|
Endoscopic ultrasound-guided fine-needle aspiration of
undifferentiated carcinoma with osteoclast-like giant cells of the
pancreas: A report of 2 cases with literature review.Diagn
Cytopathol. 2007 Sep;35(9):601-6.
Undifferentiated
carcinoma with osteoclast-like giant cells of the pancreas is rare.
Histologically it mimics the giant cell tumor of the bone and may be
associated with a ductal adenocarcinoma. We recently encountered two
such cases, both of which were biopsied by EUS-guided FNA. Abundant
multinucleated osteoclast-like giant cells and many uniform
mononuclear cells were present in case 1 so that the diagnosis was
made. In case 2, many mononuclear tumor cells with vacuolated and
basophilic cytoplasm were present, and rare osteoclast-like giant
cells were seen. A diagnosis of adenocarcinoma was made. In both
cases, no conspicuous nuclear pleomorphism was noted in the
mononuclear cells or the multinucleated giant cells. The histology of
case 2 revealed a pure undifferentiated carcinoma with osteoclast-like
giant cells. In addition, a liver biopsy revealed globular amyloidosis.
To our knowledge, this is the first report of pancreatic
undifferentiated carcinoma with osteoclast-like giant cells sampled by
EUS-guided FNA and the first case of hepatic globular amyloidosis
associated with this tumor.
Rapidly
progressing cyst of the pancreas as a manifestation of an
undifferentiated pancreatic carcinoma with osteoclastic giant cells.
Dtsch Med Wochenschr. 2007
Aug;132(31-32):1619-22.
HISTORY AND
FINDINGS ON ADMISSION: A 62-year-old woman presented with acute
abdominal pain. INVESTIGATIONS AND DIAGNOSIS: Examination revealed a 3
cm large cyst of the pancreatic head accompanied by an acute
pancreatitis. TREATMENT AND COURSE: The cystic mass showed rapid
increase. After explorative laparatomy a pancreaticoduodenectomy was
performed. Pathologic examination revealed an undifferentiated
carcinoma with osteoclast-like giant cells. The tumor grew rapidly and
the patient died 10 weeks after admission. CONCLUSIONS: An
undifferentiated carcinoma with osteoclast-like giant-cells is a very
rare cystic tumor of the pancreas. An accurate preoperative diagnosis
of cystic tumors is only achieved in about 30 percent. Therefore,
surgical exploration should be considered for all cystic neoplasms and
cystic tumors that are not clearly defined.
Osteoclast-like
giant cell tumors of the pancreas and liver.World
J Gastroenterol. 2006 Dec
28;12(48):7878-83.
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.
Undifferentiated
carcinoma with osteoclast-like giant cells of the pancreas.Korean
J Gastroenterol. 2006 Nov;48(5):355-9.
Undifferentiated carcinoma with osteoclast-like giant cells is a rare
neoplasm of exocrine pancreas. Till recently, some cases have been
reported, however histogenesis of the tumors are controversial and
their characteristic findings have not been described yet. Thirty
five-year-old men and 75-year-old men were presented with upper
abdominal pain and a palpable mass. On computed tomography, one case
showed a well enhancing solid tumor with low density and the other was
showed a mainly cystic tumor with peripheral enhancement in the body
and tail of the pancreas. One case accompanied multiple metastatic
liver masses with subhepatic lymph node enlargement. Tumor staining
was seen on angiography. Biopsy and pancreatectomy were performed.
Pathological findings revealed tumors composed of neoplastic spindle
shaped or pleomorphic large cells with scattered non-neoplastic
osteoclast-like giant cells. In one case, there were small foci of
adenocarcinoma components in the periphery of the tumor. On
immunohistochemical stain, neoplastic cells showed focal positivity
for epithelial membrane antigen and vimentin. Tumors were diagnosed as
undifferentiated carcinoma with osteoclast-like giant cells. We report
these rare cases with a review of literature.
A case of
osteoclast-like giant cell tumor of the pancreas.
Korean J Gastroenterol. 2005 Jun;45(6):441-5.
Osteoclast-like giant cell tumor of the pancreas is a very rare tumor.
Despite their striking morphologic resemblance to certain mesenchymal
tumors of bone and tendon sheath, it has been suggested that these
tumors may arise from epithelial precursors. This unusual tumor
presents in the 6th or 7th decade with a nearly equal gender ratio.
Pure forms of osteoclast-like giant cell tumor have a better prognosis
because they have a predilection to local spread, are slower to
metastasize and rarely metastasize to lymph nodes, but these forms are
very rare. We present an osteoclast-like giant cell tumor arising in
the body of the pancreas in a 71 year-old male patient. The tumor was
composed of two major cell types: atypical mononuclear cells and
abundant osteoclast-like multinucleated giant cells.
Immunohistochemical studies showed that atypical cells were strongly
reactive for vimentin and focally reactive for cytokeratin. In
contrast, the giant cells were immunoreactive for CD68, but negative
for cytokeratin. Three months later, the tumor size increased and
liver metastasis was newly developed. He died at 11 months after the
diagnosis.
A case of
osteoclast-like giant cell tumor of the pancreas with ductal
adenocarcinoma: histopathological, immunohistochemical,
ultrastructural and molecular biological studies.J
Korean Med Sci. 2005 Jun;20(3):516-20.
Osteoclast-like
giant cell tumor of the pancreas is a very rare neoplasm, of which the
histiogenesis remains controversial. A 63-yr-old woman was
hospitalized for evaluation of epigastric pain. An abdominal
computerized tomography revealed the presence of a large cystic mass,
arising from the tail of pancreas. A distal pancreatectomy with
splenectomy was performed. Histologically, the tumor was composed of
mononuclear stromal cells intermingled with osteclast-like giant
cells. In addition, there was a small area of moderately to well
differentiated ductal adenocarcinoma. The final pathologic diagnosis
was osteoclast-like giant cell tumor of the pancreas with ductal
adenocarcinoma. Here, we describe the histopathological,
immunohistochemical, ultrastructural and molecular biological findings
of this tumor with review of the literature pertaining to this
condition.
Osteoclast-like
giant cell tumor of the pancreas associated with mucus-secreting
adenocarcinoma. Case report and discussion of the histogenesis.Pancreatology.
2005;5(2-3):279-84.
BACKGROUND/AIMS: The osteoclast-like giant cell tumor of the pancreas
is a rare entity that closely resembles giant cell tumor of the bone,
which has also been observed in many other organs. Some tumors also
contain areas of ductal adenocarcinoma. Conflicting opinions exist
regarding the tumor origin, whether it is mesenchymal or epithelial,
neoplastic or reactive. METHODS: We report the case of a 69-year-old
Brazilian man with a mass in the head of the pancreas, the
histological examination of which revealed a predominant component of
osteoclast-like giant cells within a background of pleomorphic
mononuclear cells with osteoid formation and other areas composed of
conventional mucus-secreting adenocarcinoma. RESULTS:
Immunohistochemistry showed that carcinoma cells of the usual type
expressed epithelial antigens (EMA and cytokeratin) and lysozyme; the
giant cells expressed vimentin, CD45, CD68, and lysozyme; and the
mononuclear cells expressed macrophage marker (HAM56), vimentin, and
lysozyme, and only some of them expressed epithelial markers, CD45,
and CD68. CONCLUSION: Our immunohistochemical findings reveal that the
giant cells in this case are of mesenchymal origin may be from the
bone marrow cells. We believe that it is important to determine the
histogenesis in each case to carry out the pertinent adjuvant therapy.
Osteoclast-like
giant cell tumor in mucinous cystadenocarcinoma of the pancreas: an
immunohistochemical and molecular analysis.Cancer
Detect Prev. 2005;29(1):8-14.
Osteoclast-like
giant cell tumors (OLGT) are rare neoplasms of the pancreas and mostly
associated with ductal adenocarcinomas. In this report, we present the
rare case of OLGT associated with mucinous cystadenocarcinoma (MCC).
We investigated the expression profile of both tumors by methods of
molecular biology and immunohistochemistry. The panel of markers
included osteopontin, her2/neu, mismatch repair genes, K-ras, p53, E-cadherin,
VEGF-C, and podoplanin. Osteopontin was expressed by the osteoclast-like
giant cells but not by the mononuclear tumor cells of the OLGT. We
detected an amplification and overexpression of her2/neu in the MCC
but not in the OLGT. Although we observed an immunohistochemical
expression of hMSH2 and hMLH1 in the OLGT, we were not able to confirm
this result by western blot analysis. We also did not find any
microsatellite instability (D2S123, BAT26). While mutation of K-ras
codon 12 was found in both tumor components, there was wild-type DNA
of p53. E-cadherin was expressed in MCC but not in OLGT. VEGF-C was
only positive in osteoclast-like giant cells and some of the
mononuclear cells of OLGT. The vessel-rich stroma of OLGT did not
present any podoplanin-positive lymphatic vessel. The observation of
our case and others in the published literature may indicate
separating OLGT with undifferentiated carcinoma from OLGT with MCC for
the better clinical outcome of the latter.
Undifferentiated carcinoma with osteoclast-like giant cells of the
pancreas. A case report.Ann
Chir. 2004 Nov;129(9):526-9.
Undifferentiated carcinoma with osteoclast-like giant cells is a rare
pancreatic neoplasm, with a possible cystic pattern, includes an
adenocarcinoma component and giant cell mimicking osteoclastic bone
tumor. We report the case of a 72-year woman admitted for jaundice and
epigastric pain. Abdominal ultrasound and computed tomography scan
revealed a 6 x 5 cm cystic and solid tumor of the pancreatic head with
both bile duct and pancreatic duct dilatation. A
pancreaticoduodenectomy was performed and pathologic examination
revealed an undifferentiated carcinoma with osteoclast-like giant
cells of the pancreatic head. The patient was alive and disease-free
with a 18-month follow-up.
Osteoclast-like
giant cell tumor of the pancreas.Int
J Clin Oncol. 2002 Dec;7(6):376-80.
A rare case of
osteoclast-like giant cell tumor of the pancreas is reported. A
45-year-old woman presented with upper abdominal pain and weight loss.
Examination revealed a tumor in the tail of pancreas, and distal
pancreatectomy with splenectomy was performed. Pathological findings
showed the tumor was composed of two cell types: atypical mononuclear
round cells and abundant osteoclast-like multinucleated giant cells
with central nucleoli. Immunohistochemical study showed that the
atypical cells were strongly reactive for vimentin and negative for
CD68, while the giant cells were immunoreactive for CD68, but negative
for vimentin. The tumor was diagnosed as osteoclast-like giant cell
tumor of the pancreas. We report this case and review 31 cases
previously described in the literature.
Origin of
giant cells in osteoclast-like giant cell tumors of the pancreas.
Hum Pathol. 2000 Oct;31(10):1223-9.
To
clarify the origin of giant cells in osteoclast-like giant cell tumors
(OGCTs) of the pancreas, we performed microscopical,
immunohistochemical, and K-ras gene mutation analyses with a
microdissection approach in 3 cases, featuring 4 cellular components (osteoclast-like
giant cells [OGCs], pleomorphic large cells [PLCs], mononuclear cells,
and ductal carcinoma cells). Two cases had abundant OGCs, and 1 case
contained large number of both OGCs and PLCs. In each, none of the
microdissected OGCs contained any K-ras gene mutation while they were
positive for a histiocytic marker (CD-68). In contrast, PLCs, when
present, frequently harbored K-ras gene mutations and were negative
for CD-68. In all cases, mononuclear cells, a mixture of histiocyte-like
and atypical, from microscopic and immunohistochemical viewpoints,
also frequently showed K-ras alteration. Histiocyte-like mononuclear
cell was equipped with a regular and oval nucleus similar to those in
OGCs and was positive for CD-68. Atypical mononuclear cell showed an
irregular, pleomorphic, or sometimes bizarre nucleus similar to those
in PLCs and was negative for CD-68. All of the K-ras gene mutations
found in PLCs and mononuclear cells were the same as in the ductal
carcinoma cells within the same tumor. Thus, OGCs differ in origin
from ductal cells and are strongly suggested to be nonneoplastic and
of mesenchymal origin, whereas PLCs, which harbor K-ras gene
mutations, are neoplastic and presumably derived from ductal carcinoma
cells. Moreover, mononuclear cells may be classified into 2 types,
histiocyte-like and atypical.
Immunohistochemical and molecular analysis of giant cell carcinoma of
the pancreas: a report of three cases.
Pancreas 1999
Apr;18(3):308-15.
We performed
molecular biological studies as well as immuno histochemical analysis
of three cases of giant cell carcinoma of the pancreas. Histologically,
one case was a pleomorphic giant cell carcinoma consisting of
pleomorphic giant/ small cells and spindle cells, one an osteoclast-like
giant cell tumor composed of osteoclastoid giant cells and pleomorphic
small cells, and one a pleomorphic giant cell carcinoma with
osteoclastoid giant cells. Immunohistochemically, pleomorphic giant
cells and small pleomorphic cells were positive for epithelial and
mesenchymal markers throughout the cases. Osteoclastoid cells were
strongly positive for PG-M1 (CD68), but negative for lysozyme and
epithelial markers. Pleomorphic spindle cells showed the same
immunoreactivity as pleomorphic giant/small cells. Genetically, all
cases contained a mutation in the K-ras (codons 12, 13) oncogene, but
neither p53 (exons 5-8) nor p16INK4 (exons 1, 2) gene mutations were
found in any case. Furthermore, Loss of heterozygosity (LOH) of the
p53, p161NK4. APC, and DPC4 gene loci was not found in any of the
cases. Immunohistochemical study demonstrated this tumor to be of
epithelial origin with mesenchymal differentiation. Genetically,
initiation of the tumor is similar to that of usual ductal
adenocarcinoma, but progression might be rather different. The
peculiar histologic and biologic features of this tumor would be the
result of changes in other functional genes.
Osteoclast-like
giant cell tumor of the pancreas with metastases to gallbladder and
lymph nodes. A case report.
Pathol Res Pract. 1998; 194(8):587-94.
Osteoclast-like
giant cell tumor of the pancreas (OGTP) is a rare neoplasm, of which
the histogenesis is still controversial. Here we report a case of OGTP
involving the head of the pancreas in a 71-year-old woman with
metastases to the gallbladder and lymph nodes. The primary and
metastatic tumors had identical histopathological, immuno
histochemical, ultrastructural and molecular biological features.
Microscopically, the tumors were characterized by atypical, often
pleomorphic mononuclear cells associated with the proliferation of
benign-appearing osteoclast-like giant cells (OGCs). Electron
microscopic observation provided ultrastructural evidence of
epithelial differentiation of the mononuclear cells, including
microvilli and desmosomes, which was not obtained for OGCs. On
immunohistochemical study, OGCs stained for CD68 (KP-1), LCA and
HAM56, whereas mononuclear cells only reacted with PCNA. These
findings clearly suggest that mononuclear cells are capable of
differentiation and proliferation and may have been the only true
tumor cells in this neoplasm, and that OGCs may have been a
paraneoplastic product of this rare tumor. On examination of DNA from
dewaxed sections of the tumor, we found no p53 mutation in the tumor
tissue, but found two K-ras mutations in codon 12; this pattern of
mutation commonly occurs in pancreatic carcinoma, indicating a
somewhat genetic relationship of OGTP to pancreatic carcinoma.
Although OGTP often has a favorable prognosis, the outcome in the
present case was poor due to early tumor spread, with less than two
years postoperative survival.
Undifferentiated carcinoma with osteoclast-like giant cells of the
pancreas and periampullary region.Cancer.
1998 Apr 1;82(7):1279-87.
BACKGROUND:
Undifferentiated carcinomas with osteoclast-like giant cells are rare
pancreatic and periampulary neoplasms that morphologically mimic giant
cell tumor of bone. Despite numerous publications based primarily on
single case reports, the terminology, histogenesis, and biologic
behavior of these tumors remain controversial. METHODS: The authors
studied one periampullary and nine pancreatic neoplasms of this type.
Immunohistochemistry was performed on nine of the cases and clinical
follow-up data was obtained in eight. RESULTS: The neoplasms were
large (average 9 cm), partially or completely multicystic, and
hemorrhagic. Histologically, they were composed predominantly of ovoid
or spindle-shaped bland mononuclear cells and evenly spaced osteoclast-like
giant cells. However, three neoplasms had foci in which the nuclear
pleomorphism of the mononuclear cells approached that observed in
anaplastic spindle and giant cell carcinomas. Other histologic
features included phagocytosis of the mononuclear cells by the
osteoclast-like giant cells (in 7 of 10 cases), osteoid or bone
formation (in 3 of 10 cases), and chondroid differentiation (in 1 of
10 cases). Four neoplasms had foci of conventional adenocarcinoma and
two arose in preexisting mucinous cystic neoplasms of the pancreas.
The mononuclear cells were positive for epithelial markers in six of
nine tumors tested (cytokeratins AE-1, AE-3, Cam 5.2, and/or
epithelial membrane antigen). They were negative for the histiocytic
markers (CD-68, lysozyme) in all nine cases tested. In contrast, the
osteoclast-like giant cells were positive for CD-68 in all nine cases,
positive for lysozyme in four cases, and negative for cytokeratins
(AE-1, AE-3, and Cam 5.2) in all nine cases. p53 stained the
mononuclear tumor cells in three cases and MIB-1 stained the
mononuclear tumor cells in four cases, but the osteoclast-like giant
cells did not stain with either antibody in all nine cases tested.
Most of the patients died of disease within 1 year of diagnosis; only
1 patient was alive and disease free 14 years after surgical excision.
CONCLUSIONS: The association of these tumors with conventional
adenocarcinoma or mucinous cystic neoplasms, the histologic features,
and the immunohistochemical profile supports an epithelial phenotype
for the mononuclear cells and a reactive histiocytic lineage for the
nonneoplastic osteoclast-like giant cells. These neoplasms, which are
better classified as undifferentiated carcinomas, follow an aggressive
clinical course; most patients die of disease within 1 year.
|
