Case Report
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World J Gastroenterol. Mar 14, 2014; 20(10): 2725-2730
Published online Mar 14, 2014. doi: 10.3748/wjg.v20.i10.2725
Huge undifferentiated carcinoma of the pancreas with osteoclast-like giant cells
Sungho Jo
Sungho Jo, Department of Surgery, Dankook University College of Medicine, Cheonan, Chungnam 330-714, South Korea
Author contributions: Jo S designed the research, performed the research, contributed new reagents/analytic tools, analyzed the data and wrote the manuscript.
Correspondence to: Sungho Jo, MD, Department of Surgery, Dankook University College of Medicine, 119, Dandae-ro, Dongnam-gu, Cheonan, Chungnam 330-714, South Korea. agapejsh@dankook.ac.kr
Telephone: +82-41-5503959 Fax: +82-41-5563878
Received: August 21, 2013
Revised: November 8, 2013
Accepted: November 28, 2013
Published online: March 14, 2014
Processing time: 202 Days and 21 Hours
Abstract

Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells (OGCs) is very rare, less than 1% of all pancreatic malignancies, and shows worse prognosis than that of invasive ductal adenocarcinoma of the pancreas. We present a case of en bloc resection for a huge undifferentiated carcinoma with OGCs that invaded the stomach and transverse mesocolon. A 67-year female was admitted for left upper quadrant pain and computed tomography demonstrated a mass occupying the lesser sac and abutting the stomach and pancreas. There were no distant metastases and the patient underwent subtotal pancreatectomy with splenectomy, total gastrectomy, and segmental resection of the transverse colon. Histopathological examination confirmed an 11 cm-sized undifferentiated carcinoma of the pancreas with OGCs. Immunohistochemical staining revealed reactivity with pan-cytokeratin in adenocarcinoma component, with vimentin in neoplastic multi-nucleated cells, with CD45/CD68 in OGCs, and with p53 in tumor cells, respectively. The patient had suffered from multiple bone metastases and survived 9 mo after surgery. This case supports the ductal epithelial origin of undifferentiated carcinoma with OGCs and early diagnosis could result in favorable surgical outcomes. Investigations on the surgical role and prognostic factors need to be warranted in this tumor.

Keywords: Carcinoma; Giant cell; Pancreas; Prognosis; Treatment outcome

Core tip: Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells (OGCs) is very rare and shows a poor prognosis. A 67-year female underwent subtotal pancreatectomy, total gastrectomy, and segmental resection of the transverse colon for a mass occupying the lesser sac and abutting the stomach and pancreas. Histopathological examination confirmed an 11cm-sized undifferentiated carcinoma of the pancreas with OGCs. The patient had suffered from multiple bone metastases and survived 9 mo after surgery. This case supports the ductal epithelial origin of undifferentiated carcinoma with OGCs and early diagnosis could result in favorable surgical outcomes.