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Ran H, Chen G, He Y, Yu Q, Xie Y, Liu J, Liu H, Zhang T. Undifferentiated carcinoma with osteoclast‑like giant cells of the pancreas: A case report. Oncol Lett 2023; 25:252. [PMID: 37153037 PMCID: PMC10161351 DOI: 10.3892/ol.2023.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/31/2023] [Indexed: 05/09/2023] Open
Abstract
Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas (UCOGCP) is a rare pancreatic tumor that accounts for <1% of all primary pancreatic malignant tumors. Although the tumor is considered a variant of pancreatic ductal adenocarcinoma, there are substantial differences in the clinicopathological characteristics between UCOGCP and pancreatic ductal adenocarcinoma. Imaging examinations are useful in making a correct diagnosis, and providing a reasonable and effective surgical treatment regimen; however, the imaging characteristics of UCOGCP require further investigation. The present report describes a rare case of UCOGCP with rapid progression and poor prognosis. The patient could not undergo surgery and received chemotherapy drugs only. Chemotherapy did not markedly improve the outcome, and a follow-up 6 months after discharge showed that the patient had died. The present report describes this case and summarizes the available imaging findings to increase awareness, and to improve early diagnosis of this rare disease and therapeutic outcomes.
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Affiliation(s)
- Haifeng Ran
- Department of Radiology, Medical Imaging Center of Guizhou Province, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Guiqin Chen
- Department of Radiology, Medical Imaging Center of Guizhou Province, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Yulun He
- Department of Radiology, Medical Imaging Center of Guizhou Province, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Qiane Yu
- Department of Radiology, Medical Imaging Center of Guizhou Province, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Yuxin Xie
- Department of Radiology, Medical Imaging Center of Guizhou Province, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Junwei Liu
- Department of Radiology, Medical Imaging Center of Guizhou Province, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Heng Liu
- Department of Radiology, Medical Imaging Center of Guizhou Province, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
- Correspondence to: Professor Tijiang Zhang or Professor Heng Liu, Department of Radiology, Medical Imaging Center of Guizhou Province, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan, Zunyi, Guizhou 563000, P.R. China, E-mail:
| | - Tijiang Zhang
- Department of Radiology, Medical Imaging Center of Guizhou Province, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
- Correspondence to: Professor Tijiang Zhang or Professor Heng Liu, Department of Radiology, Medical Imaging Center of Guizhou Province, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan, Zunyi, Guizhou 563000, P.R. China, E-mail:
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Mugaanyi J, Lu C, Huang J, Lu C. Undifferentiated Pancreatic Carcinomas, Clinical Features and Therapeutic Options: What We Know. Cancers (Basel) 2022; 14:cancers14246102. [PMID: 36551588 PMCID: PMC9776693 DOI: 10.3390/cancers14246102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022] Open
Abstract
Undifferentiated pancreatic carcinomas are rare malignant tumors of the pancreas that are very aggressive and challenging to diagnose. The WHO categorizes them into undifferentiated osteoclast-like giant cell, sarcomatoid, and rhabdoid pancreatic carcinomas. Patients present with nonspecific symptoms such as jaundice, vague abdominal or back pain and itchy skin. Their histological characteristics include positive pan-cytokeratin mononuclear pleomorphic cells, osteoclast-like giant cells and CD68. Patients may have KRAS, TP53 and SMAD4 alterations, homozygous deletions of CDKN2A and CDKN2B, as well as INI1 deficiency. Surgical resection is the only curative treatment. Patients may benefit from postoperative adjuvant therapy. There are no widely accepted guidelines specific to this type of tumor; however, some chemotherapy regimens may be promising. The patient prognosis is mostly poor, especially in patients with unresectable tumors. However, several studies have shown patients achieving long-term survival with adjuvant therapy. In conclusion, although undifferentiated pancreatic carcinoma is rare and very aggressive, there is still potential for improved patient survival with proper diagnosis and treatment.
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Affiliation(s)
- Joseph Mugaanyi
- School of Medicine, Ningbo University, Ningbo 315211, China
- Department of Hepato-Pancreato-Billiary Surgery, Ningbo Medical Center Li Huili Hospital, Ningbo University, Ningbo 315211, China
| | - Changjiang Lu
- Department of Hepato-Pancreato-Billiary Surgery, Ningbo Medical Center Li Huili Hospital, Ningbo University, Ningbo 315211, China
| | - Jing Huang
- Department of Hepato-Pancreato-Billiary Surgery, Ningbo Medical Center Li Huili Hospital, Ningbo University, Ningbo 315211, China
| | - Caide Lu
- Department of Hepato-Pancreato-Billiary Surgery, Ningbo Medical Center Li Huili Hospital, Ningbo University, Ningbo 315211, China
- Correspondence:
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Abstract
Pancreatic giant cell tumors (PGCTs), undifferentiated pancreatic carcinoma are rare tumors of the pancreas. PGCTs consist of osteoclastic, pleomorphic and mixed variants. PGCT is usually diagnosed at an advanced stage. PGCT has a worse prognosis than pancreatic ductal adenocarcinoma. Although surgery can be curative, there is no standard treatment approach for advanced PGCT. We present a case of PGCT that is resistant to standard therapy and progresses in a short time.
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Shao H, Lu B, Sun X, Liu F. Clinical and pathological features of undifferentiated pancreatic carcinoma with osteoclastic giant cells: a rare case. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:395-399. [PMID: 34663075 DOI: 10.17235/reed.2021.8135/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION undifferentiated pancreatic carcinoma with osteoclastic giant cells (UOC) is a rare pancreatic malignancy composed of three unique cell types. Currently, the histopathologic origin of UOCs remains unclear. Some studies considered that it was differentiated from epithelial tissues, while others favored a mesenchymal derivation. METHODS we present the case of a 59-year-old UOC patient with a tumor (3.0 cm × 3.0 cm × 2.5 cm) in the pancreatic neck. He underwent an en bloc resection of the distal pancreas associated with the spleen. RESULTS light microscopic examination revealed two typical types of UOC cells, with one type absent. The immunohistochemical staining was positive for pancytokeratin, epithelial membrane antigen, vimentin and cluster of differentiation 68, which indicated different derivations for these two kinds of cells. DISCUSSION UOC is a rare condition with unique imaging and pathological features. Endoscopic ultrasonography and fine needle aspiration are dispensable preoperatively. Radical resection should be tried for UOC treatments. In our opinion, osteoclastic giant cells are reactive cells derived from histocytes. The case presented here will be of interest to the whole UOC cohort.
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Affiliation(s)
- Huijiang Shao
- Hepatobiliary and Pancreatic Surgery, Shaoxing People's Hospital
| | - Baochun Lu
- Hepatobiliary and Pancreatic Surgery, Shaoxing People's Hospital
| | - Xuezheng Sun
- Hepatobiliary and Pancreatic Surgery, Shaoxing People's Hospital
| | - Fang Liu
- Pathology, Shaoxing People's Hospital. Shaoxing Hospital of Zhejiang University, China
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Rusu A, Giuşcă SE, Apostol DGC, Ionescu L, Căruntu ID. Cephalic undifferentiated carcinoma with osteoclast-like giant cells arising from the main pancreatic duct: case report and literature review. Arch Clin Cases 2021; 6:6-21. [PMID: 34754903 PMCID: PMC8565694 DOI: 10.22551/2019.22.0601.10148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Undifferentiated carcinoma with osteoclast-like giant cell (UCOGC) is a ductal carcinoma variant with a recently reported more protracted survival and pathognomonic histology comprising two cell populations: the mononuclear tumoral cells and nontumoral multinucleated giant cells. It usually presents as a large heterogenic tumor with mixed solid-cystic components. The tumor develops from the ductal epithelium but the sequence of epithelial changes is often not identified due to the rapid tumoral growth and associated necrotic changes. We report a case of a 76-year-old patient diagnosed with cephalic UCOGC originating in the epithelium of the main pancreatic duct with endoluminal growth and foci of other ductal neoplasms (high-grade pancreatic intraepithelial neoplasia (PanIN) and conventional ductal carcinoma). The particularity of our case consists in the identification of the columnar epithelium conversion, through high-grade PanIN, into UCOGC specific malignant features, in a large size tumor - aspect usually reported in small tumors. Alongside our case we also present a brief literature review of cephalic UCOGC case reports and case series.
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Affiliation(s)
- Andreea Rusu
- Department of Morphofunctional Sciences I - Histology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania
| | - Simona Eliza Giuşcă
- Department of Morphofunctional Sciences I - Pathology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania
| | - Delia Gabriela Ciobanu Apostol
- Department of Morphofunctional Sciences I - Pathology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania.,Department of Pathology "Sf. Spiridon" County Clinical Emergency Hospital, Iaşi, Romania
| | - Lidia Ionescu
- Department of Surgery, Third Surgery Clinic, "St. Spiridon" County Clinical Emergency Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania
| | - Irina-Draga Căruntu
- Department of Morphofunctional Sciences I - Histology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania
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Kharkhach A, Bouhout T, Serji B, El Harroudi T. Undifferentiated Pancreatic Carcinoma with Osteoclast-like Giant Cells: a Review and Case Report Analysis. J Gastrointest Cancer 2021; 52:1106-1113. [PMID: 33447945 DOI: 10.1007/s12029-021-00583-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Ayoub Kharkhach
- Department of Surgical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco.
| | - Tarik Bouhout
- Department of Surgical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Badr Serji
- Department of Surgical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Tijani El Harroudi
- Department of Surgical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
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Ueberroth BE, Liu AJ, Graham RP, Bekaii-Saab TS, McWilliams RR, Mahipal A, Truty MJ, Mody K, Sonbol MB, Halfdanarson TR. Osteoclast-Like Giant Cell Tumors of the Pancreas: Clinical Characteristics, Genetic Testing, and Treatment Modalities. Pancreas 2021; 50:952-956. [PMID: 34369897 DOI: 10.1097/mpa.0000000000001858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES This study sought to better characterize patient characteristics, treatment options, and outcomes for osteoclast-like giant cell carcinoma of the pancreas, a rare subtype of pancreatic adenocarcinoma. METHODS This is a retrospective study of all patients with osteoclast-like giant cell carcinoma of pancreatic origin treated at Mayo Clinic from 2000 to present. Baseline patient characteristics, treatment modalities utilized, and outcomes were compiled. Overall survival (OS) and progression-free survival were assessed using Kaplan-Meier analysis with a significance level of P ≤ 0.05. RESULTS Fifteen patients met criteria for inclusion. Four patients had distant metastases at diagnosis, the remaining 11 with locoregional disease. Median OS for the entire cohort was 11 months. Metastatic disease was associated with significantly shorter OS (3.5 vs 14.1 months; P = 0.005). Three patients had no evidence of disease at time of analysis; all 3 were treated with complete resection followed by adjuvant chemotherapy. CONCLUSIONS Osteoclast-like giant cell carcinoma of the pancreas is an aggressive malignancy with poor prognosis. For patients with locoregional disease, surgical resection followed by adjuvant chemoradiation may play a role in extended disease-free survival. Metastatic disease presents a challenging entity to treat with little data to support any effective chemotherapy regimens.
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Affiliation(s)
| | - Alex J Liu
- From the Department of Internal Medicine, Mayo Clinic, Phoenix, AZ
| | | | | | | | - Amit Mahipal
- Department of Oncology, Mayo Clinic, Rochester, MN
| | - Mark J Truty
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - Kabir Mody
- Department of Oncology, Mayo Clinic, Jacksonville, FL
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Cavalcanti E, Schena N, Serino G, Lantone G, Armentano R. Assessment and management of undifferentiated carcinoma with osteoclastic like giant cells of the pancreas: a case report and revision of literature. BMC Gastroenterol 2021; 21:247. [PMID: 34078293 PMCID: PMC8170928 DOI: 10.1186/s12876-021-01779-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Undifferentiated carcinoma with osteoclast-like giant cells (UCOGCs) is a rare and aggressive non endocrine pancreatic carcinoma characterized by the presence of osteoclastic giant cells mixed with mononuclear cell. Very few cases have been reported in the literature and the histogenesis is controversial as, at the time of diagnosis, the tumor is often of advanced size and stage and it is difficult to pathologically observe its relationship with the pancreatic duct. CASE PRESENTATION We present a case of 65-year-old male patient presenting with abdominal pain, nausea, and weight loss, which was treated with surgical resection. Histological examination revealed an undifferentiated pancreatic carcinoma with osteoclast-like giant cells. The patient underwent to a routine pylorus preserving pancreatoduodenectomy. Actually, the patient was in good performance status and disease-free five months. CONCLUSIONS Based on the present case and limited previous data, further researches preferably with large cohorts are necessary to clarify the pathogenesis of the neoplasm. However, as show in this case, histopathological and immunohistochemically studies are the gold standard for the diagnosis of UCPOGC. Investigation of the genomic alterations in UPOGCs could help to explain the histologic diversity of variant tumor and could provide a genetic basis for prognosis and treatment.
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Affiliation(s)
- Elisabetta Cavalcanti
- Histopathology Unit of National Institute of Gastroenterology "S. de Bellis," Research Hospital, Via Turi 27, 70013, Castellana Grotte, Bari, Italy.
| | - Nicolo' Schena
- Histopathology Unit of National Institute of Gastroenterology "S. de Bellis," Research Hospital, Via Turi 27, 70013, Castellana Grotte, Bari, Italy
| | - Grazia Serino
- Laboratory of Experimental Immunopathology, National Institute of Gastroenterology "S. de Bellis," Research Hospital, Castellana Grotte, Bari, Italy
| | - Giulio Lantone
- Surgery Unit of National Institute of Gastroenterology "S. de Bellis," Research Hospital, Castellana Grotte, Bari, Italy
| | - Raffaele Armentano
- Histopathology Unit of National Institute of Gastroenterology "S. de Bellis," Research Hospital, Via Turi 27, 70013, Castellana Grotte, Bari, Italy
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9
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Besaw RJ, Terra AR, Malvar GL, Chapman TR, Hertan LM, Schlechter BL. Durable Response to PD-1 Blockade in a Patient With Metastatic Pancreatic Undifferentiated Carcinoma With Osteoclast-Like Giant Cells. J Natl Compr Canc Netw 2021; 19:247-252. [PMID: 33668025 DOI: 10.6004/jnccn.2021.7001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022]
Abstract
Undifferentiated carcinoma with osteoclast-like giant cells (UCOGC) of the pancreas is a rare and potentially aggressive variant of pancreatic ductal adenocarcinoma. Data on this disease are sparse, and despite genetic similarities to pancreatic ductal adenocarcinoma, UCOGC clinical outcomes can be markedly different. We report on a female patient aged 62 years who presented with UCOGC with pulmonary metastases initially treated with 2 lines of cytotoxic chemotherapy. After rapid disease progression with both cytotoxic treatments, the patient's tissue was sent for next-generation sequencing, which revealed a high tumor mutation burden (32 mutations per megabase), as well as somatic mutations in BRAF, NF1, PIK3CA, CDKN2A, TERT, and TP53. Pancreatic cancers have previously demonstrated suboptimal responses to immunotherapeutic approaches. However, given the high tumor mutation burden and distinctiveness of the tumor class, the patient began third-line pembrolizumab monotherapy after palliative radiation to the rapidly progressing and painful abdominal mass from her primary tumor. She had a marked response in her primary UCOGC tumor and metastatic sites, and she remains on pembrolizumab monotherapy with ongoing response after 32 months of therapy. Recent evidence showing significant PD-L1 enrichment on neoplastic cells of undifferentiated carcinomas (including UCOGC) may indicate a role for immunotherapeutic approaches in these patients. Rare cancers such as UCOGC and other undifferentiated carcinomas may benefit from next-generation sequencing to inform treatment decisions when standards of care are absent, as in this report.
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Affiliation(s)
- Robert J Besaw
- Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center
| | - Adrienne R Terra
- Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center.,Gastrointestinal Cancer Center, Dana-Farber Cancer Institute
| | - Grace L Malvar
- Department of Pathology, Beth Israel Deaconess Medical Center.,Harvard Medical School; and
| | - Tobias R Chapman
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and.,Radiation Oncology Associates PC, Inova Schar Cancer Institute, Inova Fairfax Hospital, Fairfax, Virginia
| | - Lauren M Hertan
- Harvard Medical School; and.,Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
| | - Benjamin L Schlechter
- Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center.,Gastrointestinal Cancer Center, Dana-Farber Cancer Institute.,Harvard Medical School; and
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Cai Y, Chen Y, Wu X, Yin Y, Cao L, Liu X. Seven-year disease-free survival in a patient with osteoclast-like giant cell-containing pancreatic undifferentiated carcinoma: a case report and literature review. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:3200-3205. [PMID: 33425122 PMCID: PMC7791393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/14/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Undifferentiated carcinoma with osteoclast-like giant cells (UCOGC) of the pancreas is a very rare variant of pancreatic malignant neoplasm. It is regarded as a highly aggressive tumor with a worse prognosis than conventional pancreatic ductal adenocarcinoma. CASE PRESENTATION A 54-year-old male patient presented with 3-month recurrent epigastric distress. Computed tomography of the abdomen showed a large cystic mass in the distal pancreas. On macroscopic examination, the lesion had numerous multiloculated cystic cavities. Microscopically, the tumor predominantly comprised a considerable number of evenly distributed non-neoplastic osteoclast-like giant cells and a few neoplastic pleomorphic cells. Although extensive histologic sampling was conducted, a classic ductal adenocarcinoma component was not identified. The patient received no further treatment after his surgery and has been doing well with no evidence of recurrence or metastasis for >7 years. CONCLUSIONS Our results suggest that pure UCOGC has a significantly better prognosis and supports that pure UCOGC may represent a biologically distinct variant of pancreatic carcinoma and it should be separated from other undifferentiated pancreatic carcinomas.
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Affiliation(s)
- Yongping Cai
- Department of Pathology, Anhui Medical UniversityHefei, Anhui Province, China
- Department of Pathology, The First Affiliated Hospital of Anhui Medical UniversityHefei, Anhui Province, China
| | - Yong Chen
- Department of Pathology, Anhui Medical UniversityHefei, Anhui Province, China
- Department of Pathology, Anhui Province Maternal and Child Health HospitalHefei, Anhui Province, China
| | - Xingwang Wu
- Department of Imaging, The First Affiliated Hospital of Anhui Medical UniversityHefei, Anhui Province, China
| | - Yu Yin
- Department of Pathology, Anhui Medical UniversityHefei, Anhui Province, China
- Department of Pathology, The First Affiliated Hospital of Anhui Medical UniversityHefei, Anhui Province, China
| | - Liyu Cao
- Department of Pathology, Anhui Medical UniversityHefei, Anhui Province, China
- Department of Pathology, The First Affiliated Hospital of Anhui Medical UniversityHefei, Anhui Province, China
| | - Xiuli Liu
- Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of FloridaGainesville, FL, USA
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Yang G, Yin J, Ou K, Du Q, Ren W, Jin Y, Peng L, Yang L. Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas harboring KRAS and BRCA mutations: case report and whole exome sequencing analysis. BMC Gastroenterol 2020; 20:202. [PMID: 32590950 PMCID: PMC7318525 DOI: 10.1186/s12876-020-01351-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022] Open
Abstract
Background Undifferentiated carcinoma with osteoclast-like giant cells (UC-OGC) is an extremely uncommon pancreatic neoplasm that comprises less than 1% of all exocrine pancreatic tumors. To date, cases and data from whole-exome sequencing (WES) analysis have been reported by specific studies. We report a case of pancreatic UC-OGC with a literature review, and provide novel insights into the molecular characteristics of this tumor entity. Case presentation A 31-year-old male presented with intermittent abdominal pain for several months, and positron emission tomography (PET) showed isolated high metabolic nodules during the pancreatic uncinate process that were likely to be malignant disease. Pathological examination after radical excision revealed UC-OGC associated with poorly differentiated adenocarcinoma at the head of the pancreas. The disease recurred 7.4 months after radical surgery. The KRAS p.G12D (c.35G > A) and somatic BRCA2 p.R2896C (c.8686C > T) mutations were detected by subsequent WES analysis. The patient showed no response to platinum-based systemic chemotherapy, and his condition quickly worsened. He finally died, with an overall survival of 1 year. Conclusions As an extremely uncommon tumor entity, UC-OGC is really a unique variant of conventional pancreatic ductal adenocarcinoma due to its similarities, as shown by genomic WES analysis. Clinical examination and molecular analysis by WES could further indicate potential treatment strategies for UC-OGC.
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Affiliation(s)
- Guangjian Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jiangxia Yin
- Department of Oncology, Shouguang Hospital of Traditional Chinese Medicine, Weifang, 262700, China
| | - Kai Ou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Qiang Du
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wenhao Ren
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yujing Jin
- Department of Medical Imaging, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Liming Peng
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lin Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Nehmeh WA, Trak-Smayra V, Tarhini A, Gabriel MF, Sayegh RB, Noun R. A Case Report Presenting an Undifferentiated Pancreatic Carcinoma with Osteoclastic-Like Giant Cells with an Unusual Indolent Course. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1750-1754. [PMID: 31767823 PMCID: PMC6900831 DOI: 10.12659/ajcr.916810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/19/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Undifferentiated pancreatic carcinoma with osteoclast-like giant cells represents less than 1% of pancreatic cancers. Histogenesis and prognosis are still debated. Three subtypes are defined by the World Health Organization: osteoclastic, pleomorphic, and mixed. The differential diagnosis of a pancreatic tumor with giant cells varies from a benign osteoclastoma to an undifferentiated pancreatic carcinoma with osteoclastic-like cells. The specimen should be carefully examined to rule out conventional pancreatic adenocarcinoma even in the presence of the giant cells. CASE REPORT A 77-year-old male was diagnosed with a pancreatic tail tumor with osteoclastic like cells revealed by a biopsy done by echo-endoscopy; the patient was lost to follow up for 24 months before he was admitted to our institute for severe abdominal pain. A computed tomography showed the same lesion without progression. He was operated on using laparoscopic distal pancreatectomy with splenectomy. Pathology analysis revealed the presence of osteoclast-like giant cells without pleomorphic cells. Mutated KRAS on molecular study confirmed the diagnosis of undifferentiated pancreatic carcinoma with osteoclast-like giant cells. The patient was in good performance status and disease-free 19 months after surgery without any sign of progression. CONCLUSIONS Undifferentiated pancreatic carcinoma with osteoclast-like cells has a challenging pathology diagnosis. Molecular and immunostaining are essential to diagnosis. The absence of pleomorphic cells in the present case has classified it into the osteoclastic subtype. Further cases and studies are needed to confirm the heterogeneity of the malignant course between subtypes.
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Affiliation(s)
- William A. Nehmeh
- Department of Digestive Surgery, Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Viviane Trak-Smayra
- Department of Pathology, Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Ahmad Tarhini
- Department of Digestive Surgery, Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Michel Fouad Gabriel
- Department of Digestive Surgery, Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Raymond B. Sayegh
- Department of Gastroenterology, Hotel Dieu De France Hospital, Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
| | - Roger Noun
- Department of Digestive Surgery, Saint Joseph University, Faculty of Medicine, Beirut, Lebanon
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Guo YL, Ruan LT, Wang QP, Lian J. Undifferentiated carcinoma with osteoclast-like giant cells of pancreas: A case report with review of the computed tomography findings. Medicine (Baltimore) 2018; 97:e13516. [PMID: 30508980 PMCID: PMC6283196 DOI: 10.1097/md.0000000000013516] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
RATIONALE Undifferentiated carcinoma with osteoclast-like giant cells (UC-OGCs) of the pancreas is an extremely rare and aggressive pancreatic malignancy. To our knowledge, the computed tomography (CT) findings of this disease have rarely been analyzed. PATIENT CONCERNS A 65-year-old man who experienced weight loss of about 4 kg over 3 months presented to our clinic. The abdominal ultrasound (US) detected a 5.8 × 5.5 cm well-defined, cystic-solid mass in the head of the pancreas, which had been present for 1 month. DIAGNOSIS A benign pancreatic tumor was initially suspected on the basis of the US findings. The patient then received serum tumor markers and CT examinations for further diagnosis, including carbohydrate antigen 199 (CA199), carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), contrast-enhanced CT (CECT) and CT angiography (CTA). His CA199, CEA, and CA125 marker levels were normal, which supported the diagnosis of a benign tumor. CECT showed a well-defined cystic-solid mass in the head of the pancreas, with a slightly enhanced solid portion and pancreatic ductal dilatation, which led us to consider the possibility of a malignant tumor. CTA revealed that the tumor nourishing arteries emitted from the pancreaticoduodenal superior and inferior arteries into the mass. Then, the patient underwent a pancreaticoduodenectomy. Finally, postoperative pathology and immunohistochemistry confirmed UC-OGC of the pancreas. INTERVENTIONS The patient has been treated by a pancreaticoduodenectomy alone. OUTCOMES The operation had no complications, and the patient recovered well after surgery. Ten months after surgery, the patient reviewed the CECT, and no recurrence or metastasis was noted. LESSONS Old patients with cystic-solid lesions in the pancreas should be aware of UC-OGC. CT findings usually show a clear boundary and a slightly enhanced mass with pancreatic duct expansion.
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Affiliation(s)
| | | | | | - Jie Lian
- Department of Pathological Diagnosis, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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