Nai Gisele A, Amico Enio, Gimenez Vanderlei R, Guilmar Marcello
Department of Pathology, College of Medicine, Universidade do Oeste Paulista, Presidente Prudente, São Paulo, Brazil.
Pancreatology. 2005;5(2-3):279-84. doi: 10.1159/000085283. Epub 2005 Apr 21.
BACKGROUND/AIMS: The osteoclast-like giant cell tumor of the pancreas is a rare entity that closely resembles giant cell tumor of the bone, which has also been observed in many other organs. Some tumors also contain areas of ductal adenocarcinoma. Conflicting opinions exist regarding the tumor origin, whether it is mesenchymal or epithelial, neoplastic or reactive.
We report the case of a 69-year-old Brazilian man with a mass in the head of the pancreas, the histological examination of which revealed a predominant component of osteoclast-like giant cells within a background of pleomorphic mononuclear cells with osteoid formation and other areas composed of conventional mucus-secreting adenocarcinoma.
Immunohistochemistry showed that carcinoma cells of the usual type expressed epithelial antigens (EMA and cytokeratin) and lysozyme; the giant cells expressed vimentin, CD45, CD68, and lysozyme; and the mononuclear cells expressed macrophage marker (HAM56), vimentin, and lysozyme, and only some of them expressed epithelial markers, CD45, and CD68.
Our immunohistochemical findings reveal that the giant cells in this case are of mesenchymal origin may be from the bone marrow cells. We believe that it is important to determine the histogenesis in each case to carry out the pertinent adjuvant therapy.
背景/目的：胰腺破骨细胞样巨细胞瘤是一种罕见的实体瘤，与骨巨细胞瘤极为相似，在许多其他器官中也有发现。一些肿瘤还包含导管腺癌区域。关于肿瘤起源存在相互矛盾的观点，即它是间充质起源还是上皮起源，是肿瘤性的还是反应性的。
我们报告了一例69岁巴西男性患者，其胰腺头部有一肿块，组织学检查显示在多形性单核细胞背景下以破骨细胞样巨细胞为主，伴有类骨质形成，其他区域由传统的黏液分泌腺癌组成。
免疫组化显示，常见类型的癌细胞表达上皮抗原（EMA和细胞角蛋白）和溶菌酶；巨细胞表达波形蛋白、CD45、CD68和溶菌酶；单核细胞表达巨噬细胞标志物（HAM56）、波形蛋白和溶菌酶，其中只有一些表达上皮标志物、CD45和CD68。
我们的免疫组化结果显示，该病例中的巨细胞起源于间充质，可能来自骨髓细胞。我们认为，确定每例病例的组织发生对于进行相关的辅助治疗很重要。
