Abstract
Introduction. Pleomorphic giant cell pancreatic cancer is a very rare and aggressive pancreatic neoplasm. A case of pleomorphic giant cell pancreatic cancer presenting as a cystic lesion and in association with a serous cystadenoma presents a unique case which has not been described before. Case Presentation. A 44-year-old alcoholic man presented with abdominal pain, vomiting, and weight loss. Initially, imaging suspected a pancreatic pseudocyst measuring 4.2 cm. Endoscopic ultrasound- (EUS-) guided fine-needle aspiration revealed a serous cystadenoma. With conservative intervention only (fluid resuscitation, analgesia, and antiemetics) the patient improved and was discharged under close observation. Follow-up scan at four months revealed minimal change. Three months later, he was admitted acutely. Repeat scans demonstrated mild cyst enlargement with new liver lesions. Laparoscopic biopsy revealed pleomorphic giant cell carcinoma with the organ of origin the pancreas. Conclusion. This unusual case highlights the challenges in managing pancreatic cystic lesions and emphasizes the importance of considering less common forms of pancreatic cystic masses when the findings are atypical for the presentation. Surgical excision in these cases over conservative steps may be the most appropriate management.
Highlights
Pleomorphic giant cell pancreatic cancer is a very rare and aggressive pancreatic neoplasm
We review the literature in the area and present a unique case of a patient with known alcohol abuse who developed metastatic pleomorphic giant cell cancer of the pancreas within months of a diagnosis of a pancreatic serous cystadenoma
The case highlights the challenges in managing pancreatic cystic lesions and emphasizes the importance in considering rare forms of pancreatic cystic masses when the findings are atypical for the presentation
Summary
Giant cell pancreatic cancer was first described by Sommers and Meissner in 1954 [1]. In the literature, these rare tumours have been divided into two subtypes: osteoclastlike giant cell and pleomorphic giant cell carcinoma of the pancreas. A number of reviews have shown possible prognostic differences between these two subtypes, the most recent World Health Organisation (WHO) classification places the neoplams in the same category, undifferentiated carcinoma with osteoclast like giant cells [2]. We review the literature in the area and present a unique case of a patient with known alcohol abuse who developed metastatic pleomorphic giant cell cancer of the pancreas within months of a diagnosis of a pancreatic serous cystadenoma. The case highlights the challenges in managing pancreatic cystic lesions and emphasizes the importance in considering rare forms of pancreatic cystic masses when the findings are atypical for the presentation
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