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Almodovar-Real, J. Aneiros-Fernández, R. Ruiz-Villaverde" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Almodovar-Real" "email" => array:1 [ 0 => "anamariaalmodovar@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Aneiros-Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario San Cecilio, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Anatomía Patológica, Hospital Universitario San Cecilio, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumor de lento crecimiento en región frontal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 616 "Ancho" => 800 "Tamanyo" => 240678 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry, original magnification ×20.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">A man aged 80 years, with no past medical history of interest, consulted for an exophytic tumor that had arisen a year earlier in the frontal region and had grown progressively to its current size. There were no associated symptoms and the patient did not recall any history of trauma.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">On physical examination, a single, well-defined exophytic tumor with a cylindric polypoid morphology and a fibrinous and friable surface was observed in the left lateral frontal region (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The tumor measured approximately 4<span class="elsevierStyleHsp" style=""></span>cm in its largest diameter and 3<span class="elsevierStyleHsp" style=""></span>cm in height. There were no palpable locoregional lymph nodes.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Additional Tests</span><p id="par0015" class="elsevierStylePara elsevierViewall">The lesion was completely excised and the defect was closed using a full-thickness skin graft. Histopathology revealed the presence of tumor nodules in the dermis. The nodules were composed of monomorphic mononuclear cells, spindle-shaped cells, and multinucleated osteoclast-like giant cells, with no cellular atypia (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The number of mitoses was 3 per 10 high-power fields and the Ki-67 index was 21%. Immunohistochemistry was positive for CD68 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) and negative for S100 and pancytokeratins. No vascular invasion was detected.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">¿What Is Your Diagnosis?</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Soft tissue giant cell tumor of low malignant potential (STGCTLMP).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">The patient has attended follow-up in the dermatology unit for 2 years and has presented no local recurrence or lymph-node or distant metastases.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">STGCTLMP is a rare neoplasm that presents in middle-aged men and women as an asymptomatic, well-defined tumor. Around 80 cases with similar characteristics have been reported, the majority located on the upper and lower limbs, in contrast to our patient, in whom the tumor was in the frontal region.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1–5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Although STGCTLMP was initially included as a malignant soft tissue giant cell tumor, Folpe et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> subsequently proposed the term <span class="elsevierStyleItalic">soft tissue giant cell tumor of low malignant potential</span> as, in contrast to the former tumors, this neoplasm only presents mild or moderate atypia and an indolent clinical course.</p><p id="par0045" class="elsevierStylePara elsevierViewall">They are considered to be the soft tissue analogy to giant cell tumors of bone, due to their histological and immunohistochemical similarity.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Microscopically, STGCTLMP presents a monomorphic proliferation of mononuclear cells and osteoclast-like multinucleated giant cells distributed uniformly through the tumor, as was observed in our case. These tumors can present metaplastic bone formation peripherally and vascular invasion.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The histological diagnosis is confirmed on immunohistochemistry. CD68, which is also expressed in epithelial and mesenchymal tumors such as atypical fibroxanthoma,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> is detected in the cytoplasm of the multinucleated cells. Tartrate-resistant acid phosphatase and smooth muscle actin are also positive, but CD45, protein S100, desmin, and lysozyme are negative, producing an immunophenotypic profile identical to that of giant cell tumors of bone.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Additional tests demonstrate the extraosseus situation.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The differential diagnosis should include mesenchymal tumors rich in osteoclast-like giant cells, such as the giant cell variant of malignant fibrous histiocytoma, plexiform fibrohistiocytic tumor, and extraskeletal osteosarcoma; these tumors have a more aggressive course. STGCTLMP must also be differentiated from atypical fibroxanthoma, an uncommon dermal tumor of uncertain histogenesis, considered by the majority of authors to be superficial variant of malignant fibrous histiocytoma, but with a better prognosis. This tumor typically presents as a solitary nodule in sun-exposed areas in elderly adults. Histologically, there is a predominance of spindle-shaped cells with large vesicular nuclei, associated with a variable number of giant cells, some of which are multinucleated, and polygonal cells with abundant eosinophilic cytoplasm.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> Other lesions rich in multinucleated giant cells include giant cell tumors of the tendon sheath and benign cutaneous fibrous histiocytoma.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The prognosis is favorable if resection is complete, but local recurrence can occur after incomplete resection, as is seen with its osseous form. Lymph-node and lung metastases are very rare.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">We have reported a new case of STGCTLMP, a rare lesion that must be included in the differential diagnosis of soft tissue tumors rich in giant cells, as its clinical behavior, prognosis, and treatment differ significantly.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Additional Tests" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Diagnosis" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical Course and Treatment" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Almodovar-Real A, Aneiros-Fernández J, Ruiz-Villaverde R. Tumor de lento crecimiento en región frontal. Actas Dermosifiliogr. 2016;107:851–852.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 512 "Ancho" => 800 "Tamanyo" => 81342 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical image.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 590 "Ancho" => 800 "Tamanyo" => 233051 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin and eosin, original magnification ×20.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 616 "Ancho" => 800 "Tamanyo" => 240678 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry, original magnification ×20.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary giant cell tumor of soft tissues: A study of 22 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.M. 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 13 | 13 | 26 |
2024 October | 88 | 49 | 137 |
2024 September | 103 | 18 | 121 |
2024 August | 120 | 52 | 172 |
2024 July | 108 | 36 | 144 |
2024 June | 109 | 36 | 145 |
2024 May | 91 | 29 | 120 |
2024 April | 79 | 34 | 113 |
2024 March | 78 | 22 | 100 |
2024 February | 73 | 32 | 105 |
2024 January | 63 | 34 | 97 |
2023 December | 69 | 16 | 85 |
2023 November | 70 | 24 | 94 |
2023 October | 70 | 19 | 89 |
2023 September | 50 | 28 | 78 |
2023 August | 46 | 19 | 65 |
2023 July | 61 | 27 | 88 |
2023 June | 71 | 31 | 102 |
2023 May | 70 | 22 | 92 |
2023 April | 61 | 20 | 81 |
2023 March | 73 | 27 | 100 |
2023 February | 86 | 26 | 112 |
2023 January | 54 | 32 | 86 |
2022 December | 61 | 42 | 103 |
2022 November | 30 | 19 | 49 |
2022 October | 31 | 25 | 56 |
2022 September | 26 | 32 | 58 |
2022 August | 29 | 29 | 58 |
2022 July | 35 | 38 | 73 |
2022 June | 16 | 18 | 34 |
2022 May | 63 | 38 | 101 |
2022 April | 67 | 35 | 102 |
2022 March | 75 | 45 | 120 |
2022 February | 48 | 28 | 76 |
2022 January | 51 | 32 | 83 |
2021 December | 49 | 35 | 84 |
2021 November | 57 | 48 | 105 |
2021 October | 66 | 61 | 127 |
2021 September | 57 | 40 | 97 |
2021 August | 56 | 39 | 95 |
2021 July | 38 | 21 | 59 |
2021 June | 40 | 38 | 78 |
2021 May | 51 | 51 | 102 |
2021 April | 58 | 57 | 115 |
2021 March | 35 | 29 | 64 |
2021 February | 44 | 37 | 81 |
2021 January | 27 | 17 | 44 |
2020 December | 20 | 14 | 34 |
2020 November | 24 | 17 | 41 |
2020 October | 29 | 16 | 45 |
2020 September | 20 | 14 | 34 |
2020 August | 28 | 20 | 48 |
2020 July | 29 | 17 | 46 |
2020 June | 28 | 36 | 64 |
2020 May | 31 | 8 | 39 |
2020 April | 34 | 17 | 51 |
2020 March | 37 | 14 | 51 |
2020 February | 5 | 0 | 5 |
2020 January | 4 | 0 | 4 |
2019 December | 8 | 0 | 8 |
2019 November | 4 | 0 | 4 |
2019 September | 4 | 0 | 4 |
2019 August | 6 | 0 | 6 |
2019 July | 4 | 0 | 4 |
2019 June | 6 | 0 | 6 |
2019 May | 5 | 1 | 6 |
2019 April | 3 | 3 | 6 |
2019 March | 4 | 0 | 4 |
2019 February | 2 | 0 | 2 |
2019 January | 2 | 0 | 2 |
2018 December | 4 | 0 | 4 |
2018 October | 5 | 0 | 5 |
2018 September | 3 | 0 | 3 |
2018 July | 1 | 0 | 1 |
2018 February | 16 | 6 | 22 |
2018 January | 43 | 15 | 58 |
2017 December | 43 | 9 | 52 |
2017 November | 25 | 4 | 29 |
2017 October | 36 | 8 | 44 |
2017 September | 24 | 5 | 29 |
2017 August | 37 | 6 | 43 |
2017 July | 22 | 7 | 29 |
2017 June | 30 | 11 | 41 |
2017 May | 28 | 6 | 34 |
2017 April | 31 | 12 | 43 |
2017 March | 29 | 21 | 50 |
2017 February | 23 | 6 | 29 |
2017 January | 13 | 8 | 21 |
2016 December | 67 | 39 | 106 |
2016 November | 17 | 27 | 44 |
2016 October | 1 | 4 | 5 |