Osteoclastic Giant Cell Tumor Research Articles

A single-institution analysis of a rare variant of pancreatic neoplasm-osteoclastic giant cell tumor.

e16315 Background: Pancreatic osteoclastic giant cell tumor (OGCT) is a rare variant (<1% cases) of pancreatic neoplasm. Due to its rarity, prospective studies on management are limited. The prognosis and molecular characteristics may differ from pancreatic adenocarcinoma. Methods: We analyzed demographics, clinical features, treatment modalities, and outcomes of overall survival (OS) and progression-free survival (PFS) in patients with pancreatic OGCT at our institution from 2005-2022. Results: We identified 8 OGCT patients with a median age of 67, of whom 7 had locoregional disease (resectable- 5, borderline resectable- 1, locally advanced-1), and 1 had denovo metastatic disease at diagnosis. The borderline resectable and locally advanced patients eventually developed metastatic disease. The majority of patients were male (n=5), Caucasian (n=7), former smokers (n=5), had no significant alcohol use (n=8) and had no pre-existing pancreatitis (n=8). 4 of the 5 resectable patients had surgery, and 2 received adjuvant chemotherapy. The median OS was 54 months for locoregional disease (n=5) vs.16 months for metastatic disease (denovo metastatic and progression to metastatic disease, n=3). The median OS was 54 months for surgical resection (n=4) vs. 25 months for those without surgical resection (n=4) based on quartile computations from the Kaplan-Meier survival curve. Conclusions: Our patients had a longer OS than the previously reported OS of less than 12 months for all stages of pancreatic OGCT. There was no progression in resectable patients, indicating an indolent disease with an overall good prognosis. Patients with locoregional disease or those who underwent surgical resection had longer OS, but due to the small sample size and censored patient survival times (i.e., patients still alive), the statistical significance of this trend could not be calculated. Studies are required to understand tumor biology and determine the optimal multidisciplinary treatment. [Table: see text]

S1559 A Huge Surprise: Osteoclastic Giant Cell Tumor of the Pancreas

Introduction: Cystic lesions of the pancreas are often found incidentally on routine imaging. We describe an incidentally discovered pancreatic abnormality which was later confirmed to be a rare malignancy. Case Description/Methods: A 71-year old male with Warthin’s tumor and non-insulin dependent diabetes underwent computerized tomography (CT) of the soft tissues of the neck and the sinuses, incidentally demonstrating ground glass lung opacities. CT of the thorax then revealed sub-centimeter pulmonary nodules and an incidental 2.5 cm cystic mass at the pancreatic head, with biliary and pancreatic duct dilation. A pancreatic protocol CT confirmed a necrotic mass in the pancreatic head measuring approximately 3 cm, with pancreatic duct dilation up to 5 mm in the pancreatic neck. Scout EGD was unremarkable. Echoendoscopy was performed demonstrating a multi-cystic head of pancreas lesion measuring 2.8 cm x 2.8 cm, which was sampled with fine needle biopsy. Histology of the sample confirmed osteoclastic giant cell tumor, with immunohistochemistry showing cells positive for CD68, CD4, CD45, and vimentin, and negative for cytokeratin and pan-keratin. The patient underwent uncomplicated pancreaticoduodenectomy (Whipple’s procedure) with negative margins. The gross specimen (3.2 x 3.1 x 2.9 cm) confirmed undifferentiated carcinoma with osteoclast like giant cells. Discussion: Pancreatic adenocarcinoma is the most common type of pancreatic neoplasm, typically involving the pancreatic head. Pancreatic giant cell tumors (PGCT), officially termed “undifferentiated carcinoma with osteoclast-like giant cells) by the WHO, occur with an incidence of less than 1% of all pancreatic tumors. PGCTs rarely involve the pancreatic head, and typically occur in the body or tail of the pancreas. Typically occurring between the 6th and 7th decade of live, there is no preponderance between sexes. Three types are known: osteoclastic, pleomorphic, and mixed. Osteoclastic PGCT is thought to have the most favorable prognosis. Immunohistochemistry is critical in differentiating between osteoclastic and pleomorphic types, as pleomorphic GCT – typically positive for vimentin – are aggressive and more likely to metastasize. This patient did well with en-bloc surgical resection alone, though radiation therapy is sometimes offered depending on tumor size. In summary, we describe a rare pancreatic malignancy that was incidentally detected, diagnosed by EUS-FNB and successfully managed surgically.Figure 1.: a) CT pancreas demonstrating head of pancreas (HOP) lesion b) HOP mass on echoendoscopy c) gross specimen.

Osteoclastic giant cell tumor of the pancreas with osteoid and bone formation: a case report

Background: Extraosseous giant cell tumors involving visceral organs (pancreas, kidneys, bladder, etc.) and soft tissues present similar histological features to those occurring in the bones. Rarely, they may affect pancreas and their origin remains still controversial, with some authors supporting the epithelial and some others the mesenchymal origin. Case Presentation: We report the case of a pancreatic giant cell tumor with osteoclast-like cells, negative for epithelial markers. A 64-year-old man presented with a 2-month history of progressively worsening abdominal pain, radiating to the lumbar region. He reported no other symptoms. The abdominal clinical examination was unremarkable and there was no associated jaundice. Liver function tests remained within normal limits. His past medical history had nil of note. He underwent an outpatient abdominal computed tomography which revealed a large cystic lesion at the body of the pancreas measuring 10 × 7 × 6.5 cm. We proceeded with a limited excision of the pancreatic mass alone, avoiding major dissections that would unnecessarily increase morbidity and mortality and the postoperative course was good. The histological morphological and immunohistochemical assessment revealed two tumor cell types: osteoclast-like multinucleated giant cells and pleomorphic mononuclear cells, with bone formation and without important cellular and nuclear atypia. Conclusion: Pancreatic giant cell tumors with osteoclast-like giant cells are rare tumors of the pancreas with various clinical characteristics and controversial origin. En bloc resection has prevailed as the only beneficial treatment so far.

Phonomicrosurgery - a retrospective analysis of 400 cases

Introduction Voice disorders caused by pseudotumors of the vocal folds or paralysis of the vocal folds with incomplete glottis closure frequently require phonomicrosurgery. These interventions were analyzed with regard to quality of voice after surgery and safety of the intervention. Methods Retrospective analysis of 400 consecutive phonomicrosurgery interventions. The following parameters were collected: distribution of pathologies of the vocal folds, rating of the voice quality by both the surgeon (RBH-system) and patient and videolaryngstroboscopy six weeks after the intervention compared to the state prior to surgery, complications and results of histological examination. Results In our collective vocal fold polyps (36 %), cysts (12 %) and paralysis (10 %) dominated. After the intervention the quality of voice improved in 90 % of all cases. In 14 % voice therapy was needed postoperatively because of hyperfunction.After vocal fold augmentation one patient developed an edema of the larynx and another patient a temporary paralysis of the vocal fold of the opposite side. The histological examination showed as incidental findings a malignant osteoclastic giant cell tumor, a granular cell tumor and a carcinoma in situ of the vocal fold requiring further surgery and follow up. Discussion Phonomicrosurgery is a safe and effective therapy. The histological examination is also useful in patients with macroscopically non suspicious lesions to recognize rare or malignant tumor entities. Patient observation with early detection as well as therapy of complications like edema of the larynx or vocal fold paralysis is recommended.

Tumeur à cellules géantes de type ostéoclastique de la parotide

Osteoclast-type giant cell tumors of the salivary gland are extremely rare; only 23 cases have been reported. Two presentations were observed: isolated tumor or tumor associated with a carcinomatous contingent. A 51-year-old female patient consulted for a painless left retro-angulo-mandibular swelling having appeared 2 years before. This was a 2 cm parotid mass without facial nerve palsy or cervical lymphadenopathy. The patient underwent a superficial parotidectomy to remove the nodule. The direct microscopic examination revealed an osteoclastic giant cell tumor without any carcinomatous contingent. At immunohistochemistry, mononuclear cells were diffusely and intensely stained by anti-pancytokeratin, while multinucleated cells were totally negative and CD68 positive. The patient was not given any complementary treatment. She was followed-up 23 months later and did not present any signs of recurrence or metastasis. The histogenesis and nosology of osteoclastic giant cell are currently unknown. Although this entity was not integrated into the latest WHO classification, most authors consider it as a variant of carcinoma. Published data on the epithelial or histiocytic nature of multinucleated cells is not consensual. Our case presentation supports the hypothesis of a histiocytic differentiation of giant cells and epithelial mononuclear cells.

Undifferentiated Pancreatic Carcinoma with Osteoclast-Like Giant Cells: a Case Report

Undifferentiated pancreatic carcinoma with osteoclast-like giant cells (UPC-OGCs) is a rare neoplasm with frequency of 0.2 % of reported pancreatic carcinomas [1]. Tumors with osteoclast-like giant cells have rarely been reported in a variety of extra-skeletal sites. On the alimentary tract, the pancreas is the most concerned [2, 3]. A number of terms have been used to describe variants of undifferentiated pancreatic carcinoma, especially pleomorphic carcinoma, pleomorphic giant cell carcinoma, sarcomatoid carcinoma, spindle cell carcinoma, anaplastic carcinoma, undifferentiated carcinoma, and osteoclastic or pleomorphic giant cell tumors [4]. Histologically, the tumor combines two main cell populations, a malignant mononuclear cells population and the scattered nonneoplastic osteoclast-like giant cells [3, 5]. Since the first description by Rosai in 1968 [6], there have been only a few cases reported in the world literature. Our aim is to describe a new case of undifferentiated carcinoma of the pancreas with osteoclast-like giant cells which was early diagnosed, with a review of literature.

Recurrent Acute Pancreatitis and Persistent Hyperamylasemia as a Presentation of Pancreatic Osteoclastic Giant Cell Tumor: An Unusual Presentation of a Rare Tumor

Giant cell tumors of the pancreas are rare neoplasms divided into three forms: osteoclastic, pleomorphic, and mixed. We report an unusual case of a 62-year-old male presenting with recurrent acute pancreatitis and found to have a mass in the head of the pancreas on routine imaging. Endoscopic retrograde cholangiopancreatography showed a main pancreatic duct stricture, with brush cytology revealing the diagnosis of osteoclastic giant cell tumor of the pancreas. Whipple's procedure was successfully performed for resection of this tumor.

Osteoclastic giant cell tumor of the pancreas: A distinct clinical and pathologic entity.

e14648 Background: Osteoclastic giant cell tumor of the pancreas (OGCTP) is a rare subtype of pancreatic cancer. It has been variably described in case reports as pancreatic cancer with pleomorphic, anaplastic, spindle cell, undifferentiated or mixed histology. Clinical and pathologic data regarding this tumor are very limited. Methods: We conducted a retrospective review of patient records with the above histologies at a single institution from 1994 to 2008. Archival pathology specimens were independently reviewed by two surgical pathologists (WP, DT). Results: Eleven patients with OGCTP were identified. Demographics: 9 males, median age = 66 (range 49-78), 10 Caucasian, 6 smokers. Median CA 19-9 was 70 IU/mL (range = 1.0-28,373). Site: 6 located in the body or tail, 5 locally advanced, 6 metastatic. A large, locally infiltrative mass was frequently seen on imaging studies. Pathologic examination revealed a histologically distinct entity consisting of a heterogeneous but characteristic mixture of bland osteoclast-like giant cells, mononuclear ovoid to spindle cells, large pleomorphic cells with bizarre nuclei, and a more typical adenocarcinoma component. This pattern was seen in all of the examined specimens. Treatment: 2 underwent surgical resection, 7 received gemcitabine or fluoropyrimidine chemotherapy, 3 received radiation. Response: Stable disease or partial response in 4 patients, 1 with long-term response to capecitabine. Median survival of 16.5 months (range = 2-58) was higher than usually noted historically with adenocarcinoma. Conclusions: This is the largest reported series of OGCTP and identifies this tumor as a distinct clinical and pathological entity. We are conducting additional pathologic studies to further characterize OGCTP. No significant financial relationships to disclose.

Osteoclastic and pleomorphic giant cell tumors of the pancreas: A review of clinical, endoscopic, and pathologic features

Giant cell tumors of the pancreas come in three varieties-osteoclastic, pleomorphic, and mixed histology. These tumors have distinctive endoscopic, clinical, and cytological features. Giant cell tumors have a controversial histogenesis, with some authors favoring an epithelial origin and others favoring a mesenchymal origin. The true origin of these lesions remains unclear at this time. These are also very rare tumors but proper identification and differentiation from more common pancreatic adenocarcinoma is important. The risk factors of these tumors and the prognosis may be different from those associated with standard pancreatic adenocarcinoma. Recognition of these differences can significantly affect patient care. These lesions have a unique appearance when imaged with endoscopic ultrasound (EUS), and these lesions can be diagnosed via EUS guided Fine Needle Aspiration (FNA). This manuscript will review the endoscopic, clinical, and pathologic features of these tumors.

Osteoclastic and pleomorphic giant cell tumors of the pancreas diagnosed via EUS-guided FNA: unique clinical, endoscopic, and pathologic findings in a series of 5 patients

Osteoclastic and pleomorphic giant cell tumors of the pancreas are rare entities that have been typically described only in single case reports. We report on our experience with a series of 5 patients with pancreatic giant cell tumors seen at our institution. This was a retrospective study involving a search of the study institution's medical records from 2001 to 2007 for patients diagnosed with giant cell-containing neoplasms of the pancreas. Five patients (2 women, 3 men) were identified. Age range was 59 to 81 years, with a mean of 70.2 years. None were current or former smokers. None had a history of alcohol abuse or preexisting pancreatitis of any kind. On EUS, tumors tended to be large, with a mean diameter of 47 mm (range 20-70 mm). All tumors had a heterogeneous echotexture and a distinct appearance when compared with the typical appearance of adenocarcinoma when viewed via EUS. The diagnosis of giant cell tumor of the pancreas, as well as the subtype, was made via EUS-guided FNA of the pancreatic lesion. Patients with pleomorphic giant cell tumors of the pancreas had a poor clinical course with a rapid decline, whereas those with mixed or osteoclastic giant cell tumors tended to have a better outcome, with a greater long-term survival. One patient is still alive more than 18 months after diagnosis. Retrospective study. Giant cell tumors of the pancreas have unique clinical, endoscopic, and cytologic features. The risk factors for these lesions may be different from those associated with pancreatic adenocarcinoma. Some giant cell tumor subtypes may carry a more favorable prognosis than pancreatic adenocarcinoma, and awareness and recognition of these differences can affect patient care.

Poorly differentiated squamous cell carcinoma with osteoclastic giant‐cell‐like proliferation

Although osteoclast giant-cell-like proliferations have been reported in a diverse range of human malignancies, to the best of our knowledge, they have never been described in cutaneous squamous cell carcinoma (SCC). Histologically, osteoclastic giant cell tumors within extraosseous malignancy resemble their bony and soft tissue counterparts, with round to spindle-shaped cells admixed with osteoclast-like multinucleate cells. These cells should be distinguished from sarcomatoid differentiation within a carcinoma; they have a benign morphology with a low nuclear to cytoplasmic ratio, minimal pleomorphism/mitoses and negative immunohistochemistry for cytokeratin. The authors report the rare occurrence of osteoclast-like giant cells (OGCs) and accompanying epithelioid histiocytes lacking overtly malignant features in association with a poorly differentiated SCC occurring on sun-damaged skin. Immunohistochemically, the area rich in OGCs was strongly positive for CD68 and completely negative for cytokeratin, whereas the poorly differentiated infiltrative area had the reverse immunophenotype and nuclear positivity for p63. The histological differential diagnosis and the origin of the proliferation are discussed in this article.

Immunohistochemical and Genetic Analysis of Osteoclastic Giant Cell Tumor of the Pancreas

Clinical, histopathologic, immunohistochemical, and genetic analyses of 2 osteoclastic giant cell tumors of the pancreas are presented. The neoplasms were composed of osteoclastic giant cells and pleomorphic cells (PCs). The tissue-specific markers gave evidence of mesenchymal nature of the osteoclastic giant cells, as well as other components of the tumor, and lacked any signs of epithelial differentiation in both patients. The nonepithelial nature of both components in the osteoclastic giant cell tumors presented may be associated with a better prognosis, which corresponds to the previous reports of similar neoplasms. A positive immunoreactivity to neuron-specific enolase was recorded in patient 2. The presence of CD68 in osteoclastic giant cells proved their histiocytic nature. Both components of the tumors showed a negative immunoreactivity to desmin and only a scattered reactivity to smooth muscle cell actin, typical markers of myofibroblastic differentiation. Mutation analysis of the tumor revealed the wild state of both p53 and K-ras oncogenes in both patients. A positive immunoreactivity for p53 in PCs of both osteoclastic giant cell tumors was recorded, whereas osteoclastic giant cells did not express this protein. The expression of p21 was recorded in osteoclastic giant cells in patient 1. The absence of Ki-67 in the osteoclastic giant cells and its expression in PCs gave evidence of a different proliferation rate of both cell populations. Different tissue-specific markers, a different proliferation rate, and a different state of oncogene activation in the osteoclastic giant cell tumors contribute to the idea that the tumor derives from a pluripotent cell that may differentiate into an array of phenotypes.

Gliosarcoma: cytopathologic characteristics on fine-needle aspiration (FNA) and intraoperative touch imprint.

Gliosarcoma (GS) is a rare subtype of glioblastoma multiforme (GBM), which shows a dimorphic population of glial and mesenchymal elements. The cytopathology of GS to our knowledge has not been previously described. Although prognostically insignificant within the group of GBM, an accurate recognition of this subtype may help to rule out other morphologically similar primary and metastatic central nervous system (CNS) neoplasms. Thirteen cases of histologically confirmed GS with concomitant touch imprints (TI) or prior fine-needle aspiration (FNA) were retrieved from the files of The Johns Hopkins Hospital (1985-2002). A comprehensive review of the clinico-radiologic, cytologic, and histologic material was undertaken to define the morphologic characteristics of GS. Material was obtained via computerized tomography (CT)-guided needle biopsy. Slides were stained with DiffQuik and/or hematoxylin and eosin (H and E) stains. Smears were highly cellular and showed a high-grade neoplasm with glial and mesenchymal elements. The latter component, however, predominated and showed a variety of phenotypic patterns, which included fibrosarcoma-like, rhabdoid type, osteoclastic giant cell type, undifferentiated type, and tumor with heterologous components (such as chondroid or osteoid tissue). A rich arborizing capillary network was evident, as were a high mitosis/karyorrhexis index and foci of necrosis. The glial component consisted of pleomorphic round to oval nuclei and numerous gemistocytes embedded in a fibrillary stroma.

Osteoclastic Giant Cell Tumor of the Pancreas: An Immunohistological Study and Review of the Literature

A case of an osteoclastic giant cell tumor of the pancreas is presented. The different surgical specimens during the forty months of observation suggest that the histological feature of the tumor has changed. Although immunohistological studies were performed, the histogenesis remains obscure. Additional 19 cases of the literature were briefly reviewed.

Fine‐needle aspiration cytology of osteoclastic giant‐cell tumor of the pancreas

Osteoclastic giant-cell tumor (OGCT) of the pancreas is a rare tumor. We present the fine-needle aspiration (FNA) and bile cytology findings of an OGCT arising in the head of the pancreas in a 72-yr-old male, along with immunocytochemical studies that were done on the cytologic material. The smears showed numerous giant cells with clustered, overlapping, uniform, bland-appearing nuclei with prominent nucleoli consistent with osteoclastic-type multinucleated giant cells. A second population of mononucleated cells appearing singly or in groups having similar nuclear features was also present. Immunocytochemical studies performed on the FNA and bile duct fluid material demonstrated positive staining of the malignant cells for vimentin, alpha-1 antichymotrypsin, and alpha-1 antitrypsin and negative staining for high- and low-molecular-weight cytokeratin, pooled monoclonal cytokeratin, epithelial membrane antigen, and carcinoembryonic antigen. Although not definitive, these studies are supportive of a mesenchymal-stromal histogenesis of this unusual pancreatic malignancy.

Malignant fibrous histiocytoma (giant cell type) of the pancreas. A distinctive variant of osteoclast-type giant cell tumor of the pancreas

Malignant giant cell tumors of the pancreas are rare neoplasms which have been generally thought to represent epithelial malignancies of either acinar or ductal epithelium. The authors have studied a tumor of the pancreas that was characterized histologically by a proliferation of benign-appearing osteoclast-type giant cells in association with atypical, often bizarre mononuclear cells. Immunohistochemical studies demonstrated negative staining of the tumor cells with epithelial markers, including low-molecular weight keratins, carcinoembryonic antigen and epithelial membrane antigen, and positive staining with vimentin antibodies, supporting a fibroblastic line of differentiation. Electron microscopic examination also showed absence of ultrastructural features of epithelial differentiation such as microvilli, intercellular junctions, or desmosomes. The authors believe the current case represents a true sarcoma of the pancreas, currently best classified as a malignant fibrous histiocytoma, giant cell type. This tumor should be distinguished from the epithelial type of osteoclastic giant cell tumor of the pancreas.