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

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

doi:10.1002/cncy.21859

Cited by 53 publications

(65 citation statements)

References 39 publications

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“…Undifferentiated pancreatic carcinoma with osteoclastic giant cells, formerly named pleomorphic carcinoma of the pancreas, giant cell carcinoma and sarcomatoid carcinoma, could briefly be included in the differential diagnosis due to the presence of pleomorphic tumor cells. In a study by Reid et al, three cell types (osteoclastic giant cells, pleomorphic tumor giant cells, and spindle/histiocytoid cells) were present in 12/15 cytology specimens . An important finding in 73% of their cases was the presence of pancreatic ductal carcinoma.…”

Section: Discussionmentioning

confidence: 98%

Pleomorphic and atypical multinucleated giant cells in solid pseudopapillary neoplasm of pancreas: A diagnostic pitfall in cytology and a review of the literature

Policarpio‐Nicolas

McHugh

Sae-Ow

et al. 2018

Diagnostic Cytopathology

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Solid pseudopapillary neoplasm of the pancreas (SPN) is a rare low‐grade malignancy typically occurring in young women. Occasionally, these neoplasms present with pleomorphic to atypical multinucleated giant tumor cells which may mimic high‐grade malignancy. Our patient is a 25‐year‐old male who presented with one year of intermittent epigastric pain. Magnetic resonance imaging showed a 3.1 × 2.5 cm mass in the pancreas body. Endoscopic ultrasound‐guided fine needle aspiration of the mass showed large pleomorphic cells and atypical multinucleated giant cells in a background of singly scattered polygonal cells. Focally, these cells surrounded delicate hyalinized to fibrovascular cores forming pseudopapillae. Immunohistochemical stains show tumor cells are positive for beta‐catenin, CD10, vimentin, and CD56. Although rare surgical pathology publications have described the presence of pleomorphic to atypical multinucleated giant cells occurring in SPN, to our knowledge, this is the first case reported example focused on cytomorphologic illustration and description.

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Section: Discussionmentioning

confidence: 98%

Pleomorphic and atypical multinucleated giant cells in solid pseudopapillary neoplasm of pancreas: A diagnostic pitfall in cytology and a review of the literature

Policarpio‐Nicolas

McHugh

Sae-Ow

et al. 2018

Diagnostic Cytopathology

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“…The evidence suggests that the mononuclear cells in ORUCUT represent the neoplastic cells and the association of these tumors with in situ or high-grade papillary urothelial carcinoma in all six cases supported an epithelial origin. In addition, giant cell tumors in other visceral organs, such as the pancreas, have demonstrated robust epithelial staining in the mononuclear cells [14]. To further assess the histopathogenesis of ORUCUT, this study utilizes the more specific urothelial markers of GATA3, uroplakin II, and thrombomodulin.…”

Section: Introductionmentioning

confidence: 99%

An expanded immunohistochemical profile of osteoclast-rich undifferentiated carcinoma of the urinary tract

2018

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Osteoclast-rich undifferentiated carcinoma of the urinary tract (ORUCUT) is a rare tumor composed of ovoid to spindle-shaped mononuclear cells with intermixed or focally clustered osteoclast-like giant cells. Previous studies have demonstrated that the mononuclear cells are neoplastic cells, while the giant cells are reactive cells of histiocytic lineage. The association between these tumors and classic urothelial carcinomas suggest that the mononuclear cells are derived from urothelial cells; however, no studies have been conducted to assess the immunohistochemical profile of ORUCUT with more specific urothelial markers. This study identified 21 cases of ORUCUT and performed immunohistochemistry for GATA3, uroplakin II, and thrombomodulin along with pancytokeratin (AE1/3) on all cases. Mononuclear cells stained positive in 20 cases (95%) for GATA3 and 19 cases (90%) for thrombomodulin. None of the mononuclear cells were positive for uroplakin II and only three cases showed focal positivity for AE1/3. The osteoclast-like giant cells were negative for GATA3, uroplakin II, thrombomodulin, and AE1/3, providing additional support to a reactive origin for these cells. Additionally, 15 cases (71%) were associated with either in situ or invasive urothelial carcinoma. This study provides an expanded immunohistochemical profile for ORUCUT and more definitively supports a urothelial origin for this tumor.

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“…In the process of epithelial-mesenchymal transition (EMT), epithelial cells lose polarity and intercellular cohesion to adopt a mesenchymal, fibroblast-like, single-cell migratory phenotype. 13 Although some studies have reported cytopathological features of PAC, [14][15][16] immunocytochemical (ICC) findings including EMT markers have been sparsely investigated. According to previous reports, loss of E-cadherin and gain of vimentin are considered as hallmarks of EMT and the expressions of vimentin, E-cadherin, and zinc finger E-box binding homeobox 1 (ZEB1) in PDAC represent important prognostic factors.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12] In particular, recent reports suggest ZEB1 links EMT-activation and stem cell-maintenance by suppressing stem cellinhibiting microRNAs (miRNAs), and therefore, is a promoter of mobile, migrating cancer stem cells in pancreatic tumors. 13 Although some studies have reported cytopathological features of PAC, [14][15][16] immunocytochemical (ICC) findings including EMT markers have been sparsely investigated. We report an autopsy case of PAC on cytopathological characteristics and ICC findings, focusing on the expression of EMT markers.…”

Section: Introductionmentioning

confidence: 99%

“…Cytological findings of pancreatic adenocarcinoma are generally represented by clusters of tumor cells with irregular nuclear membranes, residual mucin vacuoles in the background, and coagulative necrosis. In contrast, those of PAC are characterized by high pleomorphism with clustered or singly dispersed, highly malignant cells with or without cytoplasmic mucin vacuoles, but with high nuclear-to-cytoplasmic ratios, necrotic activity, and brisk mitotic activity, and sometimes including a mixture of osteoclastic giant cells on cytology 6,14,16. Additionally, PAC may be associated with a conventional PDAC component.…”

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confidence: 99%

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Cytopathological and immunocytochemical findings of pancreatic anaplastic carcinoma with ZEB1 expression by means of touch imprint cytology

Naito

Kawahara

Taira

et al. 2017

Diagnostic Cytopathology

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Pancreatic anaplastic carcinoma (PAC) is rare and has an aggressive clinical course. We report an autopsy case of PAC focusing on the cytopathological characteristics of the tumor and immunocytochemical staining for vimentin, E-cadherin, and zinc finger E-box binding homeobox 1 (ZEB1), which markers are associated with epithelial markers of epithelial-mesenchymal transition (EMT). A 50-year-old woman presented to our hospital with a chief complaint of jaundice. A pancreatic head tumor and multiple liver nodules were detected on abdominal computed tomography. Biliary cytology under endoscopic retrograde cholangiopancreatography suggested ductal adenocarcinoma. Three months after admission, she died of multiorgan failure. At autopsy, touch imprint cytology using squash preparation of the pancreatic tumor identified two different cell types; numerous isolated malignant cells with large and pleomorphic nuclei and a few clusters showing irregularly overlapped nuclei and irregular contours within the necrotic background. Immunocytochemically, isolated cells were positive for vimentin and ZEB1, and negative for E-cadherin. Conversely, clusters were negative for vimentin and ZEB1, and positive for E-cadherin. Histologically, the tumor was composed of sarcomatous cells with small foci of adenocarcinoma, which were consistent with a diagnosis of PAC. Immunohistochemical staining of the adenocarcinoma and sarcomatous cells corresponded to those of the clusters and isolated malignant cells, respectively. Immunostaining of these EMT markers is useful to distinguish sarcomatous cells from adenocarcinoma and can contribute to the accurate diagnosis of pancreatic tumors with EMT.

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

Cited by 53 publications

References 39 publications

Pleomorphic and atypical multinucleated giant cells in solid pseudopapillary neoplasm of pancreas: A diagnostic pitfall in cytology and a review of the literature

Pleomorphic and atypical multinucleated giant cells in solid pseudopapillary neoplasm of pancreas: A diagnostic pitfall in cytology and a review of the literature

An expanded immunohistochemical profile of osteoclast-rich undifferentiated carcinoma of the urinary tract

Cytopathological and immunocytochemical findings of pancreatic anaplastic carcinoma with ZEB1 expression by means of touch imprint cytology

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