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----Comment by: PathDoc15 on 12/17/2008 12:34:52 PM
Lesion #3 - chrondroblastoma. An s100 stain could be helpful in the diffential between this lesion and other giant cell lesion of bone (namely giant cell tumor, and ABC - but not clear cell condrosarcoma) - [Ref #1]
----Comment by: PathDoc15 on 1/9/2009 6:28:23 AM
Nuclear features are also a big clue, and should not be dismissed so flippantly. While jumping straight to the immunohistochemical stains before methodically assessing cytologic features may be an approach advocated by some, it is somewhat wreckless and should be discouraged against. Here we see that the nuclei of the mononuclear component (the neoplastic component) is clearly different than the nuclear features of the osteoclast-like giant cell next to it. When (if) examined carefully, the mononuclear cells contain nuclear irregularities, most notably, nuclear grooves and folds, which are not as evident in the multinucleated giant cell nuclei. In a giant cell tumor, the mononuclear and the giant cell nuclear features are identical.
----Comment by: Iago on 1/9/2009 11:15:26 AM
Flippantly? I would, however, be a bit cautious about the nuclear similarity point. On the giant cell tumor image ( [Ref #1]), I added a couple of arrows last week showing nuclear similarity between giant cell nuclei and non-giant cell nuclei, and I agree that this is the mantra for diagnosing a giant cell tumor of bone. However, the differences between the arrowed nuclei (in this image) are subtle. Presented with the differential of a tumor of the epiphysis with giant cells, an s100 seems like an excellent ancillary study. s100 is expressed in chrondroid tumors of bone. Thanks for the excellent trifecta of epiphysial tumors.
----Comment by: PathDoc15 on 1/11/2009 12:39:08 PM
The nucleoli and the nuclear membranes in the giant cell are much more distinct overall compared to the other cells. But alas, an S100 protein stain would be indispensible in a case like this.
----Comment by: Iago on 1/12/2009 8:44:23 AM
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