title: Undifferentiated carcinoma of the head of pancreas with osteoclast-like giant cells presenting as a symptomatic cystic mass, following acute pancreatitis: Case report and review of the literature.
abstract: BACKGROUND
  Undifferentiated head of pancreas carcinoma with osteoclast-like giant cells (UC-OGC) is a rare neoplasm, with less than a hundred cases reported. We present such a case, in which the UC-OGC presented atypically as a cystic lesion following acute pancreatitis and led to late diagnosis.
  
  
  METHODS
  A 75-year-old female patient, who had suffered acute pancreatitis three years ago, was referred with a diagnosis of osteoclast-like giant cell (OGC) tumor of the head of pancreas. She had suffered acute pancreatitis three years ago. Two years ago she developed abdominal pain, steatorrhea and weight loss. Abdominal computed tomography imaging showed a cystic mass in the head of the pancreas (maximum diameter 4cm). The initial diagnosis was pancreatic pseudocyst; however as the mass gradually increased in size and the patient continued to be symptomatic, a CT-guided biopsy was performed. Histological examination revealed an OGC pancreatic tumor. In laparotomy a large (9cm) encapsulated heterogeneous mass was found with partial involvement of the common hepatic artery. Pancreaticoduodenectomy was performed and the involved part of the common hepatic artery was replaced with a homologous graft from the major saphenous vein. Post-operative course was uneventful. Histology revealed an undifferentiated pancreatic adenocarcinoma with OGCs. She survived 10 months after the operation.
  
  
  CONCLUSIONS
  Pancreatic undifferentiated carcinomas with OGCs are very rare neoplasms and can present with an atypical clinical picture.
  
  
  CONCLUSIONS
  A symptomatic cystic lesion of the pancreas, which is growing in size, should be investigated promptly in order to exclude the presence of malignancy.
authors.affiliation: Department of Surgery, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece. Electronic address: georgmd7@gmail.com.
authors.forename: Georgios Κ
authors.initials: GΚ
authors.lastname: Georgiou
authors.affiliation: Department of Histopathology, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece.
authors.forename: Ephimia
authors.initials: E
authors.lastname: Balasi
authors.affiliation: Department of Histopathology, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Siozopoulou
authors.affiliation: Department of Radiology, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece.
authors.forename: Athina
authors.initials: A
authors.lastname: Tsili
authors.affiliation: Department of Surgery, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece.
authors.forename: Michalis
authors.initials: M
authors.lastname: Fatouros
authors.affiliation: Department of Surgery, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Glantzounis
keywords: Osteoclast giant cell tumors; Pancreatic tumor; Undifferentiated carcinoma