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Combined Osteoclastic Giant Cell and Pleomorphic Giant Cell Tumor of the Pancreas: A Rarity. An Immunohistochemical Analysis and Review of the Literature

Context :The combination of an osteoclastic giant cell tumor and a pleomorphic giant cell carcinoma of the pancreas is distinctly unusual and is associated with an adverse outcome. The origin of these two components within a tumor has long been debated based on the immunohistochemical and ultrastructural analysis. Case report :Herein we describe a tumor with amalgamation of these two distinct histomorphologies along with a minute focus of well-differentiated ductal adenocarcinoma (on multiple sections) in a 50-year male. On immunohistochemical analysis, osteoclastic giant cells were reactive for CD68 and vimentin confirming histiocytic/mesenchymal derivation whereas pleomorphic giant cells and mononuclear cells were reactive for cytokeratin which proved their epithelial nature. Conclusions :Although the present case had an equal proportion of both components, it is very important to correctly assess the predominant histology since osteoclastic giant cell tumor has a better prognosis as compared to the more aggressive pleomorphic giant cell carcinoma component.

Author(s): Anand C Loya, Kamaraju S Ratnakar, Regulagadda A Shastry

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