S1461 Undifferentiated Carcinoma of the Pancreas With Osteoclast-Like Giant Cells

Abstract

INTRODUCTION: Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells (UC-OGC) is a rare type of pancreatic giant cell tumor. It accounts for less than 1% of all pancreatic neoplasms and carries a poor prognosis. We present a patient admitted for evaluation of abdominal pain and unintentional weight loss, diagnosed with osteoclast giant cell pancreatic tumor. CASE DESCRIPTION/METHODS: An 81 year old woman presented with a 2 week history of epigastric and RUQ pain associated with nausea, jaundice, pruritus, and unintentional weight loss. Labs included AST 114 IU/L, ALT 136 IU/L, ALP 368 IU/L, total bilirubin 7.5 mg/dL with direct bilirubin of 4.5 mg/dL. Abdominal US revealed CBD of 1.39cm. CT abdomen/pelvis with moderate dilation of intrahepatic biliary ducts and dilated CBD with 2.2 cm pancreatic head enhancing soft tissue thickening. Patient underwent EUS, which confirmed presence of a 3.5 × 2.9 cm mass lesion in the head of the pancreas. Sampling via FNA was performed, followed by ERCP with CBD stent placement. Patient subsequently experienced improvement in overall symptoms. Pathology revealed undifferentiated carcinoma with osteoclast-like giant cells. Patient was not a surgical candidate due to poor nutritional status. She was started on neoadjuvant chemotherapy. DISCUSSION: UC-OGC is a rare tumor that presents in the 6th to 7th decade of life and affects both genders equally. Most tumors are located in the body or tail of the pancreas with more than 80% being larger than 5 cm. Symptoms include abdominal pain and weight loss and less commonly nausea and jaundice. Diagnosis is made with EUS-FNA. Resection is the first line therapy, however, case reports show suboptimal results with mortality after surgery being less than 1 year. Non-operable cases have worse survival. Neoadjuvant chemotherapy and radiotherapy result data is scant due to the rarity of the tumor. It has a worse prognosis than pancreatic invasive ductal adenocarcinoma. It is important to recognize that the presence of UC-OGC confers a very poor prognosis and patients should be counseled accordingly.Figure 1.: H&E stain showing osteoclast-like giant cells.