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。

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

Purpose To explore the clinicopathological features of pleomorphic carcinoma of the pancreas with osteoclast-like giant cells(PCOG). Methods The clinical data, pathologic changes and immunohistochemical findings in one case of PCOG were observed with review of the literature. Results The patient was a 58-year-old female who developed constant, intermittent upper quadrant hidden pain. An abdominal ultrasonographic and computed tomographic scan demonstrated a 9 cm mass which appeared to arise from the body and tail of the pancreas. The resected speciman showed nodular, firm, whitish yellow, and focally necrotic. Histologically, the tumor was composed of poorly differentiated adenocarcinoma cells intermixed with spindle sarcoma-like cells, both cells showed cytokeratin, vimentin, and alpha-1-antitrypsin positive immunostain. More striking were many area of the tumor resembling giant cell tumor of bone, which were composed of polygonal mononuclear cells and morphologically benign osteoclast-like giant cells, the former displayed immunoreactivity for vimentin, alpha-1-antitrypsin, and sparse immunoreactivity for cytokeratin, the latter displayed immunoreactivity only for CD68 and vimentin. Conclusions PCOG is a variant of pleomorphic carcinoma of pancreas. The osteoclast-like giant cells seen in the tumor are regarded as reactive, not neoplastic component.