Cytologic features and clinical implications of undifferentiated carcinoma with osteoclastic giant cells of the pancreas: An analysis of 15 cases

Michelle D. Reid, Takashi Muraki, Kim HooKim, Bahar Memis, Rondell P. Graham, Daniela Allende, Jiaqi Shi, David F. Schaeffer, Remmi Singh, Olca Basturk, Volkan Adsay

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

BACKGROUND: The cytologic features of undifferentiated pancreatic carcinoma with osteoclastic giant cells (UOC) are rarely described. METHODS: Cytologic and clinicopathologic characteristics in 15 UOC fine-needle aspiration (FNA) specimens were analyzed. RESULTS: FNA specimens were obtained from 6 men and 8 women with a mean age of 65 years who had UOCs (head, n = 7; body, n = 3; and tail, n = 4) with a mean radiologic size 7.3 cm, and some had a cystic component (n = 9). Three cell types (osteoclastic giant cells, pleomorphic tumor giant cells, and spindled/histiocytoid cells) were observed in 12 of 15 specimens (80%); and pancreatic ductal adenocarcinoma (PDAC) was present in 11 specimens. FNA diagnoses were UOC (n = 6), PDAC (n = 5), poorly differentiated carcinoma (n = 2), “suspicious for neoplasm” (n = 1), and “negative” (n = 1). Five of 5 specimens with osteoclastic giant cells were positive for cluster of differentiation 68 (CD68) (a glycoprotein that binds to low-density lipoprotein). Pleomorphic tumor giant cells and spindled/histiocytoid cells were positive for pancytokeratin (6 of 7 specimens), CAM5.2 (2 of 3 specimens), and epithelial membrane antigen (2 of 2 specimens). INI-1 protein expression was retained in 3 of 3 specimens. The Ki-67 labeling index was assessed in 3 specimens and was 12%, 18%, and 40%; 4 of 12 resected UOCs were pure, and 8 were mixed with PDAC. One resection specimen had intraductal papillary mucinous neoplasm, and 2 had mucinous cystic neoplasms. The median overall survival (OS) of patients who had UOCs identified on FNA was 8 months (6 died [OS, 8 months; range, 2-22 months], and 8 remained alive [OS, 3 months; range, 1-27 months]), which was similar to the survival of 74 patients who had PDACs identified on FNA (OS, 15 months; P =.279) but worse than that of the 27 patients with UOCs who did not undergo FNA (OS, 92 months; P =.0135). CONCLUSIONS: The 3 classical UOC cell types are identifiable on FNA, making cytologic diagnosis possible if considered in the differential. A PDAC component is often also observed. The survival advantage of UOC over pure PDAC appears to be negated by FNA and requires further investigation. Cancer Cytopathol 2017;125:563–75.

Original languageEnglish (US)
Pages (from-to)563-575
Number of pages13
JournalCancer Cytopathology
Volume125
Issue number7
DOIs
StatePublished - Jul 2017

Keywords

  • cytology
  • fine-needle aspiration (FNA)
  • osteoclast-like giant cell carcinoma
  • pancreas
  • undifferentiated carcinoma with osteoclastic giant cells of the pancreas

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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