Wooff Jill, Werner Dietrich, Murphy Joanne, Walsh Noreen
Department of Pathology, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada.
Am J Dermatopathol. 2009 May;31(3):282-7. doi: 10.1097/DAD.0b013e31819cf6f4.
The observation of osteoclast-like giant cells (O-LGCs) in intimate association with visceral malignancies is an uncommon phenomenon that has been recognized for over 40 years. Recently, the same observation has been made in relation to cutaneous malignancies. In an article published in 2005, O-LGCs were documented in association with 3 melanomas, and since then, there have been 3 separate case reports recording the presence of these cells in cutaneous carcinomas. In the context of both visceral and cutaneous malignancies, the exact nature of the O-LGCs has been a source of controversy, with respect to whether they represent modified tumor cells or an unusual host response to the neoplasm. We report here 2 additional cases of cutaneous squamous cell carcinoma associated with O-LGCs. The morphological pattern of the giant cell proliferation differed between these cases, taking the form of (1) a giant cell tumor-like nodule apposed to the carcinoma in one and (2) scattered O-LGCs interspersed with tumor cells in the other. Based on scrutiny of routine sections and the contrasting immunohistochemical profiles of the O-LGCs versus the carcinomas, showing CD68 positivity on one hand and high-molecular weight keratin and p63 positivity on the other, we concluded that in both instances, the O-LGC proliferation was a reactive phenomenon. This theory is supported by most publications on the subject. Clinical and histopathological details of the new cases are outlined and integrated with those in the literature.
观察到破骨细胞样巨细胞（O-LGCs）与内脏恶性肿瘤密切相关是一种罕见现象，这一现象已被认识超过40年。最近，在皮肤恶性肿瘤中也观察到了同样的情况。在2005年发表的一篇文章中，记录了3例与黑色素瘤相关的O-LGCs，从那时起，又有3篇独立的病例报告记录了这些细胞在皮肤癌中的存在。在内脏和皮肤恶性肿瘤的背景下，O-LGCs的确切性质一直存在争议，即它们是代表修饰的肿瘤细胞还是对肿瘤的一种不寻常的宿主反应。我们在此报告另外2例与O-LGCs相关的皮肤鳞状细胞癌病例。这些病例中巨细胞增殖的形态模式有所不同，一种表现为（1）一个与癌相邻的巨细胞瘤样结节，另一种表现为（2）另一个病例中散在的O-LGCs与肿瘤细胞相互穿插。基于对常规切片的仔细检查以及O-LGCs与癌的免疫组化特征对比，一方面显示CD68阳性，另一方面显示高分子量角蛋白和p63阳性，我们得出结论，在这两种情况下，O-LGCs的增殖都是一种反应性现象。这一理论得到了该主题大多数出版物的支持。本文概述了新病例的临床和组织病理学细节，并与文献中的细节进行了整合。
