Recurrence of osteoclast-like giant cell carcinoma of the pancreas after 10 years

Two Cases of Rare Pancreatic Malignancies

Background: Pancreatic adenocarcinoma remains one of the most lethal malignancies with little treatment advancements. Other less common pancreatic cancer histologies have different outcomes and disease course. In this article, we report two cases of rare pancreatic tumors.

Presentation: The first case is a 59-year old, who was undergoing surveillance of a known pancreatic cyst, which eventually enlarged. The mass was resected and pathology revealed undifferentiated carcinoma with osteoclast-like giant cells. The patient did not receive any adjuvant therapy and has had no recurrence. The second case is of a 60-year-old patient who presented with signs and symptoms of pancreatic insufficiency and was found to have clear cell adenocarcinoma of the pancreas. She received neoadjuvant chemoradiotherapy followed by surgical resection without complications.

Conclusion: Our article presents these rare malignancies, which had outcomes that are more encouraging than typical adenocarcinomas. Genomic sequencing can provide more insight into these tumors and potentially provide targets for therapy.

Giant-cell containing neoplasms of the pancreas: an aspiration cytology study

Giant-cell containing neoplasms of the pancreas are rare with few reports documenting their cytologic appearance. Giant-cell containing neoplasms of the pancreas have been divided into two subtypes corresponding to the osteoclastic giant-cell tumor of the pancreas and the pleomorphic giant-cell carcinoma of the pancreas. Despite the better prognosis reported in some series for osteoclastic giant-cell tumors, the most recent edition of the World Health Organization classification lumps the two entities into a single category designated as undifferentiated carcinoma with osteoclast-like giant cells. Smears obtained from osteoclastic giant-cell tumors show numerous giant-cells with clustered overlapping, bland appearing nuclei containing prominent nucleoli consistent with an osteoclast-type multinucleated giant-cell. These neoplasms contain a second population of mononuclear cells showing more marked nuclear atypia. Pleomorphic giant-cell carcinomas are characterized by anaplastic giant-cells displaying marked nuclear pleomorphism. The mononuclear component is also pleomorphic with markedly atypical epithelioid and spindle shaped cells. In three reported cases, a tumor contained a mixture of the two cell patterns. Thus, undifferentiated carcinoma with osteoclast-like giant cells and pleomorphic giant cell carcinoma may represent a morphologic spectrum with pure osteoclast-like giant-cell tumors at one end and pleomorphic giant-cell carcinoma at the other. Fine-needle aspiration specimens from pure osteoclast-like giant-cell tumors will contain a population of bland multinucleated osteoclastic-like giant-cells that differ markedly from the anaplastic giant-cells of pleomorphic giant-cell carcinoma. The difference in the appearance of the giant-cells aids in distinction of the two neoplasms. When in pure form, the two neoplasms may follow different clinical courses.

Osteoclast-like giant cell tumors of the pancreas and liver

Osteoclast-like giant cell tumors (OGCT) are rare abdominal tumors, which mainly occur in the pancreas. The neoplasms are composed of two distinct cell populations and frequently show an inhomogenous appearance with cystic structures. However, due to the rarity of these tumors, only very limited clinical data are available. Imaging features and sonographic appearance have hardly been characterized. Here we report on two cases of osteoclast-like giant cell tumors, one located within the pancreas, the other within the liver, in which OGCTs are extremely rare. Both patients were investigated by contrast sonography, which demonstrated a complex, partly cystic and strongly vascularized tumor within the head of the pancreas in the first patient and a large, hypervascularized neoplasm with calcifications within the liver in the second patient. The liver OGCT responded well to a combination of carboplatin, etoposide and paclitaxel. With a combination of surgical resection, radiofrequency ablation and chemotherapy, the patient’s survival is currently more than 15 mo, making him the longest survivor with an OGCT of the liver to date.

Osteoclastic giant cell tumor of the pancreas: case report and literature review

An unusual case of a 40-year-old woman seeking treatment for a 10-cm cystic neoplasm of the pancreas is described. Imaging revealed a large proteinaceous, fluid-filled cyst with a mural nodule. Laparotomy was successful with en bloc resection. Pathologic examination revealed a neoplastic mucinous epithelial tumor with an abundance of multinucleated tumor giant cells. This presentation is consistent with literature reports of an osteoclastic-type giant-cell tumor of the pancreas. The natural history, pathologic evaluation, and clinical implications of this rare neoplasm are discussed with reference to published reports.