Sarcomatoid carcinoma of the stomach with osteoclast-like giant cells

Carcinomas with osteoclast-like giant cells (OGCs) are a rare type of malignant tumor that is histologically characterized by the presence of multinucleated giant cells that resemble osteoclasts mixed with poorly differentiated adenocarcinoma cells. In this study, we report the clinicopathological and immunohistochemical features of a gastric sarcomatoid carcinoma with OGCs in a 37-year-old male. An abdominal CT scan demonstrated a large mass, measuring 15 cm × 10 cm, in the lesser curvature of the stomach. Microscopic examination revealed that the tumor was composed of sarcomatoid and carcinomatous elements with infiltrating OGCs. Immunohistochemical analysis showed that the sarcomatoid and carcinomatous elements were both variably positive for CK7 and EMA. The sarcomatoid components were also vimentin and SMA positive. This is the first report of a gastric sarcomatoid carcinoma with OGCs. The present tumor has progressed rapidly with extensive perigastric involvement and multiple intrahepatic metastases.     

Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas

Pure undifferentiated carcinoma with osteoclast-like giant cells of the pancreas is very rare. Its prognosis is grim. The clinicopathologic findings of a case of this unusual tumor are presented. Following resection, the patient at 9 mo follow-up developed local recurrence.     

Undifferentiated carcinoma of the thyroid gland with osteoclast-like giant cells--a case report

A case of undifferentiated carcinoma of the thyroid gland with osteoclast-like giant cells resembling those of a giant cell tumor of the bone is presented. A 79-year-old female had noticed swelling on the left frontal neck. Histological examination of frontal-neck tumor revealed undifferentiated carcinoma of the thyroid gland. The patient was treated with a Cobalt 60 unit and received a total tumor dose of 2800 rad. However, because of a rapid increase in size of the tumor and its metastasis, the patient died about 2 months after admission. An autopsy was performed. Histologically, the tumor differed from the usual undifferentiated carcinoma of the giant cell type in having osteoclast-like giant cells with many small, uniform, benign appearing nuclei. It is proposed that the osteoclast-like giant cell is reactive rather than neoplastic in nature because of the benign appearance, phagocytotic activity and some ultrastructural features.     

Anaplastic thyroid carcinoma

Opinion statement Anaplastic thyroid carcinoma (ATC) is a rare, highly aggressive tumor characterized by rapid growth that causes death soon after diagnosis. Optimal treatment is debatable because of inherent difficulties investigating a rare malignancy associated with a survival of only months. Nevertheless, there is evidence that a multimodality approach consisting of surgery, chemotherapy, and radiotherapy is the preferred approach when the disease is localized. Eradication by complete surgical resection with total thyroidectomy, although often not feasible, followed or preceded by concurrent doxorubicin-based chemotherapy and hyperfractionated external beam radiation has been occasionally used and can rarely be associated with long-term survival. Surgical extirpation with radical organ resection is associated with high morbidity, and, although an aggressive surgical approach is reasonable in selected patients, organ preservation should be the goal in a disease with high recurrence and death rates. Any modality used in isolation usually fails to control local and regional ATC. In otherwise healthy patients who can tolerate aggressive therapy, chemoradiation and surgery may also be warranted for palliating incurable disease in the neck, which can cause death by asphyxiation.     

Anaplastic carcinoma of the thyroid: a review of 84 cases of spindle and giant cell carcinoma of the thyroid

Eighty-four cases of spindle and giant cell carcinoma of the thyroid were reviewed. This is a swiftly growing, and rapidly fatal neoplasm that generally develops in the elderly. Treatment of this disease was generally unsuccessful with a 7.1% five-year survival rate and a mean survival period of 6.2 months from the time of tissue diagnosis. In the majority of cases, areas of well-differentiated thyroid carcinoma could be identified, supporting the concept that spindle and giant cell carcinoma results from the transformation of preexisting well-differentiated thyroid carcinoma. Because of the aggressive biologic activity of this neoplasm, we treat all cases as disseminated disease at the time of presentation. Our best therapeutic results have been obtained with a combination of surgery, irradiation, and chemotherapy; however, these results still leave much to be desired. Patients with only small foci of spindle and giant cell carcinoma, at the time of diagnosis, may have a better chance of prolonged survival.     

Cytologic and ultrastructural studies of a rare breast carcinoma with osteoclast-like giant cells

An unusual case of breast carcinoma with osteoclast-like giant cells (OGCs) was reported, for which the diagnosis was made by aspiration biopsy. The OGCs appeared to derive from large mononuclear cells, probably via their cellular fusion. The mononuclear cells had abundant lysosome-like granules, endoplasmic reticulum, and mitochondria. They were thought to be histiocytic cells, though active phagocytosis could not be demonstrated. Histologically, the tumor showed a pattern of well differentiated ductal adenocarcinoma, of which the stroma was crowded with histiocytic cells, OGCs, and lymphocytes. Marked hemorrhage and fibrosis were also seen. The tumor cells tended to be distorted and greatly diminished in accord with the accumulation of OGCs.     

Breast carcinoma with osteoclast-like giant cells: a case report and review of the Japanese literature

A 41-year-old premenopausal woman with a 3.5 cm freely mobile mass in the upper outer quadrant of the right breast was admitted to our hospital. Fine needle aspiration showed malignant epithelial cells and many multinucleated osteoclast-like giant cells (OGCs). Excisional biopsy revealed an invasive ductal carcinoma. A right modified radical mastectomy was subsequently performed. Macroscopically the tumor was well circumscribed with a dark brown cut surface. Microscopically, the tumor was a grade 2 invasive ductal carcinoma with many multinucleated OGCs adjacent the tumor cells and hemorrhage and infiltration of inflammatory cells in the stroma. The intra-mammary metastasis also contained OGCs and stromal reactions. By enzyme immunoassay, the tumor cells were negative for estrogen receptor but positive for progesterone receptor. The tumor cells were negative for both c-erbB-2 and p53. The OGCs showed positive immunostaining with the monoclonal antibody CD68, demonstrating a histiocytic origin. Lymph nodes were free of metastasis. We also review the Japanese literature concerning breast carcinoma with OGCs.     

Anaplastic thyroid carcinoma: An overview

Thyroid cancer is an uncommon malignancy that accounts for roughly 1% of all new cancers. Although anaplastic lesions constitute fewer than 5% of thyroid cancers, they represent over half of thyroid cancer-related deaths. The relative rarity of anaplastic thyroid cancer, its aggressive nature, and its rapidly fatal course have contributed to the difficulty in developing effective treatment for this disease. Radiation, chemotherapy, and surgery are rarely curative, but combinations of these modalities appear to offer greater benefit than any single treatment. New treatment modalities are desperately required, and promising molecular-based therapies are being investigated.     

Anaplastic transformation of metastatic follicular carcinoma of the thyroid

This is a case report of a patient believed to be the first reported case of pulmonary metastases from follicular carcinoma of the thyroid undergoing transformation to anaplastic carcinoma proven by serial biopsies.     

Anaplastic carcinoma of the thyroid following external irradiation.

Two patients with anaplastic carcinoma of the thyroid following irradiation for Hodgkin's disease are presented, and the previously reported cases briefly reviewed. The risk of late development of thyroid carcinoma is life-long and high-dose irradiation in patients with prolonged life expectancy may result in anaplastic carcinoma as well as less malignant histological forms.     

Anaplastic thyroid carcinoma, thyroid lymphoma, and metastasis to thyroid

Anaplastic thyroid carcinoma, thyroid lymphoma, and secondary metastasis to the thyroid gland are uncommon thyroid malignancies. They represent significant challenges for the surgeon owing to difficulties in diagnosis, aggressive biology, and the infrequency of their presentation. An awareness and appreciation of multimodality treatment strategies is essential for their management.     

Ovarian serous adenocarcinoma with anaplastic areas containing osteoclast-like multinucleated giant cells

Ovarian tumors with osteoclast-like multinucleated giant cells are rarely encountered, and the existence of osteoclast-like giant cells in ovarian tumors may have no effect on the patients' prognosis. We report a patient with ovarian serous adenocarcinoma containing osteoclast-like multinucleated giant cells in the anaplastic areas of the tumor, who had a poor prognosis. A recurrent tumor showed the same anaplastic appearance as that of the primary tumor, with osteoclast-like giant cells. Forty-one percent of tumor cells were positive for MIB-1 (Ki-67) antigen, and many cells overexpressed p53 protein. However, the giant cells were negative for both antigens, which meant that they were non-cycling cells. The giant cells were also negative for epithelial and non-epithelial antigens. The multinucleated osteoclast-like giant cells, as well as mononucleated tumor cells around the giant cells, expressed p21 (WAF1/ClP1) protein. These findings suggest that the multinucleated osteoclast-like giant cells in this tumor originated from the p21-expressing mononuclear tumor cells. The coexistence of anaplastic foci with multinucleated giant cells in serous adenocarcinomas of the ovary may indicate a poor prognosis. Received: August 31, 1999 / Accepted: April 13, 2000     

Anaplastic thyroid carcinoma: Current diagnosis and treatment

Background:Anaplastic thyroid carcinoma (ATC), accounting for5% to 15% of primary malignant thyroid neoplasms, is one of themost aggressive solid tumors in humans. Generally, it is rapidly fatal, witha mean survival of six months after diagnosis. Multimodality treatment withsurgery and/or external beam radiotherapy and chemotherapy are of fundamentalimportance for local control of disease and to enhance survival. Design:We evaluated consecutive patients with ATC observed at theMayo Clinic from 1971 to 1993 and reviewed relevant articles published inmajor English-language medical journals. We used the MEDLINE database,selected bibliographies, and articles available in our personal files. Results:ATC usually does not concentrate radioiodine or expressthyroglobulin. It is essential to verify the diagnosis histologically becauseinsular thyroid cancer, lymphomas, and medullary thyroid cancer areoccasionally confused with undifferentiated neoplasms. Immunohistochemicalstudy is helpful in establishing the diagnosis. Multimodal therapy and thedevelopment of effective systemic chemotherapeutic agents should result inimprovements in survival, although no single agent has yet been identified. Conclusions:Aggressive multimodality treatment regimens showpromise in improving local control in patients with ATC. However, survivalrates remain low. Despite intense application of such therapy, no standardizedsuccessful treatment protocol has been established.     

An unusual leiomyosarcoma of the uterus containing osteoclast-like giant cells.

An unusual variant of a poorly differentiated leiomyosarcoma of the uterus, containing osteoclast-like giant cells, is described. Areas of the resected tumor bore a close resemblance to giant cell tumor of bone. It is postulated that these giant cells, as well as the osteoclast-like giant cells reported in a number of tumors of other tissues, originate from the monocyte/histiocyte group of cells. The diagnosis of leiomyosarcoma was possible only after the tumor had been examined in the electron microscope. The ultrastructural features are consistent with a smooth muscle origin of the neoplasm; the final assessment is based on the relative proportions and frequency of such structures as: bundles of myofilaments with focal densities, marginal densities, pinocytotic vesicles, and an external lamina.     

Anaplastic thyroid carcinoma. Treatment outcome and prognostic factors

BACKGROUND: Anaplastic thyroid carcinoma (ATC) is rare but is one of the most aggressive human malignancies. Several prognostic factors have been observed in patients with ATC, and some experts advocate aggressive multimodal therapy in selected patients. However, it is unclear whether such an approach significantly improves survival. The authors analyzed prognostic factors and treatment outcomes in patients with ATC reported in the National Cancer Institute's Surveillance, Epidemiology, and End Results data base. METHODS: The cohort consisted of 516 patients with ATC reported to 12 population-based cancer registries between 1973 and 2000. Demographic, pathologic, and treatment data were used for univariate and multivariate survival analyses. RESULTS: The mean patient age at diagnosis was 71.3 years, and there were 171 men and 345 women. Eight percent of patients had intrathyroidal tumors, 38% had extrathyroidal tumors and/or lymph node invasion, and 43% of patients had distant metastasis. The average tumor size was 6.4 cm (range, 1-15 cm). Sixty-four percent of patients underwent surgical resection of their primary tumor, and 63% received external beam radiotherapy. The overall cause-specific mortality rate was 68.4% at 6 months and 80.7% at 12 months. Univariate analysis showed that age < 60 years, female gender, intrathyroidal tumor, external beam radiotherapy, surgical resection, and combined surgical resection of tumor and radiotherapy were associated with a lower cause-specific mortality. On multivariate analysis, only age < 60 years, an intrathyroidal tumor, and the combined use of surgical and external beam radiation therapy were identified as independent predictors of lower cause-specific mortality. CONCLUSIONS: Although most patients with ATC had an extremely poor prognosis, patients < 60 years old with intrathyroidal tumors survived longer. Surgical resection with external beam radiotherapy for ATC was associated with lower cause-specific mortality.     

Anaplastic thyroid carcinoma: diagnosis, treatment and prognosis

A multivariate study was carried out of prognostic factors for 32 in-patients with anaplastic thyroid carcinoma (1995-2005). Clinicopathological records including stained tissue sections were reviewed, using immunohistochemical methods in doubtful cases. Out of 20 features of prognostic importance, only three proved to affect survival: incomplete removal of tumor, pockets of differentiated cells and pseudo-histiocytic type of anaplastic thyroid carcinoma. No correlation between survival, on the one hand, and tumor size, leukocytic index of intoxication, age, gender, etc., on the other, was found. That might have been due to strict criteria of selection of patients as well as their small number.     

Anaplastic thyroid carcinoma: Long-term survival after radical surgery

Anaplastic carcinoma of the thyroid is a highly malignant disease with few survivors over one year. Radical surgery and laryngectomy are usually considered contraindicated. A 50-year-old woman with a history of papillary carcinoma treated with external radiation developed anaplastic giant-cell carcinoma of the thyroid invading the soft tissues of the neck including the larynx. Since surgery was felt to represent her only chance for survival, she underwent laryngopharyngectomy, right radical-neck dissection, and pharyngeal reconstruction. Three years after the surgery was performed, she is living an active life with only minor handicaps. Nevertheless, multiple nodules were noted in her lungs on recent tomographic examination. Our experience with this woman suggests that there is a role for radical surgery and laryngectomy in selected cases of anaplastic carcinoma.