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.

Reappraisal of giant basal cell carcinoma: Clinical features and outcomes

Giant basal cell carcinoma (GBCC) is a rare subgroup of basal cell carcinomas with a diameter of >5 cm. Current evidence about determining factors is conflicting, suggesting patient neglect, on the one hand, and biologically aggressive behaviour, on the other, with outcomes varying from clearance to death. We aimed to clarify the natural history of GBCC and its response to treatment. We extracted information from clinical records of all patients with GBCC treated from 1998 to 2017 in a tertiary oncology hospital in northwest England. Associations between patient and tumour characteristics were investigated, and modes of treatment and outcomes were assessed. In the 20-year study period, 43 patients (median age 76 years; 23 (53%) female), 3 of whom had Gorlin syndrome, were treated for GBCCs. Median diameter was 6.3 cm, and median time to presentation was 5 years. Seven (16%) GBCCs arose from recurrent BCC, while the majority (84%) presented de novo. The size of GBCC was significantly correlated with delay in presentation (p = 0.03) but not with age or sex. Of 41 patients receiving definitive treatment, 19 GBCCs were treated by excision with ≤1 cm margin and none recurred during follow-up, compared with 10 recurrences of 23 treated with photodynamic therapy (PDT), and 1 of 7 recurred after radiotherapy. Two of 43 patients with GBCC (<5%) presented with extensive local invasion, one of whom also had distant metastases, and both died of the disease. The majority of GBCCs are not clinically aggressive and respond to conservative surgical treatment with a low risk of recurrence.

Dysphagia

Dysphagia may be oropharyngeal or esophageal. Evaluation is described, including a thorough dysphagia history of associated painful swallowing, location, solids versus liquids, intermittent versus progressive, acute versus gradual onset, and associated symptoms such as weight loss. Physical examination and key diagnostic tests are also reviewed. The evidence-based management of various etiologies of esophageal dysphagia are summarized. Motor disorders described include achalasia, the other primary esophageal motility disorders, and the most common secondary esophageal motility disorders. Esophageal diverticulae are also reviewed in this section. Mechanical esophageal obstruction is presented, including discussions of esophageal webs, rings, peptic stricture, and cancer. Important inflammatory and infectious causes of dysphagia are described, including caustic ingestion, eosinophilic esophagitis, and esophageal infections. The oral phases of liquid and solid swallowing are presented, as are the pharyngeal and esophageal phases of swallowing. Figures show the results of several diagnostic tests and other conditions, including pharyngeoesophageal diverticulum, giant epiphrenic diverticulum, Schatzki ring, and midesophageal squamous cell carcinoma. A flowchart outlines evaluation and management of dysphagia. This review contains 13 figures, 12 tables, and 68 references. Keyword: Esophageal cancer, Achalasia, Diffuse esophageal spasm, Esophageal ring, Peptic esophagitis, Eosinophilic esophagitis, Scleroderma, Esophageal stricture, Chagas disease, Stroke

Dysphagia

Dysphagia may be oropharyngeal or esophageal. Evaluation is described, including a thorough dysphagia history of associated painful swallowing, location, solids versus liquids, intermittent versus progressive, acute versus gradual onset, and associated symptoms such as weight loss. Physical examination and key diagnostic tests are also reviewed. The evidence-based management of various etiologies of esophageal dysphagia are summarized. Motor disorders described include achalasia, the other primary esophageal motility disorders, and the most common secondary esophageal motility disorders. Esophageal diverticulae are also reviewed in this section. Mechanical esophageal obstruction is presented, including discussions of esophageal webs, rings, peptic stricture, and cancer. Important inflammatory and infectious causes of dysphagia are described, including caustic ingestion, eosinophilic esophagitis, and esophageal infections. The oral phases of liquid and solid swallowing are presented, as are the pharyngeal and esophageal phases of swallowing. Figures show the results of several diagnostic tests and other conditions, including pharyngeoesophageal diverticulum, giant epiphrenic diverticulum, Schatzki ring, and midesophageal squamous cell carcinoma. A flowchart outlines evaluation and management of dysphagia. This review contains 13 figures, 12 tables, and 68 references. Keyword: Esophageal cancer, Achalasia, Diffuse esophageal spasm, Esophageal ring, Peptic esophagitis, Eosinophilic esophagitis, Scleroderma, Esophageal stricture, Chagas disease, Stroke

Giant Cell Carcinoma of the Lung: Management of Surgical Treatment

Objectives: Pulmonary giant cell carcinoma (PGCC) is a histological type of nonsmall cell lung cancer and classified as one of the five subtypes of sarcomatoid carcinoma of the lung. Pure PGCC is very rare. Material and Method: We represent our experience in the management of 7 patients (6 males and 1 female, with a range of 44-63 yr) with PGCC. The most representing symptoms were cough and hemoptysis. Upper lobectomy (n=7) and additionally mediastinal lymphadenectomy were performed in all patients. Results: Definitive histological examination confirmed the diagnosis of PGCC in all cases. Even though there was no perioperative mortality, postoperative complications developed in a case were hemorrhage in the early perioperative period and bronchus fistula after two months from the operation. The mean survival of the patients was estimated as 28.8 months (38 days - 116 months). Conclusion: The main treatment for PGCC is the complete surgical resection. Complete surgical resection was found to be usefull as a treatment of choice of PGCC in the early stage and contributed to survival.

Giant basal cell carcinoma: clinical-histological characteristics of 115 cases.

Giant basal cell carcinoma (GBCC) is a tumor ≥5cm in size, with aggressive biological behavior, that represents 1% of basal cell carcinomas (BCC), and studies regarding it are scarce. Our objective was to investigate the clinical-histopathological characteristics of GBCC and the risk factors associated with its development. A retrospective study over 8years included patients with the clinical and histopathological diagnosis of GBCC. Age, sex, localization, size, evolution time, risk factors, and histological variants were compared to conventional BCC. Descriptive and inferential statistics were used, and a value of P<0.05 was considered statistically significant. Of 5958 patients with BCC, 115 (2%) of them corresponded to GBCC. The average patient age was 73±11years, and the male sex (52%) and localization on the head and neck (63%) predominated. Average tumor size was 6.6±2.2cm, evolution time was 96±86months, and high-grade histological variants (51%) predominated. The group with GBCC had higher age (P<0.01), greater frequency in the male sex (P=0.01), longer evolution time (P<0.01); a greater prevalence of risk factors (24% vs. 16%, P=0.01), antecedents of other types of cancer (P=0.03), and of burns (P=0.03); and a greater frequency of high-grade histological variants (51% vs. 29%, P<0.01). This is the largest series of GBCC published to date. Findings are similar to those previously reported, although the prevalence found here was greater.

Essential Updates in Grading, Morphotyping, Reporting, and Staging of Prostate Carcinoma for General Surgical Pathologists.

Within this decade, several important updates in prostate cancer have been presented through expert international consensus conferences and influential publications of tumor classification and staging. To present key updates in prostate carcinoma. The study comprised a review of literature and our experience from routine and consultation practices. Grade groups, a compression of the Gleason system into clinically meaningful groups relevant in this era of active surveillance and multidisciplinary care management for prostate cancer, have been introduced. Refinements in the Gleason patterns notably result in the contemporarily defined Gleason score 6 cancers having a virtually indolent behavior. Grading of tertiary and minor higher-grade patterns in radical prostatectomy has been clarified. A new classification for prostatic neuroendocrine tumors has been promulgated, and intraductal, microcystic, and pleomorphic giant cell carcinomas have been officially recognized. Reporting the percentage of Gleason pattern 4 in Gleason score 7 cancers has been recommended, and data on the enhanced risk for worse prognosis of cribriform pattern are emerging. In reporting biopsies for active surveillance criteria-based protocols, we outline approaches in special situations, including variances in sampling or submission. The 8th American Joint Commission on Cancer TNM staging for prostate cancer has eliminated pT2 subcategorization and stresses the importance of nonanatomic factors in stage groupings and outcome prediction. As the clinical and pathology practices for prostate cancer continue to evolve, it is of utmost importance that surgical pathologists become fully aware of the new changes and challenges that impact their evaluation of prostatic specimens.

A Case of Giant Squamous Cell Carcinoma Buttock Arising from Hidradenitis Suppurativa: an Unusual Presentation

A 78-year-old male presented with a large ulceroproliferative growth on the left gluteal area. Histopathology suggestive of squamous cell carcinoma. The tumor arising from underlying hidradenitis suppurativa. In this patient, unlike typical furuncles, the lesions lack characteristic central rupture and drainage. There was no signs of metastasis. Tumor removed by wide excision and reconstruction done with VY advancement flap.

Giant and metastatic basal cell carcinoma

Basal cell carcinoma (BCC) is the most common human cancer. Giant basal cell carcinoma is a rare variant of BCC, It represents only 0.4 - 1% of all BCC and is defined as a lesion greater than 5 cm it its largest diameter, most often occurring on the trunk. Giant BCC arising on the scalp is extremely rare. It presents some common epidemiological factors that include large tumor size, multiplicity of tumors, development on high-risk areas, neglect and tumor chronicity. Giant BCC can develop aggressive behavior resulting in deep local invasion, recurrence, potential regional and distant metastasis. The incidence of metastasis in basal cell carcinomas is rare and is calculated to be approximately 0.1%, most notably giant BCC, which has greater metastatic potential due to its large size. A giant basal cell carcinoma on the scalp is in some cases treated with a combination of surgery and radiation therapy, resulting in local control, a satisfactory long-term cosmetic and functional result.span style="font-family:Arial"&gt; We report the case with a neglected basal cell scalp carcinoma, treated with wide excision of the tumor with flap placement. The cosmetic result is acceptable and there is no sign of recurrence 6 mouth postoperatively.

Surgery Associated with Radiotherapy for Treatment of Giant Squamous Cell Carcinoma in Hand

Squamous cell carcinoma is the most common tumor in the hand, with actinic keratosis being its precursor lesion. It is a common tumor in light-skinned individuals with a history of excessive sun exposure and advanced age. It presents a wide variety of clinical forms, which can generate diagnostic doubt. The combination of clinical and pathological evaluations, together with detailed anamnesis, is the best way to achieve at the final diagnosis. The gold standard treatment for these tumors is surgical excision of the lesion with adequate safety margins; in some cases adjuvant radiotherapy is an excellent option. In this paper, we review the subject addressed and report the case of a patient with giant squamous cell carcinoma in one hand, with eight months of evolution, treated by surgical excision and adjuvant radiotherapy; the treatment was successful and preserved the motor function of the patient's hand.

Giant squamous cell carcinoma of the palmar right little finger: A rare case report

We report the case of a healthy 46-year-old man presenting with bulky ulcerous tumor on the volar base of right little finger. We will present the management of the tumor, based on a multidisciplinary team decision. In the literature, only a few cases of squamous cell carcinoma have been described on the palmar side of the hand. This is a rare case of hand skin tumor on an area not exposed to the sun, locally aggressive, in a young healthy patient.

A case of giant cutaneous squamous cell carcinoma effectively treated with a combination of chemotherapy (cisplatin and adriamycin) and radiotherapy

A case of giant cutaneous squamous cell carcinoma effectively treated with a combination of chemotherapy (cisplatin and adriamycin) and radiotherapy

Current Status of Diagnosis and Treatment of Pulmonary Sarcomatoid Carcinoma

肺肉瘤样癌（pulmonary sarcomatoid carcinoma, PSC）是一类罕见的非小细胞肺癌的统称，约占肺恶性肿瘤的0.1%-0.5%，按照2015年世界卫生组织（World Health Organization, WHO）对于肺恶性肿瘤分类标准，属于肺恶性上皮细胞肿瘤，包含5个亚型：多形性癌、梭形细胞癌、巨细胞癌、癌肉瘤和肺母细胞瘤。该类疾病无典型临床症状，但影像学有一定特点，确诊需要病理和免疫组化检查。治疗原则与其他非小细胞肺癌相似，早期患者是以手术为主的综合治疗模式。但对放化疗不敏感，容易复发和转移，预后不良。随着分子病理学发展，靶向治疗和免疫治疗可能会有广阔的应用前景。

Osteoclast-like giant cell–rich carcinomas of the lung: a clinicopathological, immunohistochemical, and molecular study of 3 cases

Three cases of primary carcinomas of the lung each with an extensive osteoclast-like giant cell component are presented. The patients are 3 men between the ages of 58 and 67 years (average, 62.5 years) who presented with nonspecific symptoms. A history of malignancy, infectious, or granulomatous disease was negative in all the patients. Diagnostic imaging disclosed the presence of a large intrapulmonary mass; in 1 case in the right upper lobe and in 2 cases in the right lower lobe. Surgical resection via lobectomy was performed in the 3 patients. Grossly, the tumors were described as soft, friable intrapulmonary masses, reddish in color, and measuring from 6 to 13 cm in largest diameter. Histologically, the tumors were each characterized by the extensive presence of a multinucleated osteoclast-like giant cell component, which represented approximately 80% of the tumor mass. The osteoclast-like giant cell component was admixed with a sarcomatoid carcinoma in 2 cases and an adenocarcinoma in 1 case. Immunohistochemistry showed that the osteoclast-like giant cells were positive for CD-68, cathepsin K, and histone H3, whereas the carcinoma component was positive for keratin, thyroid transcription factor-1, and histone H3 (patchy). Molecular studies were performed in 2 patients with negative results. Clinical follow-up was obtained in 2 patients; 1 died 14 months after initial diagnosis, whereas 1 remains alive 6 months after initial diagnosis. One patient was lost to follow-up. The current neoplasms represent an unusual type of lung carcinoma that needs highlighting as a separate type from conventional giant cell carcinoma.

OA03.01 The Immunophenotyping and Genomic Characteristics of Pulmonary Sarcomatoid Carcinoma: Pleomorphic, Spindle Cell and Giant Cell Carcinoma

OA03.01 The Immunophenotyping and Genomic Characteristics of Pulmonary Sarcomatoid Carcinoma: Pleomorphic, Spindle Cell and Giant Cell Carcinoma

MS05.03 Tumor Heterogeneity in Lung Cancer

MS05.03 Tumor Heterogeneity in Lung Cancer

Giant Sebaceous Cell Carcinoma of Upper Eyelid - Case Report

Giant Sebaceous Cell Carcinoma of Upper Eyelid - Case Report

Pleomorphic Spindle and Giant Cell Carcinoma of Lung With Widespread Metastases: An Autopsy Case Report

Pleomorphic Spindle and Giant Cell Carcinoma of Lung With Widespread Metastases: An Autopsy Case Report

Giant Basal Cell Carcinoma – a Case Report

Abstract Basal cell carcinoma is the most common form of cutaneous cancer. In majority of cases it is locally invasive with slow growth, ranging in size from a couple of milimeters to a couple of centimeters and located primarily on sun-exposed regions. Giant basal cell carcinoma, defined as a tumor that is larger than 5 cm in diameter, is a very rare type of cutaneous malignancy accounting for 0.5-1% of all basal cell carcinomas. We present a case of a 74-year-old man with a 17 x 14 cm giant basal cell carcinoma in the right supraclavicular region. Detailed history revealed that the lesion had started as a papule 15 years before presentation. Despite its growth, the lesion was neglected until admission. Histological examination of skin lesion confirmed superficial and focally infiltrative types of basal cell carcinoma. Electron radiotherapy was administered with 54 Gy total dose delivered in 20 daily fractions which resulted in healing of lesions and adequate response. Thus, definitive radiotherapy can be just as effective as excision when the criteria are met.

Successful vismodegib debulking of a giant basal cell carcinoma of the umbilicus

Successful vismodegib debulking of a giant basal cell carcinoma of the umbilicus