Pancreas - Undifferentiated carcinoma

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Pancreas

Exocrine tumors

Undifferentiated carcinoma

Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 26 November 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● Carcinoma in which substantial portion has no evidence of glandular, squamous or urothelial differentiation (WHO)
● Includes anaplastic carcinoma, carcinosarcoma, sarcomatoid carcinoma
● 7% of non-endocrine pancreatic malignancies
● See also Undifferentiated with osteoclastic giant cells

Clinical features
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● Usually elderly patients, who present with widely disseminated disease
● Very poor prognosis

Case reports
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● 74 year old man with carcinosarcoma (Arch Pathol Lab Med 2002;126:1114)

Gross images
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Left: Whipple resection specimen shows ill-demarcated tumor in head of pancreas with large areas of central necrosis (yellow)
Right: tumor mass in tail with extensive hemorrhagic necrosis

Micro description
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● High grade carcinoma with no evidence of glandular, squamous or urothelial differentiation
● May have discohesive, bizarre, multinucleated giant cells (not osteoclast-like), and resemble giant cell carcinoma of lung, adrenal, liver
● Dense inflammatory infiltrate with emperipolesis (neutrophils in tumor cells)

Micro images
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Various images

Poorly cohesive sarcomatoid pattern of pleomorphic large cells with single or multiple nuclei, supported by scanty fibrous stroma

Tumor cells show occasional engulfment of red blood cells or other tumor cells (cannibalism)

Spindle cell sarcomatoid features

Focus of glandular differentiation within a sarcomatoid pattern

Carcinosarcoma: left-glandular component is keratin+; right-sarcomatous component is vimentin+

Left: tumor is keratin+; right: tumor is CEA+ in glandular portions, but pleomorphic cells are negative

Positive stains
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● EMA, keratin

End of Pancreas > Exocrine tumors > Undifferentiated carcinoma

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