs). Development of a mass was the main presenting symptom. For two patients, the lesion had been evident for several years before excision. Extraorbital tumors were located in the head and neck area (3), back (3), retroperitoneum (1), hip (1), and vulva (1). Tumor size ranged from 1.3 cm to 11 cm (median: 4.5 cm). The lesions presented grossly as well-demarcated, unencapsulated soft tissue masses.
Histologically, they were characterized by the presence of alternating cellular and sclerosing areas, keloidal collagen deposition, round-to staghorn-shaped, thick-walled vessels and multinucleated giant stromal cells often lining pseudovascular spaces. Cellular areas were composed of non-atypical spindle to round cells set in a variably collagenous background. Mitotic activity ranged from 1 to 3 mitoses/10 high-power fields.
Immunohistochemical studies showed positive staining of the spindle/round cells and multinucleated stromal cells invariably for epithelial membrane antigen, and keratin.
Treatment consisted of simple tumorectomy in eight patients and wide excision in two. Follow-up information for eight patients (range: 7–32 mos; median: 14 mos), including four with microscopically positive surgical margins, showed no recurrence.
These lesions share the clinical, pathologic, and immunohistochemical features of giant cell angiofibroma and solitary fibrous tumor, supporting the view that these tumors are closely related. In addition, it shows that giant cell angiofibroma occurs equally in both sexes and has a wider distribution than initially thought, developing even more often in extraorbital locations than in the orbit.
HISTOLOGICAL TYPES CHARACTERIZATION General Intimate admixture of well-formed, thick-walled, often branching vessels of varying size with an intervening proliferation of spindle to round cells
Some homogeneously cellular and richly vascularized while others showed alternating hypercellular and hypocellular/sclerotic areas, a pronounced collagenous background, as well as a ``staghorn'' pericytomatous vascular pattern
Occasional amianthoid fibers
- A study of four cases of extra-orbital giant cell angiofibroma with documentation of some unusual features.
Thomas R, Banerjee SS, Eyden BP, Shanks JH, Bisset DL, Hunt R, Byers RJ, Oogarah P, Harris M.
Department of Pathology, Christie Hospital, Manchester, UK.
Histopathology. 2001 Oct;39(4):390-6. Abstract quote
AIMS: To document the clinical, light microscopic, immunohistochemical and ultrastructural features of four cases of extra-orbital giant cell angiofibromas.
METHODS AND RESULTS: Sections of formalin-fixed paraffin-embedded specimens were studied by haematoxylin and eosin, reticulin and immunohistochemical stains. Electron microscopy was carried out in two cases on tissue fixed in formalin. The age of the patients ranged from 30 to 41 years. Two patients presented with a soft tissue swelling in the left groin, one patient had a left axillary soft tissue lump and one patient presented with a parotid lump. All lesions were well circumscribed and contained variably cellular and vascularized tissue composed of round to spindle cells with a patternless arrangement, scattered multinucleate giant cells and pseudovascular spaces conforming to the description of giant cell angiofibroma. Mononuclear and multinucleate tumour cells were both positive for vimentin and CD34; one tumour exhibited focal S100 protein and GFAP positivity. Both of the tumours examined by electron microscopy showed fibroblastic features, but in addition one contained cells having Schwannian features. All four patients were well without recurrent disease on follow-up (average 25 months).
CONCLUSION: Giant cell angiofibroma shares many features with solitary fibrous tumour and giant cell fibroblastoma and shows a wider distribution than initially recognized. Rarely, Schwannian differentiation may be observed in these tumours.
SPECIAL STAINS/
IMMUNOPEROXIDASE/
OTHERCHARACTERIZATION Special stains Immunoperoxidase Positive for vimentin, CD34, CD99, and mostly for bcl-2
Negative for muscle specific actin, desmin, CD31, CD117 (c-kit), and inhibin. Occasionally, focal reactivity was observed for smooth muscle actin, S-100 protein,
PROGNOSIS AND TREATMENT CHARACTERIZATION Treatment Simple to wide excision
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Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Seventh Edition. WB Saunders 2005.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fourth Edition. Mosby 2001.
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Last Updated June 17, 2005
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