|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 4 | Page : 1046
Undifferentiated carcinoma of pancreas with osteoclast-like giant cells mimicking a pseudopancreatic cyst
Anchana Gulati, Vijay Kaushal, Neelam Gupta
Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
|Date of Web Publication||15-Feb-2016|
Department of Pathology, Indira Gandhi Medical College, Shimla, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
|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 2020 Jun 2];11:1046. Available from: http://www.cancerjournal.net/text.asp?2015/11/4/1046/140768
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].
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 1: Fine-needle aspiration cytology smear shows sarcomatoid tumor cells along with osteoclast like giant cells (Giemsa, ×400)|
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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 2: Macrophotograph revealing cystic mass, pancreas with grey solid area and attached spleenbody|
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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, 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.
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. 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, 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.
|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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[Figure 1], [Figure 2], [Figure 3]