PMC3161237_01
A) Clinical aspect before and after surgery; B) intraoperative aspect after sternum resection; C) intraoperative aspect after reconstruction; and D) CT sagittal reconstruction showing anterior focal cortical bone destruction and soft tissue extension (arrow). In the post-contrast image, it is also possible to identify a small region without contrast enhancement (arrowhead). E) Axial T2-weighted MRI revealed intermediate signal intensity predominance in the sternum giant cell tumor (arrow), although regions of high signal intensity were also present (arrowhead).
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Physical examination showed a bony, tender, six cm large mass of the manubrium (Figure 1A). MRI demonstrated small foci that lacked the enhancement consistent with cystic or hemorrhagic areas. MRI showed that the lesion was of intermediate signal intensity on T1- and T2-weighted images and included additional areas of high signal intensity on the T2-weighted images (Figure 1D-E). A bilateral pectoralis major flap covered the mesh and allowed skin closure (Figure 1B-C).
A-D) Histological aspect of the lesion showing a triphasic aspect with giant, mononuclear and fusiform cells (B), bone (C) and soft tissue (D) invasion of the tumor, and cystic formations (H&E, A - 400x, B - 200x, C - 100x, D - 100x); E) Cytogenetic analysis of a GCT sample showing a 51, XY, -7, +9, del(10)(q23), add(11)(p15)x2, -15, add(18)(q23), +mar1, +mar2x2, +mar3, +mar4, +mar5 karyotype.
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Occasionally, more than 100 nuclei could be perceived in the giant cells, a typical characteristic of GCT (Figure 2A). The tumor growth had induced extensive bone erosion and focally infiltrated adjacent soft tissues (Figure 2B-C). Blood-filled dilated spaces were seen, suggesting an association with an aneurysmal bone cyst (Figure 2D). The karyotype was denoted as 51, XY, -7, +9, del(10)(q23), add(11)(p15)x2, -15, add(18)(q23), +mar1, +mar2x2, +mar3, +mar4, +mar5 (Figure 2E).