Tomihara Hideo, Hashimoto Kazuhiko, Ishikawa Hajime, Terashita Daisuke, Gakuhara Atsushi, Fukuda Shuichi, Ohta Katsuya, Kitani Kotaro, Hida Jin-Ichi, Wakasa Tomoko, Kimura Yutaka
Department of Surgery, Kindai University Nara Hospital, 1248-1 Otoda-cho, Ikoma, Nara, 630-0293, Japan.
Department of Pathology and Laboratory, Kindai University Nara Hospital, 1248-1 Otoda-cho, Ikoma, Nara, 630-0293, Japan.
Surg Case Rep. 2022 Apr 29;8(1):79. doi: 10.1186/s40792-022-01437-2.
Undifferentiated carcinoma is a very rare histologic subtype, representing only 0.8% to 5.7% of all pancreatic exocrine neoplasms. Additionally, spontaneous abdominal hemorrhage is a particularly rare, life-threatening cause.
A 68-year-old man was taken by ambulance to our hospital because of sudden-onset abdominal pain. Contrast-enhanced abdominal computed tomography revealed a huge mass measuring 99 × 70 mm in the pancreatic tail with enhanced rim staining in the peripheral area. Imaging also showed extravasation and fluid collection beside the tumor. Hence, spontaneous rupture of the pancreatic tumor and intra-abdominal bleeding were diagnosed. Emergency laparotomy was performed because of acute abdominal pain with peritoneal signs. With an intraoperative diagnosis of rupture of the pancreatic tumor, distal pancreatectomy was successfully performed. Histologically, hematoxylin and eosin staining showed round to spindle-shaped, highly pleomorphic mononuclear cells and multinucleated giant cells as well as a component of ductal adenocarcinoma. Immunohistochemical staining showed that the tumor cells were negative for AE1/AE3, whereas the non-neoplastic osteoclast-like giant cells were positive for CD68. Taken together, these results led to a diagnosis of undifferentiated carcinoma with osteoclast-like giant cells. The patient's postoperative course was uneventful.
We experienced an extremely rare case of spontaneous rupture of an undifferentiated carcinoma with osteoclast-like giant cells presenting as intra-abdominal bleeding. Obtaining a correct preoperative diagnosis is quite difficult at the first evaluation. Undifferentiated carcinoma should be considered as a differential diagnosis in the case with spontaneous rupture of a pancreatic tumor.
未分化癌是一种非常罕见的组织学亚型，仅占所有胰腺外分泌肿瘤的0.8%至5.7%。此外，自发性腹腔出血是一种极其罕见的、危及生命的病因。
一名68岁男性因突发腹痛被救护车送往我院。腹部增强计算机断层扫描显示胰尾部有一个巨大肿块，大小为99×70mm，周边区域有强化边缘染色。影像学检查还显示肿瘤旁有造影剂外渗和液体积聚。因此，诊断为胰腺肿瘤自发性破裂并腹腔内出血。由于急性腹痛伴有腹膜刺激征，进行了急诊剖腹手术。术中诊断为胰腺肿瘤破裂，成功实施了胰体尾切除术。组织学上，苏木精-伊红染色显示圆形至梭形、高度多形性的单核细胞和多核巨细胞以及导管腺癌成分。免疫组织化学染色显示肿瘤细胞AE1/AE3阴性，而非肿瘤性破骨细胞样巨细胞CD68阳性。综合这些结果，诊断为伴有破骨细胞样巨细胞的未分化癌。患者术后恢复顺利。
我们遇到了一例极其罕见的伴有破骨细胞样巨细胞的未分化癌自发性破裂，表现为腹腔内出血的病例。在初次评估时很难获得正确的术前诊断。对于胰腺肿瘤自发性破裂的病例，应考虑未分化癌作为鉴别诊断。
