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1</a>&#41;&#46; 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&#46; There were no palpable locoregional lymph nodes&#46;</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&#46; Histopathology revealed the presence of tumor nodules in the dermis&#46; The nodules were composed of monomorphic mononuclear cells&#44; spindle-shaped cells&#44; and multinucleated osteoclast-like giant cells&#44; with no cellular atypia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The number of mitoses was 3 per 10 high-power fields and the Ki-67 index was 21&#37;&#46; Immunohistochemistry was positive for CD68 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; and negative for S100 and pancytokeratins&#46; No vascular invasion was detected&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">&#191;What Is Your Diagnosis&#63;</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 &#40;STGCTLMP&#41;&#46;</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&#46;</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&#44; well-defined tumor&#46; Around 80 cases with similar characteristics have been reported&#44; the majority located on the upper and lower limbs&#44; in contrast to our patient&#44; in whom the tumor was in the frontal region&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#8211;5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Although STGCTLMP was initially included as a malignant soft tissue giant cell tumor&#44; Folpe et al&#46;<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&#44; in contrast to the former tumors&#44; this neoplasm only presents mild or moderate atypia and an indolent clinical course&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">They are considered to be the soft tissue analogy to giant cell tumors of bone&#44; due to their histological and immunohistochemical similarity&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Microscopically&#44; STGCTLMP presents a monomorphic proliferation of mononuclear cells and osteoclast-like multinucleated giant cells distributed uniformly through the tumor&#44; as was observed in our case&#46; These tumors can present metaplastic bone formation peripherally and vascular invasion&#46;<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&#46; CD68&#44; which is also expressed in epithelial and mesenchymal tumors such as atypical fibroxanthoma&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> is detected in the cytoplasm of the multinucleated cells&#46; Tartrate-resistant acid phosphatase and smooth muscle actin are also positive&#44; but CD45&#44; protein S100&#44; desmin&#44; and lysozyme are negative&#44; producing an immunophenotypic profile identical to that of giant cell tumors of bone&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Additional tests demonstrate the extraosseus situation&#46;<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&#44; such as the giant cell variant of malignant fibrous histiocytoma&#44; plexiform fibrohistiocytic tumor&#44; and extraskeletal osteosarcoma&#59; these tumors have a more aggressive course&#46; STGCTLMP must also be differentiated from atypical fibroxanthoma&#44; an uncommon dermal tumor of uncertain histogenesis&#44; considered by the majority of authors to be superficial variant of malignant fibrous histiocytoma&#44; but with a better prognosis&#46; This tumor typically presents as a solitary nodule in sun-exposed areas in elderly adults&#46; Histologically&#44; there is a predominance of spindle-shaped cells with large vesicular nuclei&#44; associated with a variable number of giant cells&#44; some of which are multinucleated&#44; and polygonal cells with abundant eosinophilic cytoplasm&#46;<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&#46;<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&#44; but local recurrence can occur after incomplete resection&#44; as is seen with its osseous form&#46; Lymph-node and lung metastases are very rare&#46;<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&#44; a rare lesion that must be included in the differential diagnosis of soft tissue tumors rich in giant cells&#44; as its clinical behavior&#44; prognosis&#44; and treatment differ significantly&#46;</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&#46;</p></span></span>"
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