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Presented by Ralph Hruban, M.D. and prepared by Shiyama Mudali, M.D.
Case 1: This 60 some year old man was found to have a mass in his pancreas.
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Question 1 of 1
1. Question
Week 442: Case 1
This 60 some year old man was found to have a mass in his pancreas. The lesion was biopsied.images/1alex/07122010case1image1.jpg
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images/1alex/07122010case1image3 copy.jpgCorrect
Answer: Undifferentiated carcinoma with osteoclast-like giant cells
Histology: This neoplasm has two distinct components. Large osteoclast-like giant cells with multiple uniform nuclei are admixed with atypical appearing mononuclear cells. The mononuclear cells are notable for significant pleomorphism.
Discussion: Undifferentiated carcinomas with osteoclast-like giant cells are rare epithelial neoplasms of the pancreas. As the name suggests, they contain large osteoclast-like giant cells. These reactive (non-neoplastic) giant cells have multiple uniform nuclei and abundant cytoplasm. The neoplastic cells are actually the smaller mononuclear cells admixed among the osteoclast-like giant cells. In this case an immunostain for p53 strongly labeled the neoplastic mononuclear cells, but not the nuclei of the giant cells. Even though the mononuclear cells are of epithelial origin, they are often negative, or only focally positive when immunolabeled for cytokeratin.
Incorrect
Answer: Undifferentiated carcinoma with osteoclast-like giant cells
Histology: This neoplasm has two distinct components. Large osteoclast-like giant cells with multiple uniform nuclei are admixed with atypical appearing mononuclear cells. The mononuclear cells are notable for significant pleomorphism.
Discussion: Undifferentiated carcinomas with osteoclast-like giant cells are rare epithelial neoplasms of the pancreas. As the name suggests, they contain large osteoclast-like giant cells. These reactive (non-neoplastic) giant cells have multiple uniform nuclei and abundant cytoplasm. The neoplastic cells are actually the smaller mononuclear cells admixed among the osteoclast-like giant cells. In this case an immunostain for p53 strongly labeled the neoplastic mononuclear cells, but not the nuclei of the giant cells. Even though the mononuclear cells are of epithelial origin, they are often negative, or only focally positive when immunolabeled for cytokeratin.
