Undifferentiated (Anaplastic) Carcinoma of the Pancreas with Osteoclast-Like Giant Cells Showing Various Degree of Pancreas Duct Involvement. A Case Report and Literature Review

  • Vlad Maksymov Department of Pathology, Health Sciences Centre. St. John’s, Newfoundland and Labrador, Canada
  • Mahmoud A Khalifa Department of Pathology, Sunnybrook Health Sciences Center. Toronto, Ontario, Canada
  • Angela Bussey Department of Surgery, Health Sciences Centre. St. John’s, Newfoundland and Labrador, Canada
  • Beverly Carter Department of Pathology, Health Sciences Centre. St. John’s, Newfoundland and Labrador, Canada
  • Michael Hogan Department of Surgery, Health Sciences Centre. St. John’s, Newfoundland and Labrador, Canada
Keywords: Carcinoma, Giant Cells, Osteoclasts, Pancreas

Abstract

Context Undifferentiated (anaplastic) carcinoma of the pancreas with osteoclast-like giant cells is exceedingly rare. The prognosis of undifferentiated carcinoma is worse than that of poorly differentiated ductal adenocarcinoma of the pancreas; however, undifferentiated carcinoma with osteoclast-like giant cells might have a more favorable prognosis. Case report We report the case of undifferentiated carcinoma of the pancreas with osteoclast-like giant cells, showing an intraductal growth pattern with various degree of pancreas duct involvement in the different areas. As a result, we were able to demonstrate the entire spectrum of changes, ranging from the early, minimal intraluminal growth to the partial or complete occlusion of the branches of the main pancreatic duct, and finally invasion and formation of the large necrotic/degenerated cysts. Conclusions Our findings support the epithelial origin of undifferentiated carcinoma of the pancreas with osteoclast-like giant cells. In early stages, the affected pancreatic duct epithelium was intermingled with nonepithelial component and had an immunoprofile distinctive from the epithelial lining of the uninvolved (normal) pancreatic ducts. Distinctive immunoprofile (CK 5/6, p63 and p53 positive) of the epithelial component and p63 and p53 positivity of the nonepithelial component should be explained and further investigated in the similar cases. Our findings support prior assertions that undifferentiated carcinoma of the pancreas with osteoclast-like giant cells may develop from carcinoma in situ within the main pancreatic duct or its branches.

Image: Pancreaticoduodenectomy specimen.

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References

Chen J, Baithun SI. Morphological study of 391 cases of exocrine pancreatic carcinoma. J Pathol 1985; 146:17-29. [PMID 2989468]

Tschang TP, Garza-Garza R, Kissane JM. Pleomorphic carcinoma of the pancreas: an analysis of 15 cases. Cancer 1977; 39:2114-26. [PMID 870168]

Ichikawa T, Federle MP, Ohba S, Ohtomo K, Sugiyama A, Fujimoto H, et al. Atypical exocrine and endocrine pancreatic tumors (anaplastic, small cell and giant cell types): CT and pathologic features in 14 patients. Abdom Imaging 2000; 25:409-19. [PMID 10926196]

Paal E, Thompson LD, Frommelt RA, Przygodzki RM, Heffess CS. A clinicopathologic and immunohistochemical study of 35 anaplastic carcinomas of the pancreas with a review of the literature. Ann Diagn Pathol 2001; 5:129-40. [PMID 11436166]

Pan ZG, Wang B. Anaplastic carcinoma of the pancreas associated with a mucinous cystic adenocarcinoma. A case report and review of the literature. JOP. J Pancreas (Online) 2007; 8:775-82. [PMID 17993730]

Nojima T, Nakamura F, Ishikura M, Inoue K, Nagashima K, Kato H. Pleomorphic carcinoma of the pancreas with osteoclast-like giant cells. Int J Pancreatol 1993; 14:275-81. [PMID 8113629]

Molberg KH, Heffess C, Delgado R, Albores-Saavedra J. Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas and periampullary region. Cancer 1998; 82:1279-87. [PMID 9529019]

Goldberg RD, Michelassi F, Montag AG. Osteoclast-like giant cell tumor of the pancreas: immunophenotypic similarity to giant cell tumor of bone. Hum Pathol 1991; 22:618-22. [PMID 1864595]

Rosai J. Carcinoma of pancreas simulating giant cell tumor of bone. Electron-microscopic evidence of its acinar cell origin. Cancer 1968; 22:333-44. [PMID 5660199]

Shimosegawa T, Saegusa S, Sekoguchi T, Kuriyama N, Yuasa H, Ido M, et al. Anaplastic ductal carcinoma of the pancreas with more than 10 year postoperative survival: report of 3 cases. Pancreas 2006; 33:88-9.

Deckard-Janatpour K, Kragel S, Teplitz RL, Min BH, Gumerlock PH, Frey CF, Ruebner BH. Tumors of the pancreas with osteoclast-like and pleomorphic giant cells; immunohistochemical and ploidy study. Arch Pathol Lab Med 1998; 122:266-72. [PMID 9823867]

Moore JC, Bentz JS, Hilden K, Adler DG. Osteoclastic and pleomorphic giant cell tumors of the pancreas: A review of clinical, endoscopic, and pathologic features. World J Gastrointest Endosc 2010; 2:15-9. [PMID 21160673]

Moore JC, Hilden K, Bentz JS, Pearson RK, Adler DG. Osteoclastic and pleomorphic giant cell tumors of the pancreas diagnosed via EUS-guided FNA: unique clinical, endoscopic, and pathologic findings in a series of 5 patients. Gastrointest Endosc 2009; 69:162-6. [PMID 19111699]

Bergmann F, Esposito I, Michalski CW, Herpel E, Friess H, Schirmacher P. Early undifferentiated pancreatic carcinoma with osteoclastlike giant cells: direct evidence for ductal evolution. Am J Surg Pathol 2007; 31:1919-25. [PMID 18043049]

Naito Y, Kinoshita H, Okabe Y, Arikawa S, Higaki K, Morimitsu Y, et al. Pathomorphologic study of undifferentiated carcinoma in seven cases: relationship between tumor and pancreatic duct epithelium. J Hepatobiliary Pancreat Surg 2009; 16:478-84. [PMID 19367361]

Khalifa MA, Maksymov V, Rowsell C. Retroperitoneal margin of the pancreaticoduodenectomy specimen; Anatomic mapping for the surgical pathologist. Virchows Arch 2009; 454:125-31. [PMID 19066952]

Hansen T, Burg J, Kirkpatrick CJ, Kriegsmann J. Osteoclast-like giant cell tumor of the pancreas with ductal adenocarcinoma: case report with novel data on histogenesis. Pancreas 2002; 25:317-20. [PMID 12370546]

Hoorens A, Prenzel K, Lemoine NR, Klöppel G. Undifferentiated carcinoma of the pancreas: analysis of intermediate filament profile and Ki-ras mutations provides evidence of a ductal origin. J Pathol 1998; 185:53-60. [PMID 9713360]

Bergmann F, Aulmann S, Wente MN, Penzel R, Esposito I, Kleeff J, et al. Molecular characterisation of pancreatic ductal adenocarcinoma in patients under 40. J Clin Pathol 2006; 59:580-4. [PMID 16497872]

Gocke CD, Dabbs DJ, Benko FA, Silverman JF. KRAS oncogene mutations suggest a common histogenetic origin for pleomorphic giant cell tumor of the pancreas, osteoclastoma of the pancreas, and pancreatic duct adenocarcinoma. Hum Pathol 1997; 28:80-3. [PMID 9013836]

Westra WH, Sturm P, Drillenburg P, Choti MA, Klimstra DS, Albores-Saavedra J, et al. K-ras oncogene mutations in osteoclast-like giant cell tumors of the pancreas and liver: genetic evidence to support origin from the duct epithelium. Am J Surg Pathol 1998; 22:1247-54. [PMID 9777987]

Winter JM, Ting AH, Vilardell F, Gallmeier E, Baylin SB, Hruban RH, et al. Absence of E-cadherin expression distinguishes noncohesive from cohesive pancreatic cancer. Clin Cancer Res 2008; 14:412-8. [PMID 18223216]

Oehler U, Jurs M, Kloppel G, Helpap B. Osteoclast-like giant cell tumor of the pancreas presenting as a pseudocyst-like lesion. Virchows Arch 1997; 431:215-8. [PMID 9334844]

Tezuka K, Yamakawa M, Jingu A, Ikeda Y, Kimura W. An Unusual case of undifferentiated carcinoma in situ with osteoclast-like giant cell of the pancreas. Pancreas 2006; 33:304-10. [PMID 17003654]

Strobel O, Hartwig W, Bergmann F, Hinz U, Hackert T, Grenacher L, et al. Anaplastic pancreatic carcinoma: Presentation, surgical management, and outcome. Surgery 2011; 149:200-8. [PMID 20542529]

Pancreaticoduodenectomy specimen
Published
2011-03-09
How to Cite
MaksymovV., KhalifaM., BusseyA., CarterB., & HoganM. (2011). Undifferentiated (Anaplastic) Carcinoma of the Pancreas with Osteoclast-Like Giant Cells Showing Various Degree of Pancreas Duct Involvement. A Case Report and Literature Review. JOP. Journal of the Pancreas, 12(2), 170-176. https://doi.org/10.6092/1590-8577/3349
Section
CASE REPORT