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|LETTER TO EDITOR
|Year : 2013 | Volume
| Issue : 2 | Page : 192-193
Intracranial giant cell tumor of soft tissue: Mimicking a glioma
Sudhansu Sekhar Mishra1, Satya Bhusan Senapati1, Manmath Kumar Dhir1, Kalpalata Tripathy1, Deepak Kumar Parida2
1 Department of Neurosurgery, SCB Medical College and Hospital, Cuttack - 753 007, Odisha, India
2 Department of Pathology, SCB Medical College and Hospital, Cuttack - 753 007, Odisha, India
|Date of Submission||04-Jan-2013|
|Date of Decision||26-Jan-2013|
|Date of Acceptance||17-Mar-2013|
|Date of Web Publication||29-Apr-2013|
Satya Bhusan Senapati
Department of Neurosurgery, SCB Medical College and Hospital, Cuttack - 753 007, Odisha
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mishra SS, Senapati SB, Dhir MK, Tripathy K, Parida DK. Intracranial giant cell tumor of soft tissue: Mimicking a glioma. Neurol India 2013;61:192-3
Giant cell tumor of the soft tissue (GCT-ST), first described in 1972 by Salm and Sissons, is a rare tumor. Most of the reported tumors have been in the extremities with thigh being the most commonly reported site.  We report probably the first case of GCT-ST in brain with radiological features mimicking a glioma.
A 22-year-old male presented with complains of intermittent headache over left temporal area; associated with vomiting and progressive diminution of vision in both eyes of 3 months duration. He had one episode of generalized tonic clonic seizures during this period. Neurological examination revealed impaired memory, judgment, two point discrimination and graphasthesia over right side. Magnetic resonance imaging (MRI) of brain revealed a left-sided intra-axial deep-perisylvian lesion with perilesional edema and mass effect, hypointense on T1-weighted, and hyperintense on T2-weighted images. The lesion enhanced inhomogeneously on contrast administration [Figure 1]a and b. Cranial computed tomography (CT), bone window, did not show any bony lesion to suggest bony origin of the lesion [Figure 1]c. Preoperative radiological diagnosis was glioma. As tumor was over eloquent area, subtotal resection was done through middle temporal gyrus. Squash cytology showed multiple osteoclastic giant cells. Histopathological examination revealed a lesion composed of two components, background of mononuclear cells with numerous osteoclast-like giant cells [Figure 2]a. Mononuclear cells were spindle to oval cells with moderate amount of eosinophilic cytoplasm, round to oval nuclei with vesicular chromatin and inconspicuous nucleoli. Multinucleated giant cells were uniformly distributed with abundant cytoplasm; the nuclei were looking similar to the stoma component [Figure 2]b. Pleomorphism, cytological atypia, and mitotic activity were absent. There was no glial component, as conformed by negative GFAP immunohistochemically [Figure 2]c. At 6 month follow up, he is doing well with no local or systemic spread.
GCT-ST is an extremely rare lesion. These tumors show unpredictable behavior. Simple surgical excision gives cure in some patients whereas others develop metastasis.  The histological appearance closely resembles that of giant cell tumor of bone, it has been differentiated into low and high-grade forms on the basis of the atypia, pleomorphism, and mitotic activity of the mononuclear neoplastic component. , Differential diagnoses of GCT-ST include soft tissue mesenchymal tumors that are rich in giant cells, such as nodular tenosynovitis, nodular fasciitis, malignant fibrous histiocytoma, giant cell-rich leiomyosarcoma. Review of the literature identified few cases of giant cell tumor skull with intracranial extension; in all these cases authors had found a lytic lesion in skull bone.  In our patient, there was no osteolytic skull lesion. These observations suggest that our patient has a primary intracerebral giant cell tumor. In patients with subtotal removal as in our patient, serial follow-up is required as there is a chance of local recurrence and distance metastasis.
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[Figure 1], [Figure 2]