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  Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 55  |  Issue : 2  |  Page : 201-202
 

Gamna–Gandy bodies in a solid pseudopapillary tumor of the pancreas


Department of Pathology, Lady Hardinge Medical College, New Delhi, India

Date of Web Publication31-Dec-2018

Correspondence Address:
Dr. Shivali Sehgal
Department of Pathology, Lady Hardinge Medical College, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_170_18

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 » Abstract 


Gamna gandy bodies are sclerosiderotic granules composed of various amounts of calcium and hemosiderin in hyalinised fibrous tissue. We report a case of an 18 year old girl with solid pseudopapillary tumor of the pancreas in which numerous gamna gandy bodies were present. The pathogenesis of such a finding is unclear. To the best of our knowledge, this is the first report of Gamna Gandy bodies occurring in a solid pesudopapillary tumor of the pancreas.


Keywords: Gamna Gandy bodies, pancreas, solid pseudopapillary tumor


How to cite this article:
Nangia A, Sehgal S. Gamna–Gandy bodies in a solid pseudopapillary tumor of the pancreas. Indian J Cancer 2018;55:201-2

How to cite this URL:
Nangia A, Sehgal S. Gamna–Gandy bodies in a solid pseudopapillary tumor of the pancreas. Indian J Cancer [serial online] 2018 [cited 2019 Jul 21];55:201-2. Available from: http://www.indianjcancer.com/text.asp?2018/55/2/201/249197





 » Introduction Top


Gamna–Gandy bodies, also known as tobacco flecks or siderotic nodules, are small, firm fibrotic nodules impregnated with hemosiderin and calcium salts.[1] They occur chiefly in the spleen. We report a case of a solid pseudopapillary neoplasm of the pancreas with numerous Gamna–Gandy bodies.


 » Case Report Top


An 18-year-old girl presented with lump in the upper abdomen that was progressively increasing in size for the past 1 year. On examination, it was firm, measured 6 × 6 cm and was located in the left hypochondrium below the left costal margin. Contrast enhanced computed tomography was suggestive of a solid pseudopapillary tumor of the pancreas. Peroperatively, a mass measuring 10 × 10 cm was seen arising from the pancreas.

We received a globular tumor mass measuring 12 × 11 × 8 cm. The external surface was smooth with attached fascia and adipose tissue. Focally gray brown pancreatic tissue was seen. Serial slicing of the mass revealed a cystic tumor with presence of numerous friable, papillae arising from the wall [Figure 1]. Focal areas of hemorrhage and necrosis were identified. No area of rupture or breech of the capsule was identified. Histopathological examination was consistent with the diagnosis of solid pseudopapillary tumor of the pancreas. The tumor showed extensive hyalinization, calcification along with presence of Gamna–Gandy bodies [Figure 2]. Perls stain and Von Kossa stain confirmed that the structures were made of iron and calcium deposits [Figure 3]. Mucin secretion was present. Clusters of periodic acid Schiff positive and diastase resistant structures were seen. There was no evidence of lymphovascular invasion; mitotic activity was 1–2/10 hpf. Capsular thickness varied from 0.3–1 cm. The attached pancreatic tissue showed unremarkable histology.
Figure 1: Scan view showing numerous friable papillae in the pancreas (H and E, ×40). Inset showing low power view of the same tumor (H and E, ×100)

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Figure 2: Focus showing Gamma–Gandy body in the tumor (H and E, ×100)

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Figure 3: Figure on the left showing Perl's stain positive for iron and figure on the right showing Von Kossa stain positive for calcium in the Gamma–Gandy body (×100)

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Immunohistochemistry showed that the tumor was vimentin (Dako, 1:200) positive, CD 10 (Dako, 1:50) positive, and NSE (Dako, 1:100) positive. Pancytokeratin, CK7, CEA, chromogranin, ER were negative. Ki-67 (Dako, 1:60) was less than 1%.


 » Discussion Top


Gamma–Gandy bodies are sclerosiderotic granules composed of various amounts of calcium and hemosiderin in hyalinized fibrous tissue. Occasionally a foreign body giant cell reaction is seen in their vicinity. They are usually encountered in the spleen. Rarely, they have been reported in the lymph nodes, thyroid, ovary, and liver.[2],[3],[4] They have been described in cardiac myxoma and thymoma.[5],[6] Leroy et al.[7] reported them in renal clear cell carcinoma. Kleinschmidt-DeMasters[8] described the presence of Gamma–Gandy bodies in many central nervous and peripheral nervous neoplasms as well as schwannomas of the ulnar nerve, pituitary adenoma, cavernous angioma, myxopapillary ependymoma, and cholesterol granuloma of temporal bone.

The pathogenesis is unclear. In the spleen, they are thought to be a result of focal hemorrhage and necrosis in the splenic parenchyma secondary to congestive splenomegaly that is followed by accumulation of hemosiderin and impregnation of collagen and elastic fibers with iron and calcium.[9] The pathophysiological process in other organs appears to be the same. The four main components of Gamma–Gandy bodies are (i) blood vessels with granulomatous vasculitis, sclerosis, and hyalinization and fragmentation of elastic fibers;(ii) deposits of calcium and hemosiderin in the vessels and in the intervening connective tissue stroma; (iii) a fibroblastic reaction along with infiltration of macrophages with multinucleated foreign body giant cells; (iv) spheroid, bamboo shaped and articulated fibers, which resemble mycelia structures or parasite eggs. This peculiar fiber formation is considered characteristic of Gamna–Gandy bodies.[2]

To the best of our knowledge, this is the first report of Gamma–Gandy bodies in a solid pseudopapillary tumor of the pancreas.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 » References Top

1.
Bhatt S, Simon R, Dogra VS. Gamna–Gandy bodies. Sonographic features with histopathological correlation. J Ultrasound Med 2006;25:1625-9.  Back to cited text no. 1
    
2.
Tedeschi LG. The gamma nodule. Hum Pathol 1971;2:182-3.  Back to cited text no. 2
    
3.
Hom BL, Ng S. Gamna–Gandy nodules in an ovary. J Hong Kong Med Assoc 1986;38:97-8.  Back to cited text no. 3
    
4.
Zhang J, Krinsky GA. Iron containing nodules of cirrhosis. NMR Biomed 2004;17:459-64.  Back to cited text no. 4
    
5.
Trotter SE, Shore DF, Oslen EGJ. Gamma–Gandy nodules in a cardiac myxoma. Histopathology 1990;17:270-2.  Back to cited text no. 5
    
6.
Tedeschi LG, Sherman JD, Tedeschi CG. Sclerosiderotic granulomatosis in thymoma. Arch Pathol 1965;80:235-40.  Back to cited text no. 6
    
7.
Leroy X, Sebastein A, Gosselin B. Gamma–Gandy nodules in a renal clear cell carcinoma. Arch Pathol Lab Med 2003;127:372.  Back to cited text no. 7
    
8.
Kleinschmidt-DeMasters BK. Gamna–Gandy bodies in surgical neuropathy specimens: Observations and a historical note. J Neuropathol Exp Neurol 2004;63:106-12.  Back to cited text no. 8
    
9.
Dufour JF, Dinkel HP, Zimmermann A. Image of the month: Gamma–Gandy bodies. Gatroenterology 2003;125:1010,1294.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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