title: Undifferentiated Carcinoma With Osteoclastic Giant Cells of the Pancreas: Clinicopathologic Analysis of 38 Cases Highlights a More Protracted Clinical Course Than Currently Appreciated.
abstract: Undifferentiated carcinomas with osteoclastic giant cells of the pancreas (OGC) are rare tumors. The current impression in the literature is that they are highly aggressive tumors similar in prognosis to ductal adenocarcinomas. In this study, the clinicopathologic characteristics of 38 resected OGCs were investigated and contrasted with 725 resected pancreatic ductal adenocarcinomas without osteoclastic cells (PDCs). The frequency among systematically reviewed pancreatic cancers was 1.4%. OGCs showed a slight female predominance (62.9%, vs. 51.4% in PDCs). The mean age was 57.9 years (vs. 65.0). The mean size of invasive cancer was 5.3 cm (vs. 3.2). They were characterized by nodular, pushing-border growth, and 8 arose in tumoral intraepithelial neoplasms (4 in mucinous cystic neoplasms, 4 in intraductal papillary mucinous neoplasms type lesions), and 23 (61%) also showed prominent intraductal/intracystic growth. Twenty-nine (76%) had an invasive ductal/tubular adenocarcinoma component. Osteoid was seen in 12. Despite their larger size, perineural invasion and nodal metastasis were uncommon (31.6% and 22.6%, vs. 85.5% and 64.0%, respectively). Immunohistochemistry performed on 24 cases revealed that osteoclastic cells expressed the histiocytic marker CD68, and background spindle cells and pleomorphic/giant carcinoma cells often showed p53 and often lacked cytokeratin. Survival of OGCs was significantly better than that of PDCs (5 yr, 59.1% vs. 15.7%, respectively, P=0.0009). In conclusion, pancreatic OGCs present with larger tumor size and in slightly younger patients than PDC, 21% arise in mucinous cystic neoplasms/intraductal papillary mucinous neoplasms, and 61% show intraductal/intracystic polypoid growth. OGCs have a significantly better prognosis than is currently believed in the literature.
authors: Departments of *Pathology and Laboratory Medicine ∥Radiology #Surgery, Emory University School of Medicine, Atlanta, GA †Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY ¶Department of Pathology, Detroit Medical Center, Detroit, MI ‡Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea §Department of Pathology, Marmara University, Istanbul, Turkey.
authors: Takashi
authors: T
authors: Muraki
authors: Michelle D
authors: MD
authors: Reid
authors: Olca
authors: O
authors: Basturk
authors: Kee-Taek
authors: KT
authors: Jang
authors: Gabriela
authors: G
authors: Bedolla
authors: Pelin
authors: P
authors: Bagci
authors: Pardeep
authors: P
authors: Mittal
authors: Bahar
authors: B
authors: Memis
authors: Nora
authors: N
authors: Katabi
authors: Sudeshna
authors: S
authors: Bandyopadhyay
authors: Juan M
authors: JM
authors: Sarmiento
authors: Alyssa
authors: A
authors: Krasinskas
authors: David S
authors: DS
authors: Klimstra
authors: Volkan
authors: V
authors: Adsay
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology; D005260:Female; D015726:Giant Cells / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010010:Osteoclasts / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology*
chemical_list: D014408:Biomarkers, Tumor