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Tambasco ML, Echelard P, Perrault F, Temmar R, Trinh VQH, Collin Y. Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells, a two cases report. Int J Surg Case Rep 2024; 116:109419. [PMID: 38387371 PMCID: PMC10944003 DOI: 10.1016/j.ijscr.2024.109419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Fine needle aspiration is the standard method for the pathological evaluation of pancreatic masses. In the following context, rare variants of such masses might present a challenge. Our goal is to describe the clinical, cytological, and histological findings of two cases of undifferentiated carcinoma with osteoclast-like giant cells (UCOCGC) a rare variant of pancreatic ductal adenocarcinoma (PDAC). CASE PRESENTATION Two cases were identified. Cytological findings exhibit similarities between the two cases. One patient received multiple chemotherapy regimens and a surgery and recurred within three years of diagnosis, while the other succumbed to cholangitis resulting from hepatic metastases a year after their initial surgery. DISCUSSION UCOCGC is a rare variant of pancreatic cancer, characterized by a unique cytological aspect. Recognizing this variant is essential considering its distinct prognosis compared to usual pancreatic adenocarcinoma. CONCLUSION We presented two cases of UCOCGC a rare pancreatic cancer variant, exposing diagnostic particularities and clinical evolution.
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Affiliation(s)
- Maria Luisa Tambasco
- Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Canada.
| | - Philippe Echelard
- Department of Pathology, University of Sherbrooke, Sherbrooke, Canada.
| | - Florence Perrault
- Department of Pathology, University of Sherbrooke, Sherbrooke, Canada.
| | - Rabia Temmar
- Department of Pathology, University of Sherbrooke, Sherbrooke, Canada.
| | - Vincent Quoc-Huy Trinh
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, United States.
| | - Yves Collin
- Department of Surgery, University of Sherbrooke, Sherbrooke, Canada.
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2
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Song YJ, Choi JH. Long-term Survivor of Unresectable Pancreatic Cancer Treated with Concurrent Chemoradiotherapy. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2024; 83:28-32. [PMID: 38268166 DOI: 10.4166/kjg.2023.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024]
Abstract
Undifferentiated carcinoma of the pancreas (UPC) is a rare, aggressive pancreatic cancer subtype. In addition, there is limited data on optimal management and patients tend to present with unresectable disease. This highlights the need to explore non-surgical treatments, such as chemotherapy and radiotherapy. In 2017, a 40-year-old male was diagnosed with UPC, presenting with a 6 cm mass in the pancreas, encasing the major arteries, indicative of a locally advanced stage. Histopathology confirmed UPC with osteoclast-like giant cells. After nine cycles of modified FOLFIRINOX chemotherapy and concurrent chemoradiotherapy, treatment was stopped in 2018 because of his declining health. Remarkably, despite the cessation of treatment, by 2023, the tumor had shrunk to 3.5 cm with no metabolic activity indicated by FDG-PET/CT. This six-year survival and response to non-surgical treatment highlight potential new avenues for managing unresectable pancreatic cancer, underscoring the need for further comprehensive studies to evaluate these therapeutic strategies.
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Affiliation(s)
- Yun Je Song
- Department of Gastroenterology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Jun-Ho Choi
- Department of Gastroenterology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
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3
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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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5
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Gupta K, Goyal S, Chaudhary D, Sakhuja P, Narang P, Nag HH. Undifferentiated carcinoma with osteoclast-like giant cells of pancreas on cytology: A case report with review of literature. Diagn Cytopathol 2022; 50:E289-E294. [PMID: 35678119 DOI: 10.1002/dc.25001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 12/17/2022]
Abstract
Undifferentiated carcinoma with osteoclast-like giant cells (UC-OGC) is a rare malignant neoplasm accounting for <1% of pancreatic masses. Very few case reports and small series have described the cytomorphological features of this entity. We report a case of UC-OGC arising in the pancreas presenting with liver metastasis in a 56-year-old man diagnosed by guided fine-needle aspiration cytology (FNAC). A characteristic biphasic pattern comprising of malignant mononuclear cells with scattered bland giant cells were the hallmark features for cytological diagnosis. Our case along with review of cytology literature emphasize the utility of FNAC and the cell block in the diagnosis and management of this rare entity.
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Affiliation(s)
| | - Surbhi Goyal
- Department of Pathology, GIPMER, New Delhi, India
| | | | - Puja Sakhuja
- Department of Pathology, GIPMER, New Delhi, India
| | - Poonam Narang
- Department of Radiodiagnosis, GIPMER, New Delhi, India
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6
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Ashfaq A, Thalambedu N, Atiq MU. A Rare Case of Pancreatic Cancer: Undifferentiated Carcinoma of the Pancreas With Osteoclast-Like Giant Cells. Cureus 2022; 14:e25118. [PMID: 35733473 PMCID: PMC9205718 DOI: 10.7759/cureus.25118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2022] [Indexed: 12/24/2022] Open
Abstract
Ductal adenocarcinoma of the pancreas is the most common pancreatic cancer, but undifferentiated carcinoma of the pancreas with osteoclast-like giant cells (UC-OGCs) is an exceedingly rare tumor. Microscopically, this tumor is characterized by the presence of two different cellular elements, namely, spindle or ovoid mononuclear cells and osteoclast-like giant cells (OGCs). Here, we report a rare case of UC-OGCs in a 79-year-old male with a one-month history of epigastric abdominal pain and unintentional weight loss. A blood workup revealed new-onset type 2 diabetes mellitus, and a computed tomography scan of the abdomen showed acute pancreatitis with a hypodense lesion in the head of the pancreas concerning for malignancy. He underwent an endoscopic ultrasound that also revealed a mass in the head of the pancreas, but no lymphadenopathy was observed. Biopsy was obtained and histopathology revealed UC-OGCs. We present this case to increase awareness of this rare clinical entity in patients presenting with acute-onset pancreatitis.
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Gao Y, Cai B, Yin L, Song G, Lu Z, Guo F, Chen J, Xi C, Wei J, Wu J, Gao W, Jiang K, Miao Y. Undifferentiated Carcinoma of Pancreas with Osteoclast-Like Giant Cells: One Center’s Experience of 13 Cases and Characteristic Pre-Operative Images. Cancer Manag Res 2022; 14:1409-1419. [PMID: 35431580 PMCID: PMC9012233 DOI: 10.2147/cmar.s349625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Yong Gao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China
| | - Baobao Cai
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China
| | - Lingdi Yin
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China
| | - Guoxin Song
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China
| | - Zipeng Lu
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China
| | - Feng Guo
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China
| | - Jianmin Chen
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China
| | - Chunhua Xi
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China
| | - Jishu Wei
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China
| | - Junli Wu
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China
| | - Wentao Gao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China
| | - Kuirong Jiang
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China
| | - Yi Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China
- Pancreas Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People’s Republic of China
- Correspondence: Yi Miao, Email
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Breast carcinomas with osteoclast-like giant cells: a comprehensive clinico-pathological and molecular portrait and evidence of RANK-L expression. Mod Pathol 2022; 35:1624-1635. [PMID: 35697931 PMCID: PMC9596373 DOI: 10.1038/s41379-022-01112-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
Breast carcinomas (BC) with osteoclast-like giant cells (OGC) are rare. Despite their distinct stromal features, their molecular characteristics remain unknown. Here, we report comprehensive clinico-pathological and molecular findings for 27 patients diagnosed with BC-OGC at Institut Curie between 2000 and 2021. Seventeen (63%) cases were invasive carcinomas of no special type (IC NST) with OGC (OGC-IC NST), four (15%) were mixed or multifocal cases with and without OGC (OGC-Mixed), and six (22%) were metaplastic carcinomas with OGC (OGC-MC). All OGC-IC NST and OGC-Mixed cases were ER+ HER2- tumors (most being luminal A based on transcriptomic subtyping, when available), while all OGC-MC were triple-negative. The median age at diagnosis was 46, 45 and 62 years for OGC-IC NST, OGC-Mixed and OGC-MC, respectively. Three patients developed distant metastases (one OGC-IC NST, two OGC-Mixed), one of whom died of metastatic disease (OGC-Mixed), and one other patient died of locally advanced disease (OGC-MC). Histopathological evaluation comparing 13 OGC-IC NST and 19 control IC NST without OGC confirmed that OGC-IC NST showed significantly higher density of vessels (by CD34 immunohistochemistry (IHC)), iron deposits (Perls stain), and CD68 and CD163-positive cell infiltrates. Genomic findings for nine OGC-IC NST and four OGC-MC were consistent with the underlying histologic subtype, including activating alterations of the PI3K/AKT/mTOR pathway in 7/13 cases. Using RNA-seq data, differential gene expression analysis between OGC-IC NST (n = 7) and control IC NST without OGC (n = 7) revealed significant overexpression of TNFSF11 (RANK-L), TNFRSF11A (RANK), CSF1 (M-CSF), CSF1R, and genes encoding osteoclastic enzymes (MMP9, ACP5, CTSK, CTSB) in OGC-IC NST, while OPG (osteoprotegerin) was underexpressed. We also confirmed for the first time RANK-L expression in BC with OGC by IHC (seen in 15 out of 16 cases, and only in 2 of 16 controls without OGC). These findings could offer a rationale for further investigating RANK-L as a therapeutic target in BC with OGC.
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9
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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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10
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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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11
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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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13
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Olayinka O, Kaur G, Gupta G. Undifferentiated Pancreatic Carcinoma With Osteoclast-Like Giant Cells and Associated Ductal Adenocarcinoma With Focal Signet-Ring Features. Cureus 2021; 13:e14988. [PMID: 34131533 PMCID: PMC8195551 DOI: 10.7759/cureus.14988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Undifferentiated pancreatic carcinoma with osteoclast-like giant cells (UPC-OGC) is a unique and rare tumor characterized by the presence of highly atypical carcinoma cells and non-neoplastic osteoclast-like giant cells. The histogenesis of this tumor is unclear and data on its prognosis remain controversial. Some data show poor clinical outcomes in affected patients while other more recent studies report a better outcome especially for cases with pure UPC-OGC. There are currently no established reliable management guidelines for UPC-OGC partly because of its rarity and presence of conflicting data in the literature. Hence the need for continued reporting and further research on this neoplasm. We report an incidental finding of UPC-OGC with associated ductal adenocarcinoma and focal signet ring features in an elderly male patient who presented with symptoms of urinary tract infection (UTI).
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Affiliation(s)
| | - Gagandeep Kaur
- Pathology and Laboratory Medicine, Danbury Hospital, Danbury, USA
| | - Gunjan Gupta
- Pathology and Laboratory Medicine, Danbury Hospital, Danbury, USA
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Yamamoto S, Sakai Y. A case of undifferentiated carcinoma with osteoclast-like giant cells of the pancreas derived from an intraductal papillary mucinous neoplasm. Clin J Gastroenterol 2021; 14:1263-1268. [PMID: 33884575 DOI: 10.1007/s12328-021-01415-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022]
Abstract
Pancreatic undifferentiated carcinoma with osteoclast-like giant cells (UC-OGC) is an extremely rare and aggressive malignancy. We report the case of a 71-year-old male who presented with a solid-and-cystic mass in the pancreatic head. The cut section of the pancreaticoduodenectomy specimen showed hemorrhagic polypoid lesions localized to the cyst spaces. Histological examination revealed a cystic background as an intraductal papillary mucinous neoplasm (IPMN) with low-grade dysplasia, while the intra-cystic polypoid mass was morphologically identical to giant cell tumors (GCT) of bone and soft tissue, consisting of a mixture of mononuclear histiocyte-like cells and multinucleated osteoclast-like giant cells. Nuclei of the mononuclear cells were similar to those of the multinucleated giant cells, showing no obvious atypia. The mononuclear cells were diffusely immunoreactive for CD163 and completely negative for all examined epithelial markers. Genetic analysis showed both the IPMN and the GCT-like components harbored identical double mutations of KRAS (G12V) and GNAS (R201C), and confirmed a diagnosis of UC-OGC originating from IPMN. This case emphasized that pancreatic UC-OGC can provide bland morphology, which is morphologically and immunohistochemically undistinguishable from GCT of the bone and soft tissue. Our study also highlights the importance of genetic analyses in properly diagnosing and managing such patients.
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Affiliation(s)
- Sohei Yamamoto
- Department of Diagnostic Pathology, Anjo Kosei Hospital, 28 Higashi-hirokute, Anjo-cho, Anjo, Aichi, 446-8602, Japan.
| | - Yu Sakai
- Department of Diagnostic Pathology, Anjo Kosei Hospital, 28 Higashi-hirokute, Anjo-cho, Anjo, Aichi, 446-8602, Japan
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15
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Demetter P, Maréchal R, Puleo F, Delhaye M, Debroux S, Charara F, Gomez Galdon M, Van Laethem JL, Verset L. Undifferentiated Pancreatic Carcinoma With Osteoclast-Like Giant Cells: What Do We Know So Far? Front Oncol 2021; 11:630086. [PMID: 33747949 PMCID: PMC7973287 DOI: 10.3389/fonc.2021.630086] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/29/2021] [Indexed: 12/31/2022] Open
Abstract
Undifferentiated carcinoma of the pancreas is an aggressive but rare tumor for which several other terms have been used to describe its histological appearance. In addition, as osteoclast-like giant cells may accompany undifferentiated carcinoma of the pancreas, the WHO Classification distinguishes undifferentiated carcinoma with osteoclast-like giant cells (UC-OGC) from plain undifferentiated carcinoma since there are a few histopathological and clinical differences. UC-OGC was initially thought to be associated with worse prognosis compared to invasive ductal pancreatic adenocarcinoma, since it is often unresectable at diagnosis and tends to recur rapidly even if completely resected. When true UC-OGGs are carefully dissected out from other anaplastic carcinomas, it becomes, however, clear that UC-OGCs do have more indolent behavior, especially the pure UC-OGCs. This mini-review summarizes the current knowledge on UC-OGC.
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Affiliation(s)
- Pieter Demetter
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Raphaël Maréchal
- Department of Gastroenterology, CHU Tivoli, La Louvière, Belgium
| | - Francesco Puleo
- Department of Gastroenterology, Hôpital Delta, Brussels, Belgium
| | - Myriam Delhaye
- Department of Gastroenterology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Fadi Charara
- Department of Surgery, CHU Tivoli, La Louvière, Belgium
| | - Maria Gomez Galdon
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Luc Van Laethem
- Department of Gastroenterology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Laurine Verset
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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16
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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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17
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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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18
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Abstract
OBJECTIVES This study aimed to identify the detailed clinicopathological features of undifferentiated carcinoma of the pancreas (UCP). METHODS We investigated clinical, imaging features and the prognoses of 261 patients; 8 were our patients, and the remainder were identified by searching English-language articles in PubMed. RESULTS We classified patients with UCP into 3 types based on pathological findings: osteoclast-like giant cell-associated carcinoma, pleomorphic cell carcinoma (PLC), and spindle cell carcinoma. There were no remarkable differences in clinical, radiological features between these 3 types. However, PLCs were significantly more likely to be unresectable than were the other 2 types (P < 0.001). Patients with osteoclast-like giant cell-associated carcinoma achieved the best overall survival (OS) rates (P < 0.001), whereas those with spindle cell carcinoma had significantly longer OS rates than did those with PLC (P = 0.004). These OS patterns were maintained when considering only those patients who underwent resection. Patients with PLC had both lower curative resection and high lymph node metastasis rates (P = 0.029, P = 0.023). Patients who underwent resection had more favorable prognoses than did those who did not. CONCLUSIONS Surgery is the first choice for resectable UCP. Pleomorphic cell carcinoma is particularly malignant; postoperative treatment should be introduced immediately.
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Abstract
We report a rare case of undifferentiated carcinoma of the pancreas with osteoclast-like giant cells (UC-OGC) in a 62-year-old female who presented with a three-month history of bilateral flank pain and significant unintentional weight loss. Computed tomography (CT) scan of the abdomen showed pancreatic tail mass, concerning for malignancy. She underwent endoscopic ultrasound (EUS) which also revealed a pancreatic mass invading into the splenic artery. CT chest and positron emission tomography (PET) scan did not reveal any metastases. The patient had a distal pancreatectomy, splenectomy, and left partial adrenalectomy. Histopathology revealed undifferentiated carcinoma of the pancreas with osteoclast-like giant cells (OGCs). The patient was recently started on adjuvant chemotherapy with capecitabine and gemcitabine and the plan is to repeat imaging to assess response. We present this case to increase clinical awareness of this rare clinical entity, and also review controversies in the management and surveillance of UC-OGC.
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Affiliation(s)
- Haisam Abid
- Internal Medicine, Bassett Medical Center, Cooperstown, USA
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20
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Charifa A, Walther Z, Salem RR, Jain D. Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas arising from an intraductal papillary mucinous neoplasm. HUMAN PATHOLOGY: CASE REPORTS 2019. [DOI: 10.1016/j.ehpc.2018.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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21
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Yepuri N, Pruekprasert N, Ramani N, France A, Sarpong JO, Jain A, Cooney RN. Osteoclast-like giant cell tumor of the pancreas-an unusual presentation in a patient with large mantle cell lymphoma. J Surg Case Rep 2018; 2018:rjy341. [PMID: 30591835 PMCID: PMC6302238 DOI: 10.1093/jscr/rjy341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 12/07/2018] [Indexed: 01/14/2023] Open
Abstract
Osteoclast-like giant cell tumor of the pancreas is very rare. We report a 78-year-old male who was previously treated for large mantle cell lymphoma, was found to have an increased uptake in a peri-pancreatic node from his restaging PET scan. Endoscopic ultrasound-directed fine-needle aspiration of the mass and lymph node revealed an undifferentiated carcinoma with osteoclast-like giant cells. Osteoclast-like giant cell tumors of the pancreas are frequently found to be unresectable at diagnosis due to their large size (>5 cm). In our patient, due to its small size (<3 cm) sub-total pancreatectomy was performed. Three years from the surgery, the patient is doing well without recurrence. This case report intends to increase provider awareness that in the setting of new pancreatic lesions in a patient with previous history of lymphoma, a high index of suspicion for a primary pancreatic lesion should be included in the differential diagnosis.
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Affiliation(s)
- Natesh Yepuri
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Napat Pruekprasert
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Nisha Ramani
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Alexandra France
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - James Osei Sarpong
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Ajay Jain
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Robert N Cooney
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA
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22
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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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23
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Rare pancreatic masses: a pictorial review of radiological concepts. Clin Imaging 2018; 50:314-323. [DOI: 10.1016/j.clinimag.2018.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/08/2018] [Accepted: 05/01/2018] [Indexed: 02/07/2023]
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Yazawa T, Watanabe A, Araki K, Segawa A, Hirai K, Kubo N, Igarashi T, Tsukagoshi M, Ishii N, Hoshino K, Kuwano H, Shirabe K. Complete resection of a huge pancreatic undifferentiated carcinoma with osteoclast-like giant cells. Int Cancer Conf J 2017; 6:193-196. [PMID: 31149501 DOI: 10.1007/s13691-017-0305-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/24/2017] [Indexed: 12/17/2022] Open
Abstract
Pancreatic undifferentiated carcinoma with osteoclast-like giant cells (PUC-OGC) is a rare neoplasm. We report a case of rapidly advancing PUC-OGC. A 54-year-old man had elevated tumor marker levels. Abdominal computed tomography showed a cystic mass in the body and tail of the pancreas, which infiltrated adjacent organs. The tumor exhibited rapid growth (doubling time: 39 days) but no metastases. We diagnosed PUC-OGC clinically and excised the pancreatic body and tail along with the spleen, left kidney, adrenal gland, and transverse colon. Pathological diagnosis showed histology consistent with PUC-OGC and a negative margin without nodal involvement despite the tumor being 28 cm in maximum diameter and having invaded the left kidney. The patient survived a year with a recurrence of liver metastasis after the initial surgery due to the partial hepatectomy and chemotherapy. Complete resection might be a good strategy to cure PUC-OGC in this case.
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Affiliation(s)
- Tomohiro Yazawa
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Akira Watanabe
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Kenichiro Araki
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Atsuki Segawa
- 2Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511 Japan
| | - Keitaro Hirai
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Norio Kubo
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Takamichi Igarashi
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Mariko Tsukagoshi
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Norihiro Ishii
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Kouki Hoshino
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Hiroyuki Kuwano
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Ken Shirabe
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
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25
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Chen YC, Chen LA, Lin CH, Wang SN. Undifferentiated pancreatic carcinoma with osteoclast-like giant cells: A rare entity with potential misdiagnosis of a gastrointestinal stromal tumor on preoperative evaluation. Kaohsiung J Med Sci 2016; 32:593-594. [PMID: 27847103 DOI: 10.1016/j.kjms.2016.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 06/06/2016] [Indexed: 12/14/2022] Open
Affiliation(s)
- Yen-Cheng Chen
- Department of Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Lin-An Chen
- Department of Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Hung Lin
- Department of Pathology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Shen-Nien Wang
- Department of Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.
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26
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Kawamoto Y, Ome Y, Terada K, Hashida K, Kawamoto K, Ito T. Undifferentiated carcinoma with osteoclast-like giant cells of the ampullary region: Short term survival after pancreaticoduodenectomy. Int J Surg Case Rep 2016; 24:199-202. [PMID: 27281360 PMCID: PMC4906136 DOI: 10.1016/j.ijscr.2016.04.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 04/25/2016] [Accepted: 04/29/2016] [Indexed: 12/23/2022] Open
Abstract
A rare case of undifferentiated carcinomas with osteoclast-like giant cells of the ampullary region successfully treated with pancreaticoduodenectomy. Carcinoma in situ was also observed, spreading from the tumor at the terminal segment of the common bile duct to the surgical margin of the common hepatic duct. It is important to intraoperatively confirm negative bile duct margins by rapid pathologic diagnosis.
Introduction Undifferentiated carcinomas with osteoclast-like giant cells (UC-OGCs) of the ampullary region are very rare, with only a few cases reported to date. The clinicopathological features, treatment options, and prognosis of UC-OGCs are unclear. This report describes a patient with UC-OGCs of the ampullary region. Presentation of case A 78-year-old male patient was admitted for epigastric pain and fever. Contrast-enhanced computed tomography revealed a 2.6-cm mass at the duodenal papilla. Duodenoscopy revealed a smooth red protruding mass compressing the orifice of the papilla of Vater. Biopsy of the mass showed proliferation of osteoclast-like giant cells. A subtotal stomach-preserving pancreaticoduodenectomy was performed, and the tumor was histologically diagnosed as an UC-OGCs of the ampullary region. Carcinoma in situ was also observed, spreading from the tumor at the terminal segment of the common bile duct to the common hepatic duct, with carcinoma cells at the surgical margin of the common hepatic duct. One year after surgery, the patient is alive and without tumor recurrence. Discussion UC-OGCs of the ampullary region is very rare neoplasm containing osteoclast-like giant cells and mononuclear cells. Osteoclast-like giant cells may originate from reactive mesenchymal cells and carcinoma in situ may spread to the common hepatic duct. Surgery including pancreaticoduodenectomy may be a treatment option for resectable tumors, whereas gemcitabine may be a treatment option for unresectable tumors. Conclusion Carcinoma in situ may spread quite far (5 cm) to the common hepatic duct, making it desirable to intraoperatively confirm negative bile duct margins by rapid pathologic diagnosis.
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Affiliation(s)
- Yusuke Kawamoto
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Yusuke Ome
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Kazuhiro Terada
- Department of Diagnostic Pathology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Kazuki Hashida
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Kazuyuki Kawamoto
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Tadashi Ito
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
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Undifferentiated (anaplastic) carcinoma with osteoclast-like giant cells of the pancreas: a series of 5 cases with clinicopathologic correlation and cytomorphologic characterization. J Am Soc Cytopathol 2016; 5:321-330. [PMID: 31042543 DOI: 10.1016/j.jasc.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas (UCOGCP) is a rare neoplasm involving the pancreas. Although typically diagnosed initially via endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), cytomorphologic characterization of the neoplasm has been limited to individual cases in the literature. MATERIALS AND METHODS Five cases were identified in a retrospective review of our institution's records from 2006 to 2015. Cytomorphologic, immunophenotypic, and corresponding clinical features of the neoplasm are examined and described. RESULTS UCOGCP accounted for 0.9% of all new pancreatic neoplastic diagnoses, had a median greatest dimension of 4.3 cm, were variably located within the pancreas, and had variable features by radiologic imaging. Patients were of a median age of 78 years old at diagnosis, and had a median length of survival of 10 months. Smear-based cytomorphology and histomorphology from cell block preparations show atypical/pleomorphic mononuclear carcinomatous and bland osteoclast-like giant cellular populations. The immunophenotype of the mononuclear carcinomatous component was CD68, CD99, CK7 (variably), CKAE1/AE3 (variably), and, rarely, p40-positive. The osteoclast-like giant cells positively expressed CD68 and CD99. CONCLUSIONS Initial diagnosis of UCOGCP is frequently made via EUS-FNA of pancreas tumors, with cytomorphologic features on smears and hematoxylin and eosin stained slides prepared from cell block material being characteristic for the diagnosis. Although the cellular constituents have a consistent immunophenotype, the diagnosis can be based on the morphologic features alone. UCOGCP is an important diagnosis as it may have a distinct clinical course from undifferentiated carcinomas of the pancreas lacking osteoclast-like giant cells.
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28
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Georgiou GΚ, Balasi E, Siozopoulou V, Tsili A, Fatouros M, Glantzounis G. Undifferentiated carcinoma of the head of pancreas with osteoclast-like giant cells presenting as a symptomatic cystic mass, following acute pancreatitis: Case report and review of the literature. Int J Surg Case Rep 2015; 19:106-8. [PMID: 26745313 PMCID: PMC4756204 DOI: 10.1016/j.ijscr.2015.12.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 12/16/2015] [Accepted: 12/16/2015] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Undifferentiated head of pancreas carcinoma with osteoclast-like giant cells (UC-OGC) is a rare neoplasm, with less than a hundred cases reported. We present such a case, in which the UC-OGC presented atypically as a cystic lesion following acute pancreatitis and led to late diagnosis. PRESENTATION OF CASE A 75-year-old female patient, who had suffered acute pancreatitis three years ago, was referred with a diagnosis of osteoclast-like giant cell (OGC) tumor of the head of pancreas. She had suffered acute pancreatitis three years ago. Two years ago she developed abdominal pain, steatorrhea and weight loss. Abdominal computed tomography imaging showed a cystic mass in the head of the pancreas (maximum diameter 4cm). The initial diagnosis was pancreatic pseudocyst; however as the mass gradually increased in size and the patient continued to be symptomatic, a CT-guided biopsy was performed. Histological examination revealed an OGC pancreatic tumor. In laparotomy a large (9cm) encapsulated heterogeneous mass was found with partial involvement of the common hepatic artery. Pancreaticoduodenectomy was performed and the involved part of the common hepatic artery was replaced with a homologous graft from the major saphenous vein. Post-operative course was uneventful. Histology revealed an undifferentiated pancreatic adenocarcinoma with OGCs. She survived 10 months after the operation. DISCUSSION Pancreatic undifferentiated carcinomas with OGCs are very rare neoplasms and can present with an atypical clinical picture. CONCLUSIONS A symptomatic cystic lesion of the pancreas, which is growing in size, should be investigated promptly in order to exclude the presence of malignancy.
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Affiliation(s)
- Georgios Κ Georgiou
- Department of Surgery, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece.
| | - Ephimia Balasi
- Department of Histopathology, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece
| | - Vasiliki Siozopoulou
- Department of Histopathology, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece
| | - Athina Tsili
- Department of Radiology, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece
| | - Michalis Fatouros
- Department of Surgery, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece
| | - Georgios Glantzounis
- Department of Surgery, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece
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