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Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 867-868
Undifferentiated carcinoma with osteoclast-like giant cell tumor of the pancreas: A discussion of rare entity in comparison with pleomorphic giant cell tumor of the pancreas


1 Department of Pathology, SGRDIMSR, Amritsar (Punjab), India
2 Department of Pathology, MLN Medical College, Allahabad (Uttar Pradesh), India

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Date of Web Publication27-Oct-2010
 

How to cite this article:
Mannan R, Khanna M, Bhasin T, Misra V, Singh PA. Undifferentiated carcinoma with osteoclast-like giant cell tumor of the pancreas: A discussion of rare entity in comparison with pleomorphic giant cell tumor of the pancreas. Indian J Pathol Microbiol 2010;53:867-8

How to cite this URL:
Mannan R, Khanna M, Bhasin T, Misra V, Singh PA. Undifferentiated carcinoma with osteoclast-like giant cell tumor of the pancreas: A discussion of rare entity in comparison with pleomorphic giant cell tumor of the pancreas. Indian J Pathol Microbiol [serial online] 2010 [cited 2019 Dec 11];53:867-8. Available from: http://www.ijpmonline.org/text.asp?2010/53/4/867/72016


Sir,

Cancer of the exocrine pancreas comprises approximately 85% of all cases of pancreatic malignancy [1] of which adenocarcinoma is the most common type. Unique types of neoplasia of exocrine pancreas containing giant cells have been documented. These have been divided into two subtypes corresponding to the type of giant cells and biological expression as, osteoclastic giant cell tumor (OGCT) and the pleomorphic giant-cell tumor (PGCT) of the pancreas. A rare case of OGCT of the pancreas is reported in a 40-year-old woman who presented with slowly progressive jaundice of short duration. Hematological and biochemical investigations were within normal limits except for an increase in serum bilirubin (Total - 5.1 mg/dl). A contrast enhanced computed tomography (CECT) revealed a heterogeneous mass of 4 × 3.2 cm, arising from the head and neck of pancreas with involvement of the uncinate process [Figure 1]a.
Figure 1: (a) A contrast enhanced computed tomography showing mass head and neck of pancreas. (b) The photomicrograph showing normal pancreas (P) separated from the tumor cells (T) by a thick fibrotic band (H and E, ×100). (c) The photomicrograph from the tumor showing spindle cells of mesenchymal appearance and multinucleated giant cells (H and E, ×200). (d, e) The photomicrographs from the same section exhibiting morphology of multinucleated giant cells and pleomorphic nature of spindle cells (H and E, ×400).

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A pylorus-preserving pancreatic jejunectomy was done. The resected specimen was sent to the Histopathology Unit of the Department of Pathology. The sections processed and stained with hematoxylin and eosin showed a well-demarcated area separating normal appearing pancreas by a fibrotic band [Figure 1]b. The area consisted of two types of cells: spindle cells of mesenchymal appearance some of which showed atypical cytological features, and multinucleated giant cells. Most of these giant cells on light microscopy resembled the 'osteoclastic' type giant cells; however, a fair number of the giant cells also showed nuclear atypia and overlapping [Figure 1]c-e. No evidence of neoplastic glandular element (conventional adenocarcinoma) was seen in the pieces processed.

In view of these findings a provisional diagnosis of undifferentiated carcinoma pancreas with osteoclast type / pleomorphic type giant cells was given. Immunohistochemistry (IHC) markers CD68 (macrophage marker) and cytokeratin were recommended to subtype the tumor. On IHC giant cells were strongly immunoreactive for CD68 [Figure 2]a and b, but negative for cytokeratin [Figure 2]c and d; the accompanying spindle cells showed mild cytokeratin positivity. Thus a final diagnosis of undifferentiated carcinoma with osteoclast-like giant cells was given.
Figure 2: (a) CD68 positivity of the tumor cells in the same section as in Figure 1b (×100). (b) CD68 positivity in the giant cells proving their osteoclastic nature (×400). (c) CK negativity in the tumor cells in the same section as in Figure 1b (normal pancreatic tissue shows CK positivity) (×100). (d) CK negativity in the giant cells from the same section as in Figure 1b (×400).

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Immunohistochemical studies conducted by various researchers have revealed that both neoplastic (stromal cells) and non-neoplastic (osteoclast-like giant cells of OGCT are positive for mesenchymal markers, whereas the pleomorphic giant cells of PGCT are strongly positive for epithelial markers. It has also been concluded by studies that both OGCT and PGCT have mesenchymal and epithelial characteristics in varying proportions and, therefore, they may arise from an undifferentiated pancreatic stem cell [2] (hence the reason of their being clumped under a single category of undifferentiated carcinoma in latest WHO classification despite their obvious histological and behavioral differences).

Studies focusing on the nature and biological expression of the undifferentiated carcinomas have noted that in contrast to OGCT, PGCT shows an increased immunoreactivity for cell cycle proliferative markers and a higher degree of diploid and aneuploid populations. [3],[4] These findings could very well explain the good prognosis exhibited by OGCT as compared to PGCT.

Surgery remains the first-line treatment in many cases if the tumor is resectable. The case is considered worth reporting due to its rarity and making the histomorphologist understand the histogenesis and biological behavior of this entity.

 
   References Top

1.Warshaw AL, Fernandez-del Castillo C. Pancreatic carcinoma. N Engl J Med 1992;326:455-65.  Back to cited text no. 1
    
2.Deckard-Janatpour K, Kragel S, Teplitz RL, Min BH, Gumerlock PH, Frey CF, et al. Tumors of the pancreas with osteoclast-like and pleomorphic giant cells: An immunohistochemical and ploidy study. Arch Pathol Lab Med 1998;122:266-72.  Back to cited text no. 2
[PUBMED]    
3.Loya AC, Ratnakar KS, Shastry RA. Combined osteoclastic giant cell and pleomorphic giant cell tumor of the pancreas: A rarity: An immunohistochemical analysis and review of the literature. JOP 2004;5:220-4.   Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Sakai Y, Kupelioglu AA, Yanagisawa A, Yamaguchi K, Hidaka E, Matsuya S, et al. Origin of giant cells in osteoclast-like giant cell tumors of the pancreas. Hum Pathol 2000;31:1223-9.  Back to cited text no. 4
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Correspondence Address:
Rahul Mannan
c/o Dr. V. K. Rampal, 5-Court Road, Amritsar-143 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.72016

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