Pancreas
Exocrine tumors / carcinomas
Undifferentiated carcinoma with osteoclast-like giant cells


Topic Completed: 26 November 2019

Minor changes: 9 March 2020

Copyright: 2002-2020, PathologyOutlines.com, Inc.

PubMed Search: Undifferentiated carcinoma with osteoclast-like giant cells pancreas

Claudio Luchini, M.D., Ph.D.
Page views in 2019: 1,321
Page views in 2020 to date: 723
Cite this page: Luchini C. Undifferentiated carcinoma with osteoclast-like giant cells. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/pancreasosteoclastic.html. Accessed May 30th, 2020.
Definition / general
  • Undifferentiated carcinoma of the pancreas with no glandular differentiation and with prominent infiltration by histiocytes and osteoclast-like giant cells
  • May be found in association with a differentiated component of pancreatic ductal adenocarcinoma
Essential features
  • Undifferentiated carcinoma with atypical neoplastic cells lacking gland formation
  • Presence of multinucleated giant cells resembling osteoclasts
Terminology
  • Undifferentiated carcinoma with osteoclast-like giant cells (UCOGC, UCOCGC)
  • Old terminology, not in use: giant cell tumor of the pancreas, osteoclastoma
ICD coding
  • ICD-O: 8035 / 3 - undifferentiated carcinoma with osteoclast-like giant cells
  • ICD-10: C25.9 - malignant neoplasm of pancreas, unspecified
Epidemiology
Sites
Pathophysiology
  • Unknown; a role may be played by hemorrhagic / chronic inflammatory foci with recruitment of tumor supporting macrophages within the pancreas or within a pancreatic ductal adenocarcinoma (Hum Pathol 2018;81:157)
Clinical features
Diagnosis
  • CT scan and MRI are the preferred imaging modalities
  • Diagnosis is by biopsy or surgical resection (more difficult with cytology but may be possible, Cancer Cytopathol 2017;125:563)
Radiology description
Radiology images

Images hosted on other servers:

Ultrasound

CT

Prognostic factors
Case reports
Treatment
Gross description
Gross images

Contributed by Claudio Luchini, M.D., Ph.D.

Gross appearance



Images hosted on other servers:

Hemorrhagic mass

Cystic mass

Cystic mass with gastric invasion

Frozen section description
  • Hypercellular neoplasm with atypical cells
  • Multinucleated giant cells, although they cannot always be documented in small biopsy sent for frozen section (may be focal component)
Frozen section images

Contributed by Claudio Luchini, M.D., Ph.D.

Frozen section

Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Claudio Luchini, M.D., Ph.D.

Associated conventional adenocarcinoma

Ductal tree involvement

Microhemorrhagic foci


Extensive necrotic hemorrhage

CK8 / 18+

Focal CK8 / 18+

CK8 / 18-

Cytology description
  • 3 cell types (osteoclast-like giant cells, neoplastic cells and histiocytes) are present in most cases (~80%)
  • Cytology has a diagnostic value for this tumor in ~80% of cases (Cancer Cytopathol 2017;125:563)
Cytology images

Images hosted on other servers:

Romanowsky stain

Papanicolaou stain

Positive stains
Negative stains
Electron microscopy description
  • Neoplastic cells: abundant mitochondria, no microvilli or desmosomes (J Korean Med Sci 2005;20:516)
  • Multinucleated osteoclast-like giant cells: multiple nuclei with rim of chromatin, abundant mitochondria, free ribosomes, dilated empty rough endoplasmic reticulum cisternae (J Korean Med Sci 2005;20:516)
Electron microscopy images

Images hosted on other servers:

Neoplastic cell

Giant cell

Molecular / cytogenetics description
  • Overlaps with the genetic profile of conventional ductal adenocarcinoma, with the most common mutated genes KRAS, TP53, CDKN2A and SMAD4 (J Pathol 2017;243:148)
  • GLI3, a gene belonging to the hedgehog signaling pathway, may be found mutated in this tumor
  • The same mutation (290 M > L) affecting the gene SERPINA3 has been documented in 25% of cases in a whole exome sequencing analysis (J Pathol 2017;243:148)
Sample pathology report
  • Pancreas, pancreatectomy:
    • Pancreatic undifferentiated carcinoma with osteoclast-like giant cells (see synoptic report)
Differential diagnosis
Board review style question #1
This is an immunohistochemical slide (CK8 / 18) from a pancreatic tumor in an elderly female with jaundice. S100 was negative throughout and the multinucleated cells were CD68 positive. Which is the most likely diagnosis?



  1. Anaplastic lymphoma
  2. Melanoma
  3. Pancreatitis
  4. Primitive mesenchymal tumor of the pancreas
  5. Pancreatic undifferentiated carcinoma with osteoclast-like giant cells
Board review answer #1
E. This is a pancreatic undifferentiated carcinoma with osteoclast-like giant cells. These tumors may be composed of neoplastic cells totally negative for cytokeratin. This finding, which is not uncommon, cannot be used to exclude this tumor entity (WHO Classification of Tumours Editorial Board: Digestive System Tumours, 5th Edition, 2019).

Comment Here

Reference: Undifferentiated carcinoma with osteoclast-like giant cells
Back to top