title: Cytologic features and clinical implications of undifferentiated carcinoma with osteoclastic giant cells of the pancreas: An analysis of 15 cases.
abstract: BACKGROUND
  The cytologic features of undifferentiated pancreatic carcinoma with osteoclastic giant cells (UOC) are rarely described.
  
  
  METHODS
  Cytologic and clinicopathologic characteristics in 15 UOC fine-needle aspiration (FNA) specimens were analyzed.
  
  
  RESULTS
  FNA specimens were obtained from 6 men and 8 women with a mean age of 65 years who had UOCs (head, n = 7; body, n = 3; and tail, n = 4) with a mean radiologic size 7.3 cm, and some had a cystic component (n = 9). Three cell types (osteoclastic giant cells, pleomorphic tumor giant cells, and spindled/histiocytoid cells) were observed in 12 of 15 specimens (80%); and pancreatic ductal adenocarcinoma (PDAC) was present in 11 specimens. FNA diagnoses were UOC (n = 6), PDAC (n = 5), poorly differentiated carcinoma (n = 2), "suspicious for neoplasm" (n = 1), and "negative" (n = 1). Five of 5 specimens with osteoclastic giant cells were positive for cluster of differentiation 68 (CD68) (a glycoprotein that binds to low-density lipoprotein). Pleomorphic tumor giant cells and spindled/histiocytoid cells were positive for pancytokeratin (6 of 7 specimens), CAM5.2 (2 of 3 specimens), and epithelial membrane antigen (2 of 2 specimens). INI-1 protein expression was retained in 3 of 3 specimens. The Ki-67 labeling index was assessed in 3 specimens and was 12%, 18%, and 40%; 4 of 12 resected UOCs were pure, and 8 were mixed with PDAC. One resection specimen had intraductal papillary mucinous neoplasm, and 2 had mucinous cystic neoplasms. The median overall survival (OS) of patients who had UOCs identified on FNA was 8 months (6 died [OS, 8 months; range, 2-22 months], and 8 remained alive [OS, 3 months; range, 1-27 months]), which was similar to the survival of 74 patients who had PDACs identified on FNA (OS, 15 months; P = .279) but worse than that of the 27 patients with UOCs who did not undergo FNA (OS, 92 months; P = .0135).
  
  
  CONCLUSIONS
  The 3 classical UOC cell types are identifiable on FNA, making cytologic diagnosis possible if considered in the differential. A PDAC component is often also observed. The survival advantage of UOC over pure PDAC appears to be negated by FNA and requires further investigation. Cancer Cytopathol 2017;125:563-75. © 2017 American Cancer Society.
authors.affiliation: Department of Pathology, Emory University Hospital, Atlanta, Georgia.
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Reid
authors.affiliation: Department of Pathology, Emory University Hospital, Atlanta, Georgia.
authors.forename: Takashi
authors.initials: T
authors.lastname: Muraki
authors.affiliation: Department of Pathology, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Kim
authors.initials: K
authors.lastname: HooKim
authors.affiliation: Department of Pathology, Emory University Hospital, Atlanta, Georgia.
authors.forename: Bahar
authors.initials: B
authors.lastname: Memis
authors.affiliation: Department of Pathology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Rondell P
authors.initials: RP
authors.lastname: Graham
authors.affiliation: Department of Pathology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Daniela
authors.initials: D
authors.lastname: Allende
authors.affiliation: Department of Pathology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jiaqi
authors.initials: J
authors.lastname: Shi
authors.affiliation: Department of Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada.
authors.forename: David F
authors.initials: DF
authors.lastname: Schaeffer
authors.affiliation: Department of Pathology, Northside Hospital, Atlanta, Georgia.
authors.forename: Remmi
authors.initials: R
authors.lastname: Singh
authors.affiliation: Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Olca
authors.initials: O
authors.lastname: Basturk
authors.affiliation: Department of Pathology, Emory University Hospital, Atlanta, Georgia.
authors.forename: Volkan
authors.initials: V
authors.lastname: Adsay
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D003581:Cytodiagnosis / Q000379:methods; D018572:Disease-Free Survival; D019160:Endosonography / Q000379:methods; D005260:Female; D005870:Giant Cell Tumors / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010010:Osteoclasts / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D011379:Prognosis; D012494:Sampling Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: cytology; fine-needle aspiration (FNA); osteoclast-like giant cell carcinoma; pancreas; undifferentiated carcinoma with osteoclastic giant cells of the pancreas