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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.
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.
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.
Most pancreatic cancers arise in the head next to the bile duct, which is why jaundice is the presenting sign; bile duct cancers are named by where along the tree they sit.
Same organ: Glucagonoma, VIPoma, Somatostatinoma, Pancreatic ductal adenocarcinoma, Biliary tract cancer (cholangiocarcinoma), Intrahepatic cholangiocarcinoma, Extrahepatic cholangiocarcinoma (perihilar and distal), Biliary tract cancer (all types), Neuroendocrine tumours, Pancreatic neuroendocrine tumours, Grade 3 well-differentiated neuroendocrine tumour, Extrapulmonary neuroendocrine carcinoma, Gallbladder cancer, Gallbladder adenocarcinoma, Papillary carcinoma of the gallbladder, Mucinous carcinoma of the gallbladder, Adenosquamous and squamous carcinoma of the gallbladder, Neuroendocrine carcinoma of the gallbladder, Incidental gallbladder cancer (found after cholecystectomy), Carcinoma in situ and dysplasia of the gallbladder, Cystic duct carcinoma, Ampullary cancer (ampulla of Vater), Resectable pancreatic ductal adenocarcinoma, Borderline resectable pancreatic ductal adenocarcinoma, Locally advanced unresectable pancreatic ductal adenocarcinoma, Metastatic pancreatic ductal adenocarcinoma, KRAS G12C-mutant pancreatic ductal adenocarcinoma, KRAS wild-type pancreatic ductal adenocarcinoma, BRCA or PALB2-mutant pancreatic ductal adenocarcinoma, Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma, Pancreatic acinar cell carcinoma, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Pancreatoblastoma, Adenosquamous carcinoma of the pancreas, Colloid (mucinous non-cystic) carcinoma of the pancreas, Invasive carcinoma arising in an intraductal papillary mucinous neoplasm (IPMN-associated carcinoma), Mucinous cystic neoplasm of the pancreas with associated invasive carcinoma (MCN-associated carcinoma), Solid pseudopapillary neoplasm of the pancreas
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.
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.
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Query for this cancer: (TITLE:"Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells" OR ABSTRACT:"Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells" OR TITLE:"Undifferentiated carcinoma with osteoclast-like giant cells 1.4 percent of resected pancreatic cancers; five-year survival 59 percent" OR ABSTRACT:"Undifferentiated carcinoma with osteoclast-like giant cells 1.4 percent of resected pancreatic cancers; five-year survival 59 percent" OR TITLE:"Osteoclastic giant cell tumour of the pancreas" OR ABSTRACT:"Osteoclastic giant cell tumour of the pancreas" OR TITLE:"UC-OGC" OR ABSTRACT:"UC-OGC" OR TITLE:"Undifferentiated carcinoma with osteoclastic giant cells" OR ABSTRACT:"Undifferentiated carcinoma with osteoclastic giant cells" OR TITLE:"Giant cell carcinoma of the pancreas" OR ABSTRACT:"Giant cell carcinoma of the pancreas") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells, not a curated reading list.
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Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
The three main regimens share low blood counts, tiredness, sickness and sore mouth; FOLFIRINOX and NALIRIFOX add irinotecan diarrhoea and oxaliplatin's cold-triggered tingling and rare throat spasm, gemcitabine with nab-paclitaxel adds hair loss and neuropathy, and every regimen comes with the same temperature rule for ringing the 24-hour line.
See all on the product pages:FOLFIRINOX / mFOLFIRINOXGemcitabine + nab-paclitaxel·Printable cards in the navigator
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