Silverman J F, Dabbs D J, Finley J L, Geisinger K R
Department of Clinical Pathology, East Carolina University School of Medicine, Greenville 27834.
Am J Clin Pathol. 1988 Jun;89(6):714-20. doi: 10.1093/ajcp/89.6.714.
Four cases of pleomorphic (giant cell) carcinoma (PGC) of the pancreas, diagnosed by fine-needle aspiration biopsy, are presented. Ancillary immunocytochemical studies were also performed on the smears (four cases) and cell blocks (three cases), along with ultrastructural (electron microscopic) examination of the aspirated specimen (two cases). Three of the four patients were elderly (age range: 44-65 years), and all had large pancreatic masses. A spectrum of cytomorphologic features was encountered, including poorly cohesive bizarre mononuclear cells, many multinucleated tumor giant cells, and associated malignant spindle cells. Prominent cellular cannibalism and cytophagocytosis also were seen. Immunoperoxidase studies demonstrated dual staining of the malignant cells for cytokeratin and vimentin in two cases and exclusive staining for vimentin in the remaining two cases. Ultrastructural examination demonstrated epithelial features in both cases studied. One of the cases demonstrated intracytoplasmic whorled bundles of intermediate filaments, corresponding to pale eosinophilic globular material, appreciated both in the Diff-Quik- and Papanicolaou-stained smears and staining with positive results for vimentin. The immunocytochemical studies suggest that the coexpression of vimentin and cytokeratin within the cells is consistent with a pleomorphic malignancy of epithelial origin. It is speculated that the staining of two of the cases exclusively for vimentin can be seen in either epithelial malignancies with sarcomatoid transformation or, less likely, a pure sarcoma of the pancreas.
本文报告了4例经细针穿刺活检确诊的胰腺多形性（巨细胞）癌（PGC）。对涂片（4例）和细胞块（3例）进行了辅助免疫细胞化学研究，并对吸出标本进行了超微结构（电子显微镜）检查（2例）。4例患者中有3例为老年人（年龄范围：44 - 65岁），均有较大的胰腺肿块。观察到一系列细胞形态学特征，包括黏附性差的奇异单核细胞、许多多核肿瘤巨细胞以及相关的恶性梭形细胞。还可见明显的细胞吞噬和胞质吞噬现象。免疫过氧化物酶研究显示，2例恶性细胞对细胞角蛋白和波形蛋白呈双重染色，其余2例仅对波形蛋白染色。超微结构检查显示，所研究的2例均有上皮特征。其中1例显示胞质内有中间丝的漩涡状束，对应于淡嗜酸性球状物质，在Diff - Quik染色和巴氏染色涂片中均可见，波形蛋白染色呈阳性。免疫细胞化学研究表明，细胞内波形蛋白和细胞角蛋白的共表达与上皮源性多形性恶性肿瘤一致。推测2例仅对波形蛋白染色的情况可见于伴有肉瘤样转化的上皮性恶性肿瘤，或可能性较小的胰腺纯肉瘤。
