[1558] Pancreatobiliary Osteoclastic-Giant Cell Carcinomas (OGCCs) Are Often Characterized by Intraductal Growth and Polypoid Pattern Similar to Sarcomatoid Carcinomas (SCs) of Other Organs

O Basturk, I Coban, S Bandyopadhyay, K Jang, J Sarmiento, NV Adsay. NYU, NY; Emory U, GA; WSU, MI; Samsung MC, Seoul, Korea

Background: Pancreatobiliary OGCCs are very rare tumors (the largest pathologically analyzed series, 7 cases), regarded as a distinct form of SCs, and associated with striking chemotaxis of OGCs. Biologic nature of these tumors has yet to be determined. Here, we present our observations on common intraductal growth of OGCCs, which may have implications on their biology.
Design: 6 OGCCs, 4 of which we had personally dissected, were analyzed.
Results: Clinic: F/M=5. Mean age=67(51-86). Presentation symptoms: Back pain(4/6), weight loss(3/6), jaundice(1/6) and diarrhea(2/6). Gross: 3 tumors were localized in the head, 3 in tail. Mean size=5.7 cm(2-10). Those 4 dissected by the authors were polypoid, smooth-surfaced, focally hemorragic lesions within the ducts, 1 with cyst formation. Microscopy: All cases showed intraductal/intracystic growth. 3 different cells were noted: I.OGCs II.Relatively small, ovoid-spindle histiocyte-like cells(HLCs) III.Pleomorphic giant cells(PGCs). 5 cases were associated with an ordinary inv ductal adenocarcinoma(DA). DA component ranged from microscopic to 80% of the tumor(mean, 30%). 1 also had IPMN, 2 had multifocal PanIN-3. 2 contained osteoid. F/U: 1 patient who had extensive DA died(25 mos), 3 are alive(19-27 mos).

CKCD68Ki67p53
OGCs0/44/40/40/4
HLCs1/4, Focal4/4*4/4; 20-40%2/4; 70%
PGCs0/41/4, Focal4/4; 30-50%2/4; >80%
* In contrast with the literature. In-built controls staining appropriately.




Conclusions: Careful macroscopic examination/microscopic correlation discloses that pancreatobiliary OGCCs often have prominent intraductal growth, a finding previously not fully appreciated in the literature. This may not be surprising, considering that SCs occurring in other sites also often form polypoid lesions with pushing-border infiltration. It may be important to document relative amount of OGCC and DA patterns, because our limited F/U suggests that OGCC-predominant cases may not be as aggressive. Further studies are warranted on larger number of cases.
Category: Liver & Pancreas

Tuesday, March 23, 2010 1:00 PM

Poster Session IV # 221, Tuesday Afternoon

 

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