Case Report
Osteoclast-Like Giant Cell Tumor of the Pancreas Associated with Mucus-Secreting Adenocarcinoma
Case Report and Discussion of the Histogenesis
Gisele A. Naia, Enio Amicob, Vanderlei R. Gimenezb, Marcello Guilmarb
aDepartments of Pathology and bSurgery, College of Medicine, Universidade do Oeste Paulista, Presidente Prudente, São Paulo, Brazil
Address of Corresponding Author
Pancreatology 2005;5:279-284 (DOI: 10.1159/000085283)
Key Words
- Giant cell
- Osteoclast-like
- Adenocarcinoma
- Pancreatic tumor
- Immunohistochemistry
- Histogenesis
Abstract
Background/Aims: The osteoclast-like giant cell tumor of the pancreas is a rare entity that closely resembles giant cell tumor of the bone, which has also been observed in many other organs. Some tumors also contain areas of ductal adenocarcinoma. Conflicting opinions exist regarding the tumor origin, whether it is mesenchymal or epithelial, neoplastic or reactive. Methods: We report the case of a 69-year-old Brazilian man with a mass in the head of the pancreas, the histological examination of which revealed a predominant component of osteoclast-like giant cells within a background of pleomorphic mononuclear cells with osteoid formation and other areas composed of conventional mucus-secreting adenocarcinoma. Results: Immunohistochemistry showed that carcinoma cells of the usual type expressed epithelial antigens (EMA and cytokeratin) and lysozyme; the giant cells expressed vimentin, CD45, CD68, and lysozyme; and the mononuclear cells expressed macrophage marker (HAM56), vimentin, and lysozyme, and only some of them expressed epithelial markers, CD45, and CD68. Conclusion: Our immunohistochemical findings reveal that the giant cells in this case are of mesenchymal origin may be from the bone marrow cells. We believe that it is important to determine the histogenesis in each case to carry out the pertinent adjuvant therapy. Copyright © 2005 S. Karger AG, Basel and IAP
References
- 1.
- Rosai J: Carcinoma of pancreas simulating giant cell tumor of bone: Electro-microscopic evidence of its acinar cell origin. Cancer 1968;22:333-344.

- 2.
- Dworak O, Wittekind CH: Osteoclastic giant cell tumor of the pancreas. An immunohistological study and review of the literature. Path Res Pract 1993;189:228-231.

- 3.
- Solcia E, Capella C, Klöppel G: Tumors of exocrine pancreas. Atlas of Tumor Pathology, 3rd series, Fascicle 20. Washington, DC, Armed Forces Institute of Pathology, 1997.
- 4.
- Berendt RC, Shnitka TK, Wiens E, Manickavel V, Jewell LD: The osteoclast-type giant cell tumor of the pancreas. Arch Pathol Lab Med 1987;111:43-48.

- 5.
- Suster S, Phillips M, Robinson MJ: Malignant fibrous histiocytoma (giant cell type) of the pancreas. A distinctive variant of osteoclast-type giant cell tumor of the pancreas. Cancer 1989;64:2303-2308.

- 6.
- Tschang T, Garza-Garza R, Kissane JM: Pleomorphic carcinoma of the pancreas. An analysis of 15 cases. Cancer 1977;39:2114-2126.

- 7.
- Leighton CC, Shum DT: Osteoclastic giant cell tumor of pancreas. Case report and literature review. Am J Clin Oncol 2001;24:77-80.

- 8.
- Batsakis J, Ordonez N, Sevidal P Jr, Baker JR: Osteoclast-type giant cell neoplasms of the parotid gland. J Laryngol Otol 1988;102:901-904.

- 9.
- Kumar P, Torabinejad S, Omrani G: Osteoclastoma like anaplastic carcinoma of the thyroid gland diagnosed by fine needle aspiration cytology. Report of two cases. Acta Cytol 1997;41:1345-1348.

- 10.
- Andreev N, Raitchev R, Nikolova D: Malignant osteoclastoma of the skin. Br J Dermatol 1964;76:40-44.

- 11.
- Abdalla M, Hosni F: Osteoclastoma of the orbit. Case report. J Ophthalmol 1966;50:95-98.

- 12.
- Heller K, Manyak M Tabbara SO, Kerr LA: Malignant osteoclast-like giant cell tumor of the kidney. Urology 1998;51:495-498.

- 13.
- Shabb N, Tawil A, Mufarrij A, Obeid S, Halabi J: Mammary carcinoma with osteoclast-like giant cells citologically mimicking benign breast disease. A case report. Acta Cytol 1997;41:1284-1288.

- 14.
- Posen JA: Giant cell tumor of the pancreas of the osteoclastic type associated with a mucous secreting cystoadenocarcinoma. Hum Pathol 1981;12 944-947.

- 15.
- Mentes A, Yüce G: Osteoclast-type giant cell tumor of the pancreas associated with mucinous cystoadenoma. Eur J Surg Oncol 1993;19:84-86.

- 16.
- Watanabe M, Miura H, Inoue H, Uzuki M, Noda Y, Fujita N, Yamazaki T, Sawai T: Mixed osteoclastic/pleomorphic-type giant cell tumor of the pancreas with ductal adenocarcinoma: Histochemical and immunohistochemical study with review of the literature. Pancreas 1997;15:201-208.

- 17.
- Machado MAC, Herman P, Montagnini AL, Jukemura J, Leite KRM, Machado MCC: Benign variant of osteoclast-type giant cell tumor of the pancreas: Importance of the lack of epithelial diffferentiation. Pancreas 2001;22:105-107.

- 18.
- Trepeta RW, Mathur B, Lagin S, LiVolsi VA: Giant cell tumor ('osteoclastoma') of the pancreas: A tumor of epithelial origin. Cancer 1981;48:2022-2028.

- 19.
- Fischer HP, Altmannsberger M, Kracht J: Osteoclast-type giant cell tumour of the pancreas. Virchows Archiv A Pathol Anat Histopathol 1988;412:247-253.
- 20.
- 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;22:618-622.

- 21.
- Newbould MJ, Benbow, EW, Sene A, Young M, Taylor TV: Adenocarcinoma of the pancreas with osteoclast-like giant cells: A case report with immunocytochemistry. Pancreas 1992;7:611-615.

Author Contacts
Dr. Gisele A. Nai Laboratório de Anatomia Patológica e Citopatologia, UNOESTE Rua José Bongiovani, 700 19050-900 Presidente Prudente, São Paulo (Brazil) Tel. +55 18 229 1059, Fax +55 18 229 1013, E-Mail gica@muranet.com.br
Article Information
Published online: April 21, 2005
Number of Print Pages : 6
Number of Figures : 5, Number of Tables : 1, Number of References : 21
Publication Details
Pancreatology Vol. 5, No. 2-3, Year 2005 (Cover Date: 2005)
Journal Editor: M.V. Singer, Mannheim; C.W. Imrie, Glasgow
ISSN: 1424-3903 (print), 1424-3911 (Online) For additional information: http://www.karger.com/pan
Drug Dosage / Copyright
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center. |
|
|