J Korean Surg Soc.  2011 Aug;81(2):146-150. 10.4174/jkss.2011.81.2.146.

Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells

• Hur YH
• Kim HH
• Seoung JS
• Seo KW
• Kim JW
• Jeong YY
• Lee JH
• Koh YS
• Kim JC
• Kim HJ
• Cho CK

• KMID: 2096670
• DOI: http://doi.org/10.4174/jkss.2011.81.2.146

Abstract

Undifferentiated carcinoma with osteoclast-like giant cells is a rare neoplasm of the exocrine pancreas. Some similar cases have been reported, but the histogenesis of these tumors varies and is controversial. We report here on a case of undifferentiated carcinoma of the pancreas with osteoclast-like giant cells. A 77-year old woman presented with abdominal pain and anorexia. Abdominal computed tomography and magnetic resonance imaging showed an approximately 10 x 5 cm highly attenuated mass arising from the tail of the pancreas and invading the spleen and adjacent bowel loop. The initial impression was a malignant endocrine tumor or solid-pseudopapillary tumor of the pancreas. The patient underwent a distal pancreatectomy with splenectomy and left hemicolectomy. The histopathology and immunohistochemistry helped make the diagnosis that of an undifferentiated carcinoma with osteoclast-like giant cells of the pancreas.

Keyword

Osteoclast-like giant cells; Undifferentiated carcinoma; Pancreas

MeSH Terms

Abdominal Pain
Anorexia
Carcinoma
Female
Giant Cells
Humans
Immunohistochemistry
Magnetic Resonance Imaging
Pancreas
Pancreas, Exocrine
Pancreatectomy
Spleen
Splenectomy

Figure

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  Fig. 1 Abdominal computed tomography (CT) findings. Abdominal CT scan reveals about a 12 × 10 cm-sized heterogenous enhanced mass arising from the tail of the pancreas. The mass has invaded the spleen and the adjacent bowel loop.

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  Fig. 2 Abdominal magnetic resonance imaging findings. (A) The T1-weighted image shows a 10 × 5 cm, low signal intensity mass with invasion into the spleen. (B) The T2-weighted image shows heterogenous high signal intensity with multifocal cystic lesions.

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  Fig. 3 Gross findings of undifferentiated carcinoma with osteoclast-like giant cells of the pancreas. Gross pathologic examination reveals a 14 × 7.7 cm-sized mass in the pancreatic tail. The cut surface of the tumor is yellowish-white, and the tumor shows signs of hemorrhage and fibrosis.

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  Fig. 4 Microscopic findings. Histologically, the tumor was composed of two major cell types: atypical mononuclear round cells and abundant osteoclast-like multinucleated giant cells with central nucleoli (A, H&E, ×100; B, H&E, ×200). Many mitotic figures are present (C, red circle) (H&E, ×200). The immunohistochemical findings show positive staining by vimentin (D, ×200).

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