Pancreas - Undifferentiated carcinoma - Osteoclastic giant cell tumor

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Undifferentiated carcinoma - Osteoclastic giant cell tumor

Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 8 December 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● Aggressive malignant epithelial neoplasm composed of giant cells resembling osteoclasts and atypical cells that do not display glandular or squamous differentiation (WHO)
● Different morphologically (but occasionally coexists) from anaplastic carcinoma, with better prognosis
● Tumor cells (undifferentiated) appear to induce osteoclasts
● Similar tumor in the liver
● Resembles giant cell tumor of bone (Hum Pathol 1991;22:618)

Case reports
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● 39 year old man with familial atypical multiple mole melanoma syndrome (Am J Surg Pathol 2008;32:1905)
● 77 year old woman with mass in tail invading spleen and adjacent bowel (J Korean Surg Soc 2011;81:146)

Gross description
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● Large, hemorrhagic

Gross images
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77 year old woman

Micro description
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● Contain 5 cellular components - osteoclast-like giant cells, pleomorphic large cells, histiocyte-like mononuclear cells, atypical mononuclear cells (nucleus resembles pleomorphic large cells), ductal carcinoma cells

Micro images
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77 year old woman

Various images

Osteoclast-like giant cells and bizarre tumor giant cells are mixed with a few spindle and smaller pleomorphic cells; osteoclast-like cells are relatively uniformly nucleated, and each nucleus has little chromatin and one small distinct nucleolus

Elongated spindle cells vary from those with small cell nuclei and relatively little chromatin to cells containing abundant chromatin; an osteoclast-like giant cell can be seen at upper left

Osteoid formation (lower right) with a few osteoclast-like giant cells, plus many small, pleomorphic, mononucleated cells

Rare small focus of adenocarcinoma

Osteoclast giant cells are LCA/CD45+; non-neoplastic macrophages and lymphocytes are also immunoreactive

Cytology images
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Osteoclastic giant cell tumor of pancreas

Positive stains
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● Osteoclast-like giant cells: CD68+, keratin negative, no Kras mutation; non-neoplastic
● Pleomorphic large cells (not always present): CD68-, often have Kras mutations
● Histiocyte-like mononuclear cells: CD68+, keratin+, often have Kras mutations
● Atypical mononuclear cells: CD68-, often have Kras mutations
● Ductal carcinoma cells: CD68-, same Kras mutations as pleomorphic large cells and mononuclear cells

Electron microscopy images
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Various images

Molecular description
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● Osteoclast-like giant cells lack Kras mutations, but mononuclear cells have similar Kras mutations as ductal carcinoma cells (Am J Surg Pathol 1998;22:1247, Hum Pathol 2000;31:1223, Arch Pathol Lab Med 1998;122:266)

End of Pancreas > Tumors > Undifferentiated carcinoma - Osteoclastic giant cell tumor

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