Surgical case reports · 2026
Undifferentiated Carcinoma with Osteoclast-Like Giant Cells Associated with Carcinoma In Situ of the Main Pancreatic Duct.
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Taguchi Masanobu, Sasanuma Hideki, Ikeda Eriko, Morishima Kazue, Miyato Hideyo, Endo Kazuhiro, Sakuma Yasunaru, Kawata Hirotoshi, Yamashita Hiroharu, Fukushima Noriyoshi, Sata Naohiro, Yamaguchi Hironori
Аннотация
INTRODUCTION: Undifferentiated carcinoma with osteoclast-like giant cells (UC-OGC) of the pancreas is an extremely rare subtype of pancreatic malignancy, accounting for less than 1% of cases and generally associated with a poor prognosis. Its histogenesis and progression remain incompletely understood. We report a rare case in which UC-OGC appeared to be associated with carcinoma in situ (CIS) of the main pancreatic duct and achieved long-term disease-free survival after curative resection.
CASE PRESENTATION: A 52-year-old man was referred for evaluation of a pancreatic cyst. Imaging revealed a cystic lesion with an enhancing solid component in the pancreatic tail and distal pancreatic duct dilatation. Cytological examination of pancreatic juice suggested malignancy. An open distal pancreatectomy was performed. The tumor measured 62 × 30 × 24 mm and was classified as pT3N0M0 (Stage IIA). Histopathological examination demonstrated a tumor within the main pancreatic duct extending into the surrounding parenchyma. The tumor consisted of spindle-shaped cells with numerous CD68-positive osteoclast-like multinucleated giant cells, consistent with UC-OGC. No invasive conventional ductal adenocarcinoma component was identified. CIS was identified only in the main pancreatic duct directly continuous with the UC-OGC component, whereas no CIS component was observed in the remaining main pancreatic duct or in the branch pancreatic ducts. Immunohistochemically, the tumor cells were negative for cytokeratin and positive for vimentin. Resection margins were negative, and no lymph node metastasis was detected. The patient received adjuvant chemotherapy and remained recurrence-free for 6 years and 2 months after surgery; however, recurrence subsequently developed in the liver, lymph nodes, and remnant pancreas, and he died 6 years and 4 months after the initial surgery.
CONCLUSIONS: This case raises the possibility that UC-OGC may arise in continuity with CIS, suggesting a potential pathway of morphological progression from a preinvasive lesion. Although long-term survival is achievable after curative resection and adjuvant therapy, late recurrence may occur, underscoring the need for prolonged follow-up. Accumulation of further cases is required to clarify the biological behavior and optimal management of this rare entity.
CASE PRESENTATION: A 52-year-old man was referred for evaluation of a pancreatic cyst. Imaging revealed a cystic lesion with an enhancing solid component in the pancreatic tail and distal pancreatic duct dilatation. Cytological examination of pancreatic juice suggested malignancy. An open distal pancreatectomy was performed. The tumor measured 62 × 30 × 24 mm and was classified as pT3N0M0 (Stage IIA). Histopathological examination demonstrated a tumor within the main pancreatic duct extending into the surrounding parenchyma. The tumor consisted of spindle-shaped cells with numerous CD68-positive osteoclast-like multinucleated giant cells, consistent with UC-OGC. No invasive conventional ductal adenocarcinoma component was identified. CIS was identified only in the main pancreatic duct directly continuous with the UC-OGC component, whereas no CIS component was observed in the remaining main pancreatic duct or in the branch pancreatic ducts. Immunohistochemically, the tumor cells were negative for cytokeratin and positive for vimentin. Resection margins were negative, and no lymph node metastasis was detected. The patient received adjuvant chemotherapy and remained recurrence-free for 6 years and 2 months after surgery; however, recurrence subsequently developed in the liver, lymph nodes, and remnant pancreas, and he died 6 years and 4 months after the initial surgery.
CONCLUSIONS: This case raises the possibility that UC-OGC may arise in continuity with CIS, suggesting a potential pathway of morphological progression from a preinvasive lesion. Although long-term survival is achievable after curative resection and adjuvant therapy, late recurrence may occur, underscoring the need for prolonged follow-up. Accumulation of further cases is required to clarify the biological behavior and optimal management of this rare entity.