title: Pleomorphic giant cell carcinoma of the pancreas with hepatic metastases--initially presenting as a benign serous cystadenoma: a case report and review of the literature.
abstract: BACKGROUND
  Pleomorphic giant cell pancreatic cancer is a very rare and aggressive pancreatic neoplasm. A case of pleomorphic giant cell pancreatic cancer presenting as a cystic lesion and in association with a serous cystadenoma presents a unique case which has not been described before.
  
  
  METHODS
  A 44-year-old alcoholic man presented with abdominal pain, vomiting, and weight loss. Initially, imaging suspected a pancreatic pseudocyst measuring 4.2 cm. Endoscopic ultrasound- (EUS-) guided fine-needle aspiration revealed a serous cystadenoma. With conservative intervention only (fluid resuscitation, analgesia, and antiemetics) the patient improved and was discharged under close observation. Follow-up scan at four months revealed minimal change. Three months later, he was admitted acutely. Repeat scans demonstrated mild cyst enlargement with new liver lesions. Laparoscopic biopsy revealed pleomorphic giant cell carcinoma with the organ of origin the pancreas.
  
  
  CONCLUSIONS
  This unusual case highlights the challenges in managing pancreatic cystic lesions and emphasizes the importance of considering less common forms of pancreatic cystic masses when the findings are atypical for the presentation. Surgical excision in these cases over conservative steps may be the most appropriate management.
authors.affiliation: Department of Hepatobilary Surgery, Churchill Hospital, Oxford OX3 7LJ, UK.
authors.forename: Petrou
authors.initials: P
authors.lastname: Athanasios
authors.forename: Papalambros
authors.initials: P
authors.lastname: Alexandros
authors.forename: Brennan
authors.initials: B
authors.lastname: Nicholas
authors.forename: Karles
authors.initials: K
authors.lastname: Dimitrios
authors.forename: Bramis
authors.initials: B
authors.lastname: Kostantinos
authors.forename: Manzelli
authors.initials: M
authors.lastname: Antonio
authors.forename: Papalambros
authors.initials: P
authors.lastname: Efstathios
mesh_terms: D000328:Adult; D018286:Carcinoma, Giant Cell / Q000175:diagnosis* / Q000556:secondary*; D018293:Cystadenoma, Serous / Q000175:diagnosis*; D003937:Diagnosis, Differential; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D008297:Male; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology