HUMAN PATHOLOGY
Volume 21, No. 11 [November 1990)
CELL TUMOR OF THE PANCREAS OF MIXED OSTEOCLASTIC AND PLEOMORPHIC FOR A HISTOGENETIC RELATIONSHIP AND MESENCHYMAL DIFFERENVATION
GIANT
CELL TYPE: EVIDENCE
KEYI. B. LEWANDROWSKI, MD, LYNN WESIX)S, MD. G. RICHARD DICKERSIN, MD, DAVID W. RA.I.TNER, MD, CAROLYN C. COMPTON, MD, PHD We describe u giunf cell tumor vf the pancrea.s compo.sed of u mixture of osteoclastic and pleomorphic cell types. This rure tumor had a unique immunohistochemical profile. Both types of tumo? giant cells stained for vimentin. a-l -antitrypsin, a-l antichymot~psin, spptup~yin, muscle nctin, und neuron-specific enoiase, but not for epitheIm1 markers. Electron microscopy showed ceils which resembled primitive fi‘broblwts and ostroc1a.s~~ with no epithelial features. These findings are most consisfeut with mesenchymal d@erentiation. The extensive homologies in immunohiytochemical staining of both osteociastic and pleomorphic giant cells in this case indicates that these cells ure histogenetically related. HC’M PAT~IOL 21:1181-l 187. 0 1990 by W.B. Saunders Comfiany.
Giant cell tumors of the pancreas are rare nonendocrine neoplasms. Two histopathologic types are generally recognized. One t.ype, osteoclastic giant cell tumor of the pancreas (OGTP) 1s indistinguishable from giant cell tumor of bone by light microscopy.’ The second type, pleomorphic giant cell carcinoma (PGCP), is a noncohesive, sarcoma-like tumor with bizarre pleomorphic mononucleated and multinucleated giant cells. Although both OGTP and PGCP may have small numbers of giant cells of the opposite type, only rarely have true mixed tumors containing both osteoclastlc and pleomorphic giant cells in significant proportions been reported.‘,” The histogenesis of these two neoplasms has been debated in the literature. Most authors favor an epithelial origin for OGTP (acinar) and PGCP (ductal). based on ultrastructural and immunohistochemical studies as well as the presence of a mucin-secreting glandular component in some of these tumors. Recently, however, immunohistochemical staining for vimentin has been demonstrated in both PGCP’ and OGTP,“,” suggesting either mesenchymal origin or differentiation. We describe the third reported case of a giant cell tumor of the pancreas having mixed elements of both OGTP and PGCP. This tumor exhibited a unique immunohistochemical profile with staining for vimentin, actin, a-1-antitrypsin. c-x-1-antichymotrypsin. synaptophysin. and neuron-specific enolase, but not for epithelial markers. Electron microscopic study showed cells having features of primitive fibroblasts and osteoclasts with no evidence of epithelial structures. The significance of these findings in regard to the histogenesis of giant cell tumors of the pancreas IS discussed. CASE REPORT A previously healthy 60-year-old man presented with a l-month history of left upper quadrant and back pain. XI-
Received December 1.5. IYSY, from the Departmenrs of Pathology and Surgery, Massachusetts General fiospital. Boston. MA, and Harvard Medical School. Boston. hlA. Accented for Dublication February 7. 1990. K?T ulork: pancreas. giant cell tumor, osteoclastic iype. pleomorphtc type. sarcoma. Address correspondence and reprint requests to Carolyn C.
Volume 21, No. 11 [November 1990)
CELL TUMOR OF THE PANCREAS OF MIXED OSTEOCLASTIC AND PLEOMORPHIC FOR A HISTOGENETIC RELATIONSHIP AND MESENCHYMAL DIFFERENVATION
GIANT
CELL TYPE: EVIDENCE
KEYI. B. LEWANDROWSKI, MD, LYNN WESIX)S, MD. G. RICHARD DICKERSIN, MD, DAVID W. RA.I.TNER, MD, CAROLYN C. COMPTON, MD, PHD We describe u giunf cell tumor vf the pancrea.s compo.sed of u mixture of osteoclastic and pleomorphic cell types. This rure tumor had a unique immunohistochemical profile. Both types of tumo? giant cells stained for vimentin. a-l -antitrypsin, a-l antichymot~psin, spptup~yin, muscle nctin, und neuron-specific enoiase, but not for epitheIm1 markers. Electron microscopy showed ceils which resembled primitive fi‘broblwts and ostroc1a.s~~ with no epithelial features. These findings are most consisfeut with mesenchymal d@erentiation. The extensive homologies in immunohiytochemical staining of both osteociastic and pleomorphic giant cells in this case indicates that these cells ure histogenetically related. HC’M PAT~IOL 21:1181-l 187. 0 1990 by W.B. Saunders Comfiany.
Giant cell tumors of the pancreas are rare nonendocrine neoplasms. Two histopathologic types are generally recognized. One t.ype, osteoclastic giant cell tumor of the pancreas (OGTP) 1s indistinguishable from giant cell tumor of bone by light microscopy.’ The second type, pleomorphic giant cell carcinoma (PGCP), is a noncohesive, sarcoma-like tumor with bizarre pleomorphic mononucleated and multinucleated giant cells. Although both OGTP and PGCP may have small numbers of giant cells of the opposite type, only rarely have true mixed tumors containing both osteoclastlc and pleomorphic giant cells in significant proportions been reported.‘,” The histogenesis of these two neoplasms has been debated in the literature. Most authors favor an epithelial origin for OGTP (acinar) and PGCP (ductal). based on ultrastructural and immunohistochemical studies as well as the presence of a mucin-secreting glandular component in some of these tumors. Recently, however, immunohistochemical staining for vimentin has been demonstrated in both PGCP’ and OGTP,“,” suggesting either mesenchymal origin or differentiation. We describe the third reported case of a giant cell tumor of the pancreas having mixed elements of both OGTP and PGCP. This tumor exhibited a unique immunohistochemical profile with staining for vimentin, actin, a-1-antitrypsin. c-x-1-antichymotrypsin. synaptophysin. and neuron-specific enolase, but not for epithelial markers. Electron microscopic study showed cells having features of primitive fibroblasts and osteoclasts with no evidence of epithelial structures. The significance of these findings in regard to the histogenesis of giant cell tumors of the pancreas IS discussed. CASE REPORT A previously healthy 60-year-old man presented with a l-month history of left upper quadrant and back pain. XI-
Received December 1.5. IYSY, from the Departmenrs of Pathology and Surgery, Massachusetts General fiospital. Boston. MA, and Harvard Medical School. Boston. hlA. Accented for Dublication February 7. 1990. K?T ulork: pancreas. giant cell tumor, osteoclastic iype. pleomorphtc type. sarcoma. Address correspondence and reprint requests to Carolyn C.
