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LETTER TO THE EDITOR
Year : 2015  |  Volume : 11  |  Issue : 4  |  Page : 1046

Undifferentiated carcinoma of pancreas with osteoclast-like giant cells mimicking a pseudopancreatic cyst


Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Date of Web Publication15-Feb-2016

Correspondence Address:
Anchana Gulati
Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.140768

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How to cite this article:
Gulati A, Kaushal V, Gupta N. Undifferentiated carcinoma of pancreas with osteoclast-like giant cells mimicking a pseudopancreatic cyst. J Can Res Ther 2015;11:1046

How to cite this URL:
Gulati A, Kaushal V, Gupta N. Undifferentiated carcinoma of pancreas with osteoclast-like giant cells mimicking a pseudopancreatic cyst. J Can Res Ther [serial online] 2015 [cited 2019 Sep 20];11:1046. Available from: http://www.cancerjournal.net/text.asp?2015/11/4/1046/140768

Sir, Undifferentiated carcinoma of pancreas with osteoclast-like giant cells is a rare entity. The prognosis of these cancers is more favorable than conventional undifferentiated carcinoma. We report a case of undifferentiated carcinoma with osteoclast-like giant cells of pancreas, which was diagnosed on aspiration cytology and confirmed on histopathology. A 60-year-old female presented to the surgery department with the complaints of upper abdominal pain since 1 year. The pain was insidious in onset with radiation to the back. There was no history of vomiting, jaundice or weight loss. Physical examination revealed a lump of 12 cm × 10 cm in the left hypochondrium extending to the epigastrium and umbilical region. Laboratory investigations were unremarkable. Peritoneal fluid for cytology showed a white blood cell count of 640/mm 3. Imaging of the abdomen revealed a 13 cm × 10 cm cystic mass in relation to pancreatic tail. Pancreatic head and body were normal. Possibility of pseudopancreatic cyst was suggested and fine-needle aspiration cytology (FNAC) was done. Fine-needle aspiration showed predominantly single pleomorphic cells, occasional cluster of tumor cells, and multinucleate osteoclastic giant cells. Undifferentiated carcinoma of pancreas with osteoclast-like giant cells was suggested [Figure 1].
Figure 1: Fine-needle aspiration cytology smear shows sarcomatoid tumor cells along with osteoclast like giant cells (Giemsa, ×400)

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The patient underwent distal pancreatectomy with splenectomy. We received 10 cm × 7 cm × 7 cm sized cystic pancreatic mass with a solid grey focus [Figure 2].
Figure 2: Macrophotograph revealing cystic mass, pancreas with grey solid area and attached spleenbody

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Microscopy showed areas of spindle cells, numerous osteoclast-like multinucleated giant cells admixed with foamy and pigment-laden macrophages. A focus of conventional adenocarcinoma was also identified [Figure 3].
Figure 3: Histology of the tumor shows cyst wall revealing sarcomatoid tumor cells with osteoclast-like giant cells. Inset shows focus of conventional adenocarcinoma (H and E, ×400)

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The tumor stage was 1B (T2, N0, M0). Cancer of the exocrine pancreas comprises approximately 85% of all cases of pancreatic malignancy. The most common type are ductal adenocarcinomas,[1] while undifferentiated carcinomas are only about 7%. Though, they are variants of duct derived carcinomas, their behavior is aggressive. Grossly, they are large and hemorrhagic and may grow in a fashion simulating an undifferentiated pseudocyst. In a small number of undifferentiated carcinomas, osteoclast-like multinucleated giant cells are present mimicking giant cell tumors of bone. Giant cells are concentrated in the foci of osseous metaplasia, calcification or hemorrhage, which suggests their reactive nature.[2] The tumors with giant cells have two variants: Osteoclastic giant cell tumors (OGCTs) and pleomorphic giant cell tumors (PGCTs). Immunohistochemistry has revealed that neoplastic stromal cells as well as nonneoplastic osteoclast-like giant cells of OGCT are positive for mesenchymal markers, whereas PGCT are positive for epithelial markers.[3] The latest World Health Organization classification includes them in a single category as both variants may arise from an undifferentiated pancreatic stem cell. Pleomorphic giant cell tumor showed an increased immunoreactivity for cell cycle proliferation markers and a high degree of diploid and aneuploid populations,[4] explaining the good prognosis of OGCT as compared to PGCT. Surgery is the first-line treatment in cases with a resectable tumor. Our patient was also given six cycles of adjuvant chemotherapy and was doing well until the last follow-up. This case is being reported as it is a rare entity, less common in females and FNAC was instrumental in diagnosing it.

 
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1.
Warshaw AL, Fernández-del Castillo C. Pancreatic carcinoma. N Engl J Med 1992;326:455-65.  Back to cited text no. 1
    
2.
Mannan R, Khanna M, Bhasin TS, 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.  Back to cited text no. 2
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3.
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. 3
    
4.
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. 4
    


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