伴有破骨细胞样巨细胞的胰腺未分化癌1例报道及文献复习

目的：探讨伴有破骨细胞样巨细胞的胰腺未分化癌的临床病理特点.方法：观察1例伴有破骨细胞样巨细胞的胰腺未分化癌的形态学特征,并进行免疫组织化学染色.结果：伴有破骨细胞样巨细胞的胰腺未分化癌肿瘤主要有两种细胞组成,一种为单核细胞,分为组织细胞样单核细胞和梭形或多形性瘤细胞两型;另一种为多核巨细胞,分为非肿瘤性的破骨细胞样巨细胞和瘤巨细胞两型.免疫组织化学研究显示,这两种细胞Vimentin均阳性,均不表达cytokeratin（AE1/AE3）,CK5/6,CEA,CgA;其中破骨细胞样巨细胞、组织细胞样单核细胞CD45,CD68阳性,而瘤巨细胞和梭形瘤细胞阴性.结论：伴有破骨细胞样巨细胞的胰腺未分化癌是一种罕见恶性肿瘤,可能为胰腺未分化癌的一个亚型.诊断需与胰腺恶性纤维组织细胞瘤、转移的骨巨细胞瘤或黑色素瘤等鉴别.     

Significance of giant cells in fine-needle aspiration biopsies of benign and malignant lesions of the pancreas

The cytologic results of 44 consecutive fine-needle aspiration (FNA) biopsies of the pancreas are reported. The series consisted of 27 women and 17 men with an age range of 31-89 yr (mean, 61.5). Excluding insufficient cases, the sensitivity of the procedure was 88%, specificity was 100%, positive predicative value (PV) was 100%, negative PV was 69%, and efficiency of the test was 90%. There were 29 true-positive, four false-negative, and nine true-negative diagnoses. Two specimens were insufficient for diagnosis. Giant cells of varying types were seen in both the malignant and benign cases. Two of the benign cases demonstrated rare multinucleated foreign body-type giant cells, most likely representing the changes seen in pancreatitis. In 13 malignant cases, multinucleated tumor cells were present, while six additional cases had multinucleated benign histiocytes reflecting the associated pancreatitis. Two malignant cases each had tumor giant cells and benign multinucleated histiocytes. Three of the malignant cases had numerous multinucleated tumor giant cells arranged in a dissociative fashion with evidence of cytophagocytosis consistent with a pleomorphic giant-cell carcinoma of the pancreas. One additional case demonstrated numerous multinucleated osteoclastic-like cells consistent with an osteoclastic tumor of the pancreas. This article documents the accuracy of FNA biopsy of the pancreas and notes that giant cells of varying types can be found in pancreatic FNA biopsies. Appreciation of the various types of giant cells in pancreatic FNA biopsy is important for diagnostic accuracy and prognosis.     

A case of osteoclast-like giant cell tumor of the pancreas with ductal adenocarcinoma: histopathological, immunohistochemical, ultrastructural and molecular biological studies

Osteoclast-like giant cell tumor of the pancreas is a very rare neoplasm, of which the histiogenesis remains controversial. A 63-yr-old woman was hospitalized for evaluation of epigastric pain. An abdominal computerized tomography revealed the presence of a large cystic mass, arising from the tail of pancreas. A distal pancreatectomy with splenectomy was performed. Histologically, the tumor was composed of mononuclear stromal cells intermingled with osteclast-like giant cells. In addition, there was a small area of moderately to well differentiated ductal adenocarcinoma. The final pathologic diagnosis was osteoclast-like giant cell tumor of the pancreas with ductal adenocarcinoma. Here, we describe the histopathological, immunohistochemical, ultrastructural and molecular biological findings of this tumor with review of the literature pertaining to this condition.     

Osteoclast-like giant cell tumour of the pancreas presenting as a pseudocyst-like lesion

 A 57-year-old male patient presented with a cystic lesion in the tail of the pancreas, which was considered to be a pseudocyst. He was treated by cystojejunostomy but one year later a tumour was found to have invaded the stomach and jejunum. This was an osteoclast-like giant cell tumour containing a small area of typical ductal adenocarcinoma. Immunohistochemical staining revealed that the pleomorphic tumour cells were positive for cytokeratin, epithelial membrane antigen, vimentin and the proliferation marker MIB-1. The osteoclast-like giant cells and some small histiocytic cells stained for leukocyte common antigen and histiocytic markers and were negative for MIB-1. At autopsy, tumour rests were found in the pancreas but there were no metastases. Osteoclast-like giant cell tumours of the pancreas may present as cystic lesions and should be included in the differential diagnosis of pseudocysts. Received: 19 December 1996 / Accepted: 20 March 1997     

含破骨巨细胞样细胞的胰腺多形性癌1例及文献复习

目的 探讨含破骨巨细胞样细胞的胰腺多形性癌的临床病理特征。方法 对1例含破骨巨细胞样细胞的胰腺多形性癌进行临床、病理组织学和免疫组织化学观察。结果 患者为58岁女性，因中上腹部持续性隐痛2个月余就诊，B超、CT检查发现胰腺占位。切除标本示实性结节状肿块，灰白、灰黄色，存灶性坏死。镜下见肿瘤由低分化腺癌伴梭形肉瘤样细胞构成，两种细胞均示CK、Vim、α-AT阳性。可见多灶性巨细胞瘤样结构，由单核瘤细胞和形态上良性的破骨巨细胞样细胞构成；前者见CK散在阳性，Vim和α-AT阳性；后者仅见CD68和Vim阳性。结论 含破骨巨细胞样细胞的胰腺多形性癌是多形性胰腺癌的一种亚型，破骨巨细胞为反应性细胞，非肿瘤成分。     

Non-differentiated carcinoma with osteoclast-like giant cells of the pancreas

We report the case of a 53-year-old man who presented a mass involving the head of the pancreas resulting in isolated jaundice. Histologically, the tumor was an undifferentiated carcinoma with osteoclast-like giant cells of the pancreas. This very rare neoplasm resembles giant cell tumor of bone. An epithelial origin is now established and this tumor has been recently considered as a variant of ductal adenocarcinoma of the pancreas in the last WHO histological classification. The diagnosis requires both morphology and immunohistochemistry. Although the prognosis of these tumors is reported to be poor, our case is unusual because of a favorable outcome without relapse after 2 years.     

Endoscopic ultrasound-guided fine-needle aspiration of undifferentiated carcinoma with osteoclast-like giant cells of the pancreas: a report of 2 cases with literature review

Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas is rare. Histologically it mimics the giant cell tumor of the bone and may be associated with a ductal adenocarcinoma. We recently encountered two such cases, both of which were biopsied by EUS-guided FNA. Abundant multinucleated osteoclast-like giant cells and many uniform mononuclear cells were present in case 1 so that the diagnosis was made. In case 2, many mononuclear tumor cells with vacuolated and basophilic cytoplasm were present, and rare osteoclast-like giant cells were seen. A diagnosis of adenocarcinoma was made. In both cases, no conspicuous nuclear pleomorphism was noted in the mononuclear cells or the multinucleated giant cells. The histology of case 2 revealed a pure undifferentiated carcinoma with osteoclast-like giant cells. In addition, a liver biopsy revealed globular amyloidosis. To our knowledge, this is the first report of pancreatic undifferentiated carcinoma with osteoclast-like giant cells sampled by EUS-guided FNA and the first case of hepatic globular amyloidosis associated with this tumor.     

Osteoclast-like giant cell tumor of the pancreas: immunophenotypic similarity to giant cell tumor of bone

An immunophenotype was performed on an osteoclast-like giant cell tumor of the pancreas using a panel of antibodies to epithelial and leukocyte antigens. Several antibodies to cytokeratin and carcinoembryonic antigen were negative in the tumor. Osteoclast-like cells were positive for CD4, CD13, CD45, CD68, CD71, and vimentin, but negative for lysozyme and HLA-DR. Mononuclear tumor cells were positive for CD4, CD11c, CD13, CD14, CD45, CD68, CD71, HLA-DR, and vimentin, but negative for lysozyme. The phenotype is similar to that previously described for giant cell tumor of bone. The osteoclast-like cell phenotype is also similar to that reported for normal osteoclasts. The findings support a nonepithelial origin for osteoclast-like giant cell tumor of the pancreas, and suggest a derivation similar to giant cell tumor of bone.     

Osteoclast-type giant cell tumour of the pancreas.

A case of osteoclast-type giant cell tumour of the pancreas is described and the features of eight other previously reported patients are reviewed. Characteristically, these neoplasms are large at presentation and show focal haemorrhage and necrosis, but seem slow to give rise to metastases. Histological examination reveals numerous osteoclast-like giant cells set in a sarcomatous stroma, the appearances being similar to those seen in giant cell tumours of bone. They are distinct from pleomorphic giant cell carcinomas of the pancreas and may have a slightly better prognosis after resection than ordinary adenocarcinomas. The histogenesis of these rare tumours is unknown.     

Giant cell tumour (osteoclastoma) of the pancreas--an epithelial tumour probably of pancreatic acinar origin

A case of giant cell tumour of the pancreas has been studied. The light microscopical appearance of the tumour is indistinguishable from osteoclastoma of bone. Electron microscopy of the tumour shows many typical desmosomes between stromal cells. This is strong evidence of its epithelial nature. The cytoplasm of both the osteoclast-like giant cells and stromal cells contain abundant rough endoplasmic reticulum, many with dilated cisternae containing prominent dense granules. There are also some larger homogeneous granules, some of them electron-dense, in the cytoplasm of the cells. These findings when compared with the features of other cases of giant cell tumour of the pancreas studied by electron microscopy support the view that this epithelial tumour is of acinar origin.     

Fine-needle aspiration cytology of osteoclastic giant-cell tumor of the pancreas.

Osteoclastic giant-cell tumor (OGCT) of the pancreas is a rare tumor. We present the fine-needle aspiration (FNA) and bile cytology findings of an OGCT arising in the head of the pancreas in a 72-yr-old male, along with immunocytochemical studies that were done on the cytologic material. The smears showed numerous giant cells with clustered, overlapping, uniform, bland-appearing nuclei with prominent nucleoli consistent with osteoclastic-type multinucleated giant cells. A second population of mononucleated cells appearing singly or in groups having similar nuclear features was also present. Immunocytochemical studies performed on the FNA and bile duct fluid material demonstrated positive staining of the malignant cells for vimentin, alpha-1 antichymotrypsin, and alpha-1 antitrypsin and negative staining for high- and low-molecular-weight cytokeratin, pooled monoclonal cytokeratin, epithelial membrane antigen, and carcinoembryonic antigen. Although not definitive, these studies are supportive of a mesenchymal-stromal histogenesis of this unusual pancreatic malignancy.     

Cytologic features of ascites in malignant fibrous histiocytoma of the colon

The cytologic features of ascitic fluid in a case of malignant fibrous histiocytoma (MFH) of the colon are described. At autopsy, two solid tumor masses were found around the ascending and transverse colon, accompanied by about 3,000 ml of ascites. Tumor cells had infiltrated diffusely into the outer layers of almost all of the gastrointestinal wall, simulating peritonitis carcinomatosa. Cytologic examination of the ascites revealed various kinds of tumor cells; short spindle-like cells, multinucleated giant cells, and round cells with an invaginated nuclear margin, forming small clusters. These cytologic findings were considered to be very useful in the diagnosis of MFH, especially in cytologic examinations of ascites.     

Giant cell tumor of the pancreas of the osteoclastic type associated with a mucous secreting cystadenocarcinoma

A case report of a rare pancreatic neoplasm is presented having the histological characteristics of a giant cell tumor, indistinguishable on light microscopy from a giant cell tumor of bone in one area of the neoplasm, and a multilocular mucous secreting cystadenocarcinoma in other areas. This type of giant cell tumor should be distinguished from pleomorphic carcinoma and sarcoma of the pancreas containing tumor giant cells that are not of the osteoclastic type. The exact histogenesis of the tumor remains undertermined, but an epithelial origin is suggested.     

Osteoclast-like giant cell tumor of the pancreas: an immunohistochemical and ultrastructural study

We report a rare case of osteoclast-like giant cell tumor of the pancreas in a 70-year-old Japanese woman. The tumor was composed of a proliferation of ovoid to spindle-shaped mononuclear cells admixed with osteoclast-like giant cells. The tumor cells were immunore-active for vimentin, ±₁-antitrypsin, and CD68. In ultrastructural examination, the giant cells resembled osteoclasts, and the mononuclear stromal cells had fibroblastic and histiocytic features. No elements of epithelial differentiation were found in this tumor. These findings suggest that this tumor had a derivation similar to giant cell tumor of bone.This study was presented at the 28th Annual Meeting of the Clinical Electron Microscopy Society of Japan, Osaka, October 17–19, 1996.     

CYTOLOGIC FEATURES OF ASCITES IN MALIGNANT FIBROUS HISTIOCYTOMA OF THE COLON

The cytologic features of ascitic fluid in a case of malignant fibrous histiocytoma (MFH) of the colon are described. At autopsy, two solid tumor masses were found around the ascending and transverse colon, accompanied by about 3,000 ml of ascites. Tumor cells had infiltrated diffusely into the outer layers of almost all of the gastrointestinal wall, simulating peritonitis carcinomatosa. Cytologic examination of the ascites revealed various kinds of tumor cells; short spindle-like cells, multinucleated giant cells, and round cells with an invaginated nuclear margin, forming small clusters. These cytologic findings were considered to be very useful in the diagnosis of MFH, especially in cytologic examinations of ascites. ACTA PATHOL JPN 38: 921 ∼ 928, 1988.     

Epithelioid hemangioendothelioma with osteoclast-like giant cells

Epithelioid hemangioendothelioma is an unusual entity of intermediate malignant vascular tumors and rarely admixes with multinucleated osteoclast-like giant cells. We describe such a case in a 50-year-old woman with an 1-year follow-up period. When the patient was 39 years old, a 0.7 x 1-cm firm mass was found in the left neck. She developed ascites three years later. At that time, the specimen from the neck mass was excised and found to be composed of cords of epithelioid cells in a myxoid hyaline stroma. Scattered intracytoplasmic vacuoles were seen. Immunohistochemical studies confirmed the diagnosis of epithelioid hemangioendothelioma. Abdominal ultrasonography and computed tomographic scan revealed multiple low density areas in the liver. Eleven years later, a metastatic lesion was found in the thoracic spine at the level of Th7-8. The histologic findings were basically similar to those of the left neck mass. However, because of the presence of Kp-1-positive multinucleated osteoclast-like giant cells throughout the tumor, the thoracic lesion was diagnosed as an epithelioid hemangiothelioma with osteoclast-like giant cells. This unique form of epithelioid hemangioendothelioma is extremely rare and should be distinguished from other benign and malignant tumors with osteoclast-like giant cells.     

Giant-cell containing neoplasms of the pancreas: an aspiration cytology study

Giant-cell containing neoplasms of the pancreas are rare with few reports documenting their cytologic appearance. Giant-cell containing neoplasms of the pancreas have been divided into two subtypes corresponding to the osteoclastic giant-cell tumor of the pancreas and the pleomorphic giant-cell carcinoma of the pancreas. Despite the better prognosis reported in some series for osteoclastic giant-cell tumors, the most recent edition of the World Health Organization classification lumps the two entities into a single category designated as undifferentiated carcinoma with osteoclast-like giant cells. Smears obtained from osteoclastic giant-cell tumors show numerous giant-cells with clustered overlapping, bland appearing nuclei containing prominent nucleoli consistent with an osteoclast-type multinucleated giant-cell. These neoplasms contain a second population of mononuclear cells showing more marked nuclear atypia. Pleomorphic giant-cell carcinomas are characterized by anaplastic giant-cells displaying marked nuclear pleomorphism. The mononuclear component is also pleomorphic with markedly atypical epithelioid and spindle shaped cells. In three reported cases, a tumor contained a mixture of the two cell patterns. Thus, undifferentiated carcinoma with osteoclast-like giant cells and pleomorphic giant cell carcinoma may represent a morphologic spectrum with pure osteoclast-like giant-cell tumors at one end and pleomorphic giant-cell carcinoma at the other. Fine-needle aspiration specimens from pure osteoclast-like giant-cell tumors will contain a population of bland multinucleated osteoclastic-like giant-cells that differ markedly from the anaplastic giant-cells of pleomorphic giant-cell carcinoma. The difference in the appearance of the giant-cells aids in distinction of the two neoplasms. When in pure form, the two neoplasms may follow different clinical courses.     

In vitro induction of giant cell tumors from cultured hamster islets treated with N-Nitrosobis(2-Oxopropyl)amine

Giant cell carcinoma of the pancreas is a rare tumor. Its histogenesis is still controversial. In a Syrian hamster pancreatic cancer model, tumors similar to human giant cell carcinomas have been induced at an extremely low rate of incidence and after the use of high doses of pancreatic carcinogens. Thus far no tumors of giant cell type have been induced by the in vitro treatment of hamster pancreatic ductal cells with the potent pancreatic carcinogen N-nitrosobis(2-oxopropyl)amine (BOP). In the present study we report the induction of giant cell carcinoma from hamster islets treated with BOP in vitro. The results suggest that in hamsters some component of islet cells, probably stem cells, are the origin of giant cell carcinoma.     

Undifferenzierte Pankreaskarzinome

Undifferentiated pancreatic carcinomas are rare anaplastic variants of ductal adenocarcinoma of the pancreas. They have to be distinguished immunohistochemically from metastases of malignant melanoma or an infiltrating sarcoma. An uncommon variant is undifferentiated pancreatic carcinoma with osteoclast-like giant cells. This variant can be associated with mucinous cystic neoplasms and is characterized by abundant non-neoplastic osteoclast-like giant cells.