Ann Hepatobiliary Pancreat Surg.  2024 May;28(2):125-133. 10.14701/ahbps.23-161.

Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas: An individual participant data meta-analysis

• Mylonakis A
• Driva TS
• Lykoudis P
• Frountzas M
• Machairas N
• Tsapralis D
• Toutouzas KG
• Schizas D

• KMID: 2555925
• DOI: http://doi.org/10.14701/ahbps.23-161

Abstract

Undifferentiated carcinoma with osteoclast-like giant cells (UC−OGCs) of the pancreas is a rare neoplasm that accounts for less than 1% of all pancreatic malignancies. The aim of this study was to review the literature regarding UC−OGC, and to highlight its biological behavior, clinicopathologic characteristics, prognosis, and therapeutic options. A systematic review of the literature in PubMed/ Medline and Scopus databases was performed (last search October 31st, 2023) for articles concerning pancreatic UC−OGC in the adult population. Fifty-seven studies met the inclusion criteria, involving 69 patients with a male-to-female ratio of 1.1:1 and a mean age of 62.96. Main symptoms included abdominal pain (33.3%), jaundice (14.5%), weight loss (8.7%), while fourteen patients (20.3%) were asymptomatic. Surgical resection was performed in 88.4% of cases. Survival rates at one, three, and five years were 58%, 44.7%, and 37.3% respectively. Sex, age, size (cut-off of 4 cm), location, and adjuvant treatment did not significantly affect patient survival. UC− OGC of the pancreas is a rare subtype of undifferentiated pancreatic carcinoma with a better prognosis than conventional pancreatic ductal adenocarcinoma or undifferentiated carcinoma without giant cells. The establishment of a dedicated patient registry is imperative to further delineate the optimal treatment for this uncommon clinical entity.

Keyword

Pancreas; Carcinoma; Undifferentiated; Osteoclast-like giant cells

Figure

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  Fig. 1 Trial flowchart of this systematic review.

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  Fig. 2 Cumulative survival Kaplan–Meier curve of pancreatic undifferentiated carcinoma with osteoclast-like giant cells.

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  Fig. 3 Enhanced computed tomography (CT). The arterial phase (47 seconds after contrast injection) of the CT image showed (A) a low-attenuated mass located at the pancreatic uncinate process (arrow), (B) continuously invading the duodenum with marginal enhancement (small arrow). (C) The tumor was slightly enhanced at the late phase (3 minutes), especially at the margin (small arrows). Cited from the article of Matsubayashi et al. (Intern Med 2019;58: 3545-3550) [20].

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  Fig. 4 Magnetic resonance imaging. A low-signal-intensity mass was seen on (A) T1-weighted, (B) T2-weighted, and (C) diffusion-weighted images. Cited from the article of Matsubayashi et al. (Intern Med 2019;58: 3545-3550) [20].

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  Fig. 5 (A, B) A representative case of the undifferentiated carcinoma of the pancreas with osteoclast-like giant cells, with an associated ductal adenocarcinoma, is shown. (A) Hematoxylin–eosin staining reveals an undifferentiated carcinoma with atypical cells and the presence of multinucleated osteoclast-like giant cells; neoplastic glands of the associated ductal adenocarcinoma are also evident (original magnification, × 20). (B) E–cadherin expression is lost by undifferentiated neoplastic cells, while it is retained by neoplastic glands (original magnification, × 20). (C, D) A representative case of undifferentiated carcinoma of the pancreas with osteoclast-like giant cells (without an associated ductal adenocarcinoma) is shown. (C) Hematoxylin–eosin staining reveals an undifferentiated carcinoma with atypical cells and the presence of multinucleated osteoclast-like giant cells (original magnification, × 20). (D) E–cadherin expression is lost by undifferentiated neoplastic cells (original magnification, × 20). Cited from the article of Mattiolo et al. (Virchows Arch 2021;478:319-326) [31].

Reference

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