# Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells

Source: https://onco.cc/cancers/pancreatic-undifferentiated-carcinoma-ogc/  
OnCo record `pancreatic-undifferentiated-carcinoma-ogc` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Undifferentiated carcinoma with osteoclast-like giant cells is a rare form of pancreatic cancer studded with large bone-eating-type cells that are not themselves cancerous. It grows as a big, well-circumscribed mass, often within a cyst, spreads to nerves and lymph nodes far less often than ordinary pancreatic cancer, and about six in ten patients are alive five years after surgery.

## Summary

What it is. A WHO variant of ductal adenocarcinoma (Nagtegaal 2020) in which undifferentiated, often spindled or pleomorphic carcinoma cells are mixed with non-neoplastic osteoclast-like giant cells that express the histiocytic marker CD68; the background spindle and giant carcinoma cells often show p53 and often lack cytokeratin, and osteoid was seen in 12 of 38 tumours (Muraki 2016). A 2021 review sets out its pathology and molecular features and the questions it raises (Luchini 2021). Undifferentiated (anaplastic) carcinoma without giant cells is a separate, aggressive variant that this record does not describe.

How it differs from its parent. In 38 resected cases against 725 resected ductal adenocarcinomas, the tumours were larger (mean 5.3 against 3.2 cm), nodular with pushing borders, arose in a mucinous cystic or IPMN-type lesion in 8 cases and showed prominent intraductal or intracystic growth in 61 percent; 76 percent also had an invasive ductal or tubular component. Despite their size, perineural invasion (31.6 against 85.5 percent) and nodal metastasis (22.6 against 64.0 percent) were uncommon, and five-year survival was 59.1 percent against 15.7 percent (Muraki 2016).

How common it is. 1.4 percent of the resected pancreatic cancers reviewed at one centre; no population count is published.

How it is treated. Resection, with adjuvant chemotherapy by extrapolation from ductal adenocarcinoma; there is no trial. The more protracted course than the literature had assumed is the main lesson of the 2016 series, and it argues for offering surgery even to large tumours.

## Fields

- Kind: Cancer
- Last checked: 2026-09-24
- Also known as: Undifferentiated carcinoma with osteoclast-like giant cells (1.4 percent of resected pancreatic cancers; five-year survival 59 percent); Osteoclastic giant cell tumour of the pancreas; UC-OGC; Undifferentiated carcinoma with osteoclastic giant cells; Giant cell carcinoma of the pancreas
- Tags: gi; pancreatic; subtype-page
- Group: gastrointestinal
- Burden: 1.4 percent of systematically reviewed resected pancreatic cancers in the largest series (38 of about 2,700 cases); slight female predominance (62.9 percent) and a mean age of 57.9 against 65.0 for ordinary ductal adenocarcinoma.
- Subtypes: Undifferentiated carcinoma with osteoclast-like giant cells and an invasive ductal (PDAC) component (76 percent of cases); Undifferentiated carcinoma with osteoclast-like giant cells arising in a mucinous cystic neoplasm or IPMN; Undifferentiated (anaplastic) carcinoma without giant cells (aggressive; treated as ductal adenocarcinoma)
- Biomarkers: CD68-positive osteoclast-like giant cells (non-neoplastic) among cytokeratin-poor, p53-positive carcinoma cells; Associated ductal adenocarcinoma component or cystic precursor on histology; KRAS as in ductal adenocarcinoma

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/pancreatic-undifferentiated-carcinoma-ogc/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/pancreatic-undifferentiated-carcinoma-ogc/#overview [1 state-of-the-art points]
- What it is (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/pancreatic-undifferentiated-carcinoma-ogc/#what-it-is [3 subtypes]
- Finding it (on the hub): How it shows itself, how it is confirmed, what screening exists, and the biomarkers clinicians test for. https://onco.cc/cancers/pancreatic-undifferentiated-carcinoma-ogc/#finding-it [3 biomarkers]
- Treating it (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/pancreatic-undifferentiated-carcinoma-ogc/#treating-it [2 settings, 1 decision with options]
- Evidence (on the hub): Trials recruiting now, the landmark trials, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/pancreatic-undifferentiated-carcinoma-ogc/#evidence [2 milestones]
- The science (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/pancreatic-undifferentiated-carcinoma-ogc/#science [2 targets, 3 pathways]
- Where you are (own page): Cases by country, the UK and NHS pathway and other country lenses, and the expert centres with trials on record. https://onco.cc/cancers/pancreatic-undifferentiated-carcinoma-ogc/where-you-are/
- Living with it (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/pancreatic-undifferentiated-carcinoma-ogc/#living-with-it [12 questions, 2 red cards]
- What is coming (own page): Everything in development, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/pancreatic-undifferentiated-carcinoma-ogc/coming/ [2 medicines, 2 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/pancreatic-undifferentiated-carcinoma-ogc/data/ [15 connected records]

## Standard of care

- Resectable: Resection even of large tumours, given the low rates of nodal and perineural spread and the 59 percent five-year survival in the resected series; adjuvant chemotherapy by extrapolation from ductal adenocarcinoma. ([Whipple procedure (pancreaticoduodenectomy)](https://onco.cc/terms/whipple/), [Distal pancreatectomy (removal of the body and tail of the pancreas, usually with the spleen)](https://onco.cc/terms/distal-pancreatectomy/), [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/))
- Advanced: Treated as pancreatic ductal adenocarcinoma: resection with adjuvant chemotherapy when removable, the chemotherapy rows of the parent page when not; the parent record carries the trials. ([FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/))

## State of the art

- The 2016 series of 38 cases overturned the assumption that this variant behaves like ductal adenocarcinoma.

## Open problems

- No trial; adjuvant treatment is extrapolated.
- Whether the immune-rich microenvironment makes it a candidate for immunotherapy is unproven.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Giant-cell_tumor_of_bone
- Muraki, Am J Surg Pathol 2016: undifferentiated carcinoma with osteoclastic giant cells of the pancreas, 38 cases: https://doi.org/10.1097/pas.0000000000000689
- Luchini, Virchows Arch 2021: undifferentiated carcinoma of the pancreas with osteoclast-like giant cells, a review: https://doi.org/10.1007/s00428-021-03021-9
- Nagtegaal, Histopathology 2020: the 2019 WHO classification of tumours of the digestive system: https://doi.org/10.1111/his.13975

## Connected records

- cancers: [Adenosquamous carcinoma of the pancreas](https://onco.cc/cancers/pancreatic-adenosquamous-carcinoma/), [Invasive carcinoma arising in an intraductal papillary mucinous neoplasm (IPMN-associated carcinoma)](https://onco.cc/cancers/ipmn-associated-carcinoma/), [Mucinous cystic neoplasm of the pancreas with associated invasive carcinoma (MCN-associated carcinoma)](https://onco.cc/cancers/mcn-associated-carcinoma/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Undifferentiated pleomorphic sarcoma (UPS)](https://onco.cc/cancers/undifferentiated-pleomorphic-sarcoma/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/)
- targets: [KRAS](https://onco.cc/targets/kras/), [TP53](https://onco.cc/targets/tp53/)
- drugs: [FOLFIRINOX / mFOLFIRINOX](https://onco.cc/drugs/folfirinox/), [Gemcitabine + nab-paclitaxel](https://onco.cc/drugs/gemcitabine-nab-paclitaxel/)
- pathways: [Epithelial-mesenchymal transition & drug efflux](https://onco.cc/pathways/emt/), [Pancreatic cancer (KEGG map)](https://onco.cc/pathways/pancreatic-cancer-signalling/), [RAS / RAF / MEK / ERK (MAPK)](https://onco.cc/pathways/ras-mapk/)
- terms: [Distal pancreatectomy (removal of the body and tail of the pancreas, usually with the spleen)](https://onco.cc/terms/distal-pancreatectomy/), [Grade](https://onco.cc/terms/tumour-grade/), [Resection margins (R0 / R1 / R2)](https://onco.cc/terms/resection-margins/), [Whipple procedure (pancreaticoduodenectomy)](https://onco.cc/terms/whipple/)

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JSON: https://onco.cc/api/v1/entities/pancreatic-undifferentiated-carcinoma-ogc.json