Undifferentiated pancreatic carcinoma with osteoclast-like giant cells: report of a case with osteochondroid differentiation.
We report a case of an undifferentiated pancreatic carcinoma with osteoclast-like giant cells with focal osteochondroid differentiation in a 66-year-old man, who presented with painless jaundice, pruritus, and weight loss. Imaging studies revealed an inhomogeneous mass in the head of the pancreas. A pylorus preserving pancreaticoduodenectomy was performed. The resection specimen revealed a 9.5 x 4.2 x 3.2 cm(3) solid neoplasm in the pancreatic head with direct extension into duodenum and common bile duct. Microscopy showed a cellular neoplasm composed of pleomorphic mononuclear cells (pancytokeratin, and EMA-positive; LCA, and CD68 negative) and osteoclast-like multinucleated giant cells (vimentin, LCA, and CD68-positive; pancytokeratin, and EMA-negative) consistent with OGTP. The tumor contained a focal area of osteochondroid differentiation. Evidence supports that the tumor giant cells are non-neoplastic and of histiocytic origin. Osteochondroid differentiation within undifferentiated carcinoma is unusual; its presence might suggest a sarcoma diagnosis on biopsy material.
Manduch
Marosh
M
Department of Pathology and Molecular Medicine, Queen's University and Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L2V7, Canada.
Dexter
David F
DF
Jalink
Diederick W
DW
Vanner
Stephen J
SJ
Hurlbut
David J
DJ
D000368:Aged; D002277:Carcinoma / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D002454:Cell Differentiation; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D015726:Giant Cells / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D010010:Osteoclasts / Q000378:metabolism / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D016577:Pancreaticoduodenectomy