Anaplastic Giant Cell Carcinoma Research Articles

1414 Prognosis and Management of Rare Pancreatic Tumors: A Case Series to Highlight the Importance of Accurate Pathologic Diagnosis in Pancreatic Malignancy

INTRODUCTION: Most pancreatic tumors are adenocarcinomas. Less than 6% of all pancreatic cancers are anaplastic (undifferentiated, ACP). ACPs with osteoclast-like giant cells (OGC) occur in less than 1% of all tumors and are classified separately from other subtypes of ACP by the WHO. Here we present 2 rare & unusual histologic subtypes of pancreatic cancer, both diagnosed by EUS-FNA/FNB, with varying prognosis & management. CASE DESCRIPTION/METHODS: Case 1: An 81-year-old male presented with indigestion and 10-pound unintentional weight loss. Abdominal CT scan showed a 6.6 cm pancreatic body-tail mass with splenic artery encasement and splenic vein occlusion. EUS confirmed the lesion with internal necrotic/cystic areas and celiac trunk involvement. FNA was performed with a 22-gauge needle; cytology confirmed undifferentiated carcinoma with osteoclast-like giant cells (OGC) (Figure 1). PET/CT revealed a hypermetabolic pancreatic lesion (SUV 21) and a 1.5 cm right hepatic dome lesion (SUV 10.2). He was deemed not a surgical candidate and was treated with palliative chemotherapy (gemcitabine). Restaging CT scan showed marked tumor progression with a 17 cm pancreatic tumor and a 4 cm liver tumor. He entered hospice less than three months after diagnosis. Case 2: A 74-year-old male presented with abdominal pain and weight loss. Laboratory evaluation revealed total bilirubin of 1.00 mg/dL, AST 40 U/L, ALT 87 U/L, and alkaline phosphatase 138 U/L. CT scan showed a pancreatic head mass measuring 4.3 cm abutting the portal vein. Tumor markers were normal. EUS revealed a 4.5 cm pancreatic head lesion with portal vein invasion and double duct sign. FNB was performed with 22-gauge needle; histology revealed anaplastic giant cell carcinoma (ACP) (Figure 2). After multidisciplinary discussion, pancreaticoduodenectomy was recommended. Intraoperatively, he was found to have unresectable locally advanced tumor. Palliative chemotherapy was started. DISCUSSION: OGCs & ACPs are rare histological subtypes of pancreatic cancer with aggressive clinical behavior. In both our patients, there was evidence of vascular and/or intraductal invasion by tumor at diagnosis. Data suggests OGCs may have a better prognosis than ACPs and ductal adenocarcinomas. Pancreas cancer multidisciplinary teams should be aware of these rare tumor subtypes and the treatment and prognostic implications thereof.

Anaplastic carcinoma of the pancreas arising in an intraductal papillary mucinous neoplasm: A case report.

We herein report a case of anaplastic carcinoma of the pancreas arising in an intraductal papillary mucinous neoplasm (IPMN). A 68-year-old Japanese woman was admitted to our hospital complaining of fatigue. Computed tomography revealed an irregular mass in the pancreatic head, which displayed high-signal intensity on diffusion-weighted magnetic resonance imaging. Accordingly, the patient was diagnosed with pancreatic cancer and underwent pancreaticoduodenectomy. The histopathological findings revealed intraductal papillary proliferative changes involving the main and branch ducts of the pancreatic head. Based on the immunohistochemistry results, the intraductal lesion was diagnosed as IPMN. The pathological diagnosis for the invasive carcinoma was anaplastic giant-cell carcinoma of the pancreas (ACP), and the focus of IPMN dedifferentiation to ACP was found to be located at the periphery of the IPMN. At 18 months postoperatively, the patient remains disease-free.

Primary peritoneal anaplastic giant cell carcinoma: case report of an unusual and highly malignant müllerian neoplasm.

Abstract Virtually all primary peritoneal carcinomas (PPCs) are of serous papillary type. We report an unusual histologic type of PPC composed of anaplastic giant cells, which exhibited an aggressive clinical course. A 72-year-old woman presented with lower abdominal pain. Computed tomography showed a diffuse omental thickening. The patient underwent an exploratory laparotomy with omentectomy, total hysterectomy, bilateral salpingo-oophorectomy, and appendectomy. Pathologic examination revealed extensive omental replacement by tumor but only superficial surface cortical involvement of both ovaries, a disease distribution consistent with a typical mullerian-derived PPC. However, this neoplasm was composed of diffuse anaplastic tumor giant cells, rather than serous carcinoma, which is the usual histologic type encountered in PPC. The patient died within 1 month after surgery. We report this unusual histologic variant of PPC to raise awareness that anaplastic giant cell carcinoma may arise in the pelvic peri...

Primary Peritoneal Anaplastic Giant Cell Carcinoma: Case Report of an Unusual and Highly Malignant Müllerian Neoplasm

Virtually all primary peritoneal carcinomas (PPCs) are of serous papillary type. We report an unusual histologic type of PPC composed of anaplastic giant cells, which exhibited an aggressive clinical course. A 72-year-old woman presented with lower abdominal pain. Computed tomography showed a diffuse omental thickening. The patient underwent an exploratory laparotomy with omentectomy, total hysterectomy, bilateral salpingo-oophorectomy, and appendectomy. Pathologic examination revealed extensive omental replacement by tumor but only superficial surface cortical involvement of both ovaries, a disease distribution consistent with a typical müllerian-derived PPC. However, this neoplasm was composed of diffuse anaplastic tumor giant cells, rather than serous carcinoma, which is the usual histologic type encountered in PPC. The patient died within 1 month after surgery. We report this unusual histologic variant of PPC to raise awareness that anaplastic giant cell carcinoma may arise in the pelvic peritoneum as a primary tumor.

Cytology of anaplastic giant cell carcinoma of the thyroid with osteoclast‐like giant cells—A case report

Anaplastic carcinoma of the thyroid is known for its highly aggressive behaviour and rapid spread. While the giant cell variant is a well recognized morphologic pattern, the presence of osteoclast-like giant cells is a rare occurrence. We report a case of anaplastic carcinoma of the thyroid with focal presence of osteoclast-like giant cells occurring in an elderly male patient, diagnosed on aspiration cytology.

Anaplastic giant cell carcinoma of the thyroid gland: treatment and survival over a 25-year period.

Anaplastic giant cell carcinoma of the thyroid is a rare but highly malignant tumor. At the Karolinska Hospital in Stockholm, surgery, chemotherapy, and radiotherapy have been used separately or in various combinations in 81 patients admitted with this diagnosis during 1971-1997. In this study, we present the various multimodality treatment regimens and their changes over the years and the subsequent differences in survival and local tumor control. Overall, eight patients (10%) survived more than 2 years. All survivors were treated with combinations of chemotherapy, radiotherapy, and surgery. Among the patients who died, local tumor control was achieved by the therapy given in many cases. The results suggest that our current strategy with a combination of preoperative hyperfractionated accelerated radiotherapy, doxorubicin pre- and postoperatively, and debulking surgery whenever possible results in better local tumor control and an increased chance of survival.

Combination therapy for anaplastic giant cell thyroid carcinoma

Since 1981, 20 patients with anaplastic giant cell carcinoma of the thyroid have been prospectively treated according to a combination regimen of chemotherapy and external beam radiation therapy. Two types of chemotherapy were used every 4 weeks, depending on the patient's age. For those younger than 65 years, a combination of doxorubicin (60 mg/m2) and cisplatin (90 mg/m2) was given, and for older patients mitoxantrone (14 mg/m2) was used. Radiotherapy was carried out between Day 10 and Day 20 of the first four cycles of chemotherapy. It delivered 17.5 Gy in 7 fractions to the neck and the superior mediastinum. Survival exceeding 20 months was observed in three patients. Complete neck tumor response was observed in five patients, among whom four had undergone previous operations. No response was seen in distant metastases, which were the cause of death in 14 patients. These treatment modalities are effective in some patients, both in terms of survival and of local control, avoiding death from local invasion. Gross tumor resection should be performed whenever possible but should not delay the commencement of this protocol. Toxicity was high and remains the main limiting factor.

Multimodal therapy in anaplastic giant cell thyroid carcinoma.

AbstractA therapy aiming at pre‐ and postoperative radiotherapy with concomitant chemotherapy has been used in 19 patients with anaplastic giant cell carcinoma of the thyroid gland. Radiotherapy was administered twice daily, 5 days a week; the cytostatic drugs employed were bleomycin, cyclophosphamide, and 5‐fluorouracil. Patients with advanced disease (distant metastases and/or vocal cord paralysis,n= 9) had a median survival time from diagnosis of 7 months, while patients with less advanced disease survived on average 12 months. In the latter group there were 3 survivors. The patients who died succumbed to metastatic disease rather than to local growth. No patient required tracheostomy and the side effects due to treatment were usually well tolerated.

Ultrastructure of a primary fibrosarcoma of the human thyroid gland

A primary fibrosarcoma of the thyroid occurring in a patient with a nodular goiter is described. Light microscopy showed interwoven bundles of spindle cells admixed with plump ovoid cells, and foci of multinucleated giant cells. Remnants of distorted thyroid follicles were found only at the periphery of the tumor. "Transitional" epithelial elements were not discernible but the tumor resembled an anaplastic giant cell carcinoma. Multiple blocks studied by electron microscopy, however, revealed that the tumor cells, including the giant cells, have the ultrastructure features of a fibroblast.

Anaplastic giant-cell carcinoma of the thyroid. A study of treatment and prognosis.

In 79 cases of histologically verified anaplastic giant-cell carcinoma, symptoms, treatment, and prognosis were documented. Seventy-eight patients are dead, the mean survival time being 2.5 months. One patient is cured. It was concluded that surgery and/or radiotherapy alone are not sufficient. The results from an additional 8 patients also treated with methotrexate indicate a positive therapeutic effect, the mean survival time being 9.4 months. Disappearance of recurrent tumor or pulmonary metastases was noted in 2 patients.