Unusual Multinucleated Giant Cell Reaction in a Tongue Squamous Cell Carcinoma: Histopathological and Immunohistochemica
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CASE REPORT
Unusual Multinucleated Giant Cell Reaction in a Tongue Squamous Cell Carcinoma: Histopathological and Immunohistochemical Features Celeste Sánchez‑Romero1 · Roman Carlos2 · Ciro Dantas Soares1 · Oslei Paes de Almeida1 Received: 1 November 2017 / Accepted: 5 February 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Multinucleated giant cell (MGC) reaction in oral squamous cell carcinoma (OSCC) usually represents a stromal foreign body reaction to keratin from neoplastic epithelial cells. We describe and illustrate by double immunohistochemistry a case of a tongue squamous cell carcinoma (SCC) in a 70-year-old female patient, with a copious MGC reaction not associated to keratin, showing a histopathological pattern not described before. The MGCs were directly associated with neoplastic cells, which are phagocytosed by the MGCs. Immunohistochemistry for CD68, AE1/AE3, CD163, CD11c, RANK, RANK-L, OPG were performed, as well as double staining for CD68 and AE1/AE3 to better illustrate the relationship between MGCs and neoplastic cells. The clinical and biological significance of this pattern of MGC reaction in OSCC needs to be better elucidated. Keywords Oral squamous cell carcinoma · Multinucleated giant cells · Immunohistochemistry · Phagocytosis
Introduction Interactions between tumoral and stromal cells are important events in cancer, and inflammation is an important reaction that can be associated with better or worse prognosis of neoplasms, depending on the type of inflammation and of the malignancy. Macrophages are an important component of the cancer-associated inflammation in several types of cancer, including oral squamous cell carcinoma (OSCC) [1–3]. There are two different cell populations in macrophages given by a mechanism called macrophage polarization by which, in response to microenvironmental signals, the macrophage expresses different functional programs, acquiring a specific phenotype such as M1 or M2. M1 macrophages (classically activated macrophages), produce pro-inflammatory cytokines: interleukin (IL)-1, IL-6, IL-12, and tumor necrosis factor alpha (TNFa), these M1 macrophages can
present a antitumoral response in cancer; while M2 macrophages (alternatively activated macrophages), may have a pro-tumoral response, by releasing IL-4, IL-10 cytokines and transforming growth factor (TGF)-b promoting tumoral growth, angiogenesis, extracellular matrix (ECM) remodeling, and even metastasis [4–7]. Macrophages fusion resulting into multinucleated giant cells (MGC) has been described as a host response to the tumoral cells in several types of carcinomas, however, the prognostic implications are not clear [8–13]. To the best of our knowledge, few cases of OSCC and lip squamous cell carcinoma (SCC) presenting MGCs have been reported, usually representing a foreign body reaction to keratin. In this study we describe and illustrate a case of tongue SCC with an unusual profuse reaction of MGC surrounding and phagocytosing neoplastic cells, but without associa
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