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Rusu A, Giuşcă SE, Apostol DGC, Ionescu L, Căruntu ID. Cephalic undifferentiated carcinoma with osteoclast-like giant cells arising from the main pancreatic duct: case report and literature review. Arch Clin Cases 2021; 6:6-21. [PMID: 34754903 PMCID: PMC8565694 DOI: 10.22551/2019.22.0601.10148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Undifferentiated carcinoma with osteoclast-like giant cell (UCOGC) is a ductal carcinoma variant with a recently reported more protracted survival and pathognomonic histology comprising two cell populations: the mononuclear tumoral cells and nontumoral multinucleated giant cells. It usually presents as a large heterogenic tumor with mixed solid-cystic components. The tumor develops from the ductal epithelium but the sequence of epithelial changes is often not identified due to the rapid tumoral growth and associated necrotic changes. We report a case of a 76-year-old patient diagnosed with cephalic UCOGC originating in the epithelium of the main pancreatic duct with endoluminal growth and foci of other ductal neoplasms (high-grade pancreatic intraepithelial neoplasia (PanIN) and conventional ductal carcinoma). The particularity of our case consists in the identification of the columnar epithelium conversion, through high-grade PanIN, into UCOGC specific malignant features, in a large size tumor - aspect usually reported in small tumors. Alongside our case we also present a brief literature review of cephalic UCOGC case reports and case series.
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Affiliation(s)
- Andreea Rusu
- Department of Morphofunctional Sciences I - Histology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania
| | - Simona Eliza Giuşcă
- Department of Morphofunctional Sciences I - Pathology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania
| | - Delia Gabriela Ciobanu Apostol
- Department of Morphofunctional Sciences I - Pathology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania.,Department of Pathology "Sf. Spiridon" County Clinical Emergency Hospital, Iaşi, Romania
| | - Lidia Ionescu
- Department of Surgery, Third Surgery Clinic, "St. Spiridon" County Clinical Emergency Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania
| | - Irina-Draga Căruntu
- Department of Morphofunctional Sciences I - Histology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania
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Ueberroth BE, Liu AJ, Graham RP, Bekaii-Saab TS, McWilliams RR, Mahipal A, Truty MJ, Mody K, Sonbol MB, Halfdanarson TR. Osteoclast-Like Giant Cell Tumors of the Pancreas: Clinical Characteristics, Genetic Testing, and Treatment Modalities. Pancreas 2021; 50:952-956. [PMID: 34369897 DOI: 10.1097/mpa.0000000000001858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES This study sought to better characterize patient characteristics, treatment options, and outcomes for osteoclast-like giant cell carcinoma of the pancreas, a rare subtype of pancreatic adenocarcinoma. METHODS This is a retrospective study of all patients with osteoclast-like giant cell carcinoma of pancreatic origin treated at Mayo Clinic from 2000 to present. Baseline patient characteristics, treatment modalities utilized, and outcomes were compiled. Overall survival (OS) and progression-free survival were assessed using Kaplan-Meier analysis with a significance level of P ≤ 0.05. RESULTS Fifteen patients met criteria for inclusion. Four patients had distant metastases at diagnosis, the remaining 11 with locoregional disease. Median OS for the entire cohort was 11 months. Metastatic disease was associated with significantly shorter OS (3.5 vs 14.1 months; P = 0.005). Three patients had no evidence of disease at time of analysis; all 3 were treated with complete resection followed by adjuvant chemotherapy. CONCLUSIONS Osteoclast-like giant cell carcinoma of the pancreas is an aggressive malignancy with poor prognosis. For patients with locoregional disease, surgical resection followed by adjuvant chemoradiation may play a role in extended disease-free survival. Metastatic disease presents a challenging entity to treat with little data to support any effective chemotherapy regimens.
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Affiliation(s)
| | - Alex J Liu
- From the Department of Internal Medicine, Mayo Clinic, Phoenix, AZ
| | | | | | | | - Amit Mahipal
- Department of Oncology, Mayo Clinic, Rochester, MN
| | - Mark J Truty
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - Kabir Mody
- Department of Oncology, Mayo Clinic, Jacksonville, FL
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Abstract
OBJECTIVES This study aimed to identify the detailed clinicopathological features of undifferentiated carcinoma of the pancreas (UCP). METHODS We investigated clinical, imaging features and the prognoses of 261 patients; 8 were our patients, and the remainder were identified by searching English-language articles in PubMed. RESULTS We classified patients with UCP into 3 types based on pathological findings: osteoclast-like giant cell-associated carcinoma, pleomorphic cell carcinoma (PLC), and spindle cell carcinoma. There were no remarkable differences in clinical, radiological features between these 3 types. However, PLCs were significantly more likely to be unresectable than were the other 2 types (P < 0.001). Patients with osteoclast-like giant cell-associated carcinoma achieved the best overall survival (OS) rates (P < 0.001), whereas those with spindle cell carcinoma had significantly longer OS rates than did those with PLC (P = 0.004). These OS patterns were maintained when considering only those patients who underwent resection. Patients with PLC had both lower curative resection and high lymph node metastasis rates (P = 0.029, P = 0.023). Patients who underwent resection had more favorable prognoses than did those who did not. CONCLUSIONS Surgery is the first choice for resectable UCP. Pleomorphic cell carcinoma is particularly malignant; postoperative treatment should be introduced immediately.
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Yazawa T, Watanabe A, Araki K, Segawa A, Hirai K, Kubo N, Igarashi T, Tsukagoshi M, Ishii N, Hoshino K, Kuwano H, Shirabe K. Complete resection of a huge pancreatic undifferentiated carcinoma with osteoclast-like giant cells. Int Cancer Conf J 2017; 6:193-196. [PMID: 31149501 DOI: 10.1007/s13691-017-0305-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/24/2017] [Indexed: 12/17/2022] Open
Abstract
Pancreatic undifferentiated carcinoma with osteoclast-like giant cells (PUC-OGC) is a rare neoplasm. We report a case of rapidly advancing PUC-OGC. A 54-year-old man had elevated tumor marker levels. Abdominal computed tomography showed a cystic mass in the body and tail of the pancreas, which infiltrated adjacent organs. The tumor exhibited rapid growth (doubling time: 39 days) but no metastases. We diagnosed PUC-OGC clinically and excised the pancreatic body and tail along with the spleen, left kidney, adrenal gland, and transverse colon. Pathological diagnosis showed histology consistent with PUC-OGC and a negative margin without nodal involvement despite the tumor being 28 cm in maximum diameter and having invaded the left kidney. The patient survived a year with a recurrence of liver metastasis after the initial surgery due to the partial hepatectomy and chemotherapy. Complete resection might be a good strategy to cure PUC-OGC in this case.
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Affiliation(s)
- Tomohiro Yazawa
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Akira Watanabe
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Kenichiro Araki
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Atsuki Segawa
- 2Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511 Japan
| | - Keitaro Hirai
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Norio Kubo
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Takamichi Igarashi
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Mariko Tsukagoshi
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Norihiro Ishii
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Kouki Hoshino
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Hiroyuki Kuwano
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
| | - Ken Shirabe
- 1Department of Integrative Center of General Surgery, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511 Japan
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Yamada M, Furukawa D, Yazawa N, Izumi H, Masuoka Y, Mashiko T, Kawaguchi Y, Ogawa M, Kawashima Y, Mine T, Hirabayashi K, Nakagohri T. Undifferentiated carcinoma of the ampulla of Vater. Surg Case Rep 2017; 3:9. [PMID: 28063144 PMCID: PMC5218948 DOI: 10.1186/s40792-016-0284-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/27/2016] [Indexed: 01/07/2023] Open
Abstract
Undifferentiated carcinoma of the ampulla of Vater is a rare disease with unclear and clinical characteristics and prognosis. Here, we report the case of a 61-year-old man with undifferentiated carcinoma of the ampulla of Vater. He presented to our hospital with an increase in hepatobiliary system enzymes that was detected during a health check-up. Imaging and endoscopy demonstrated a tumor with ulcer in the ampulla of Vater, which was diagnosed as a carcinoma by biopsy. No distant metastasis was observed. Subtotal stomach-preserving pancreaticoduodenectomy was performed. Undifferentiated carcinoma was confirmed based on the presence of small round atypical cells with the formation of a solid alveolar lesion on histopathological examination and immunohistochemical staining that was positive for CAM 5.2 but negative for chromogranin A and synaptophysin. The tumor infiltrated the duodenum, but not the pancreas; no lymph node metastasis was observed. However, liver metastases were detected 2 months postoperatively. Chemotherapy was performed, and the tumor size temporality decreased; however, it grew in size again, and the patients subsequently died of the primary disease 15 months postoperatively. Undifferentiated carcinoma of the ampulla of Vater is a very rare histological type. More number of cases is necessary to clarify optimal treatment.
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Affiliation(s)
- Misuzu Yamada
- Department of Gastrointestinal Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Daisuke Furukawa
- Department of Gastrointestinal Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Naoki Yazawa
- Department of Gastrointestinal Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Hideki Izumi
- Department of Gastrointestinal Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yoshihito Masuoka
- Department of Gastrointestinal Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Taro Mashiko
- Department of Gastrointestinal Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yoshiaki Kawaguchi
- Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masami Ogawa
- Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yohei Kawashima
- Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Tetsuya Mine
- Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Kenichi Hirabayashi
- Department of Pathology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Toshio Nakagohri
- Department of Gastrointestinal Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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MDCT and MRI of the ampulla of Vater. Part I: technique optimization, normal anatomy, and epithelial neoplasms. ACTA ACUST UNITED AC 2016; 40:3274-91. [PMID: 26306515 DOI: 10.1007/s00261-015-0528-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The purpose of this two-part article is to review the cross-sectional anatomy of the ampulla and periampullary region, to propose novel and optimized MDCT and MRI techniques that allow accurate evaluation of the ampulla of Vater, and to summarize the cross-sectional imaging features of benign and malignant ampullary conditions. In this first part, we will review the normal anatomy of the ampullary region, provide suggestions on how to optimize evaluation of the ampullary region by MDCT and MRI, and review the imaging features of select epithelial neoplasms of the ampulla. Familiarity with the normal ampullary anatomy and the pathologic conditions involving the ampulla, as well as the use of optimized MDCT and MRI techniques, may improve the diagnostic accuracy of radiologists facing ampullary abnormalities.
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Kawamoto Y, Ome Y, Terada K, Hashida K, Kawamoto K, Ito T. Undifferentiated carcinoma with osteoclast-like giant cells of the ampullary region: Short term survival after pancreaticoduodenectomy. Int J Surg Case Rep 2016; 24:199-202. [PMID: 27281360 PMCID: PMC4906136 DOI: 10.1016/j.ijscr.2016.04.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 04/25/2016] [Accepted: 04/29/2016] [Indexed: 12/23/2022] Open
Abstract
A rare case of undifferentiated carcinomas with osteoclast-like giant cells of the ampullary region successfully treated with pancreaticoduodenectomy. Carcinoma in situ was also observed, spreading from the tumor at the terminal segment of the common bile duct to the surgical margin of the common hepatic duct. It is important to intraoperatively confirm negative bile duct margins by rapid pathologic diagnosis. Introduction Undifferentiated carcinomas with osteoclast-like giant cells (UC-OGCs) of the ampullary region are very rare, with only a few cases reported to date. The clinicopathological features, treatment options, and prognosis of UC-OGCs are unclear. This report describes a patient with UC-OGCs of the ampullary region. Presentation of case A 78-year-old male patient was admitted for epigastric pain and fever. Contrast-enhanced computed tomography revealed a 2.6-cm mass at the duodenal papilla. Duodenoscopy revealed a smooth red protruding mass compressing the orifice of the papilla of Vater. Biopsy of the mass showed proliferation of osteoclast-like giant cells. A subtotal stomach-preserving pancreaticoduodenectomy was performed, and the tumor was histologically diagnosed as an UC-OGCs of the ampullary region. Carcinoma in situ was also observed, spreading from the tumor at the terminal segment of the common bile duct to the common hepatic duct, with carcinoma cells at the surgical margin of the common hepatic duct. One year after surgery, the patient is alive and without tumor recurrence. Discussion UC-OGCs of the ampullary region is very rare neoplasm containing osteoclast-like giant cells and mononuclear cells. Osteoclast-like giant cells may originate from reactive mesenchymal cells and carcinoma in situ may spread to the common hepatic duct. Surgery including pancreaticoduodenectomy may be a treatment option for resectable tumors, whereas gemcitabine may be a treatment option for unresectable tumors. Conclusion Carcinoma in situ may spread quite far (5 cm) to the common hepatic duct, making it desirable to intraoperatively confirm negative bile duct margins by rapid pathologic diagnosis.
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Affiliation(s)
- Yusuke Kawamoto
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Yusuke Ome
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Kazuhiro Terada
- Department of Diagnostic Pathology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Kazuki Hashida
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Kazuyuki Kawamoto
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
| | - Tadashi Ito
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
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Georgiou GΚ, Balasi E, Siozopoulou V, Tsili A, Fatouros M, Glantzounis G. Undifferentiated carcinoma of the head of pancreas with osteoclast-like giant cells presenting as a symptomatic cystic mass, following acute pancreatitis: Case report and review of the literature. Int J Surg Case Rep 2015; 19:106-8. [PMID: 26745313 PMCID: PMC4756204 DOI: 10.1016/j.ijscr.2015.12.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 12/16/2015] [Accepted: 12/16/2015] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Undifferentiated head of pancreas carcinoma with osteoclast-like giant cells (UC-OGC) is a rare neoplasm, with less than a hundred cases reported. We present such a case, in which the UC-OGC presented atypically as a cystic lesion following acute pancreatitis and led to late diagnosis. PRESENTATION OF CASE A 75-year-old female patient, who had suffered acute pancreatitis three years ago, was referred with a diagnosis of osteoclast-like giant cell (OGC) tumor of the head of pancreas. She had suffered acute pancreatitis three years ago. Two years ago she developed abdominal pain, steatorrhea and weight loss. Abdominal computed tomography imaging showed a cystic mass in the head of the pancreas (maximum diameter 4cm). The initial diagnosis was pancreatic pseudocyst; however as the mass gradually increased in size and the patient continued to be symptomatic, a CT-guided biopsy was performed. Histological examination revealed an OGC pancreatic tumor. In laparotomy a large (9cm) encapsulated heterogeneous mass was found with partial involvement of the common hepatic artery. Pancreaticoduodenectomy was performed and the involved part of the common hepatic artery was replaced with a homologous graft from the major saphenous vein. Post-operative course was uneventful. Histology revealed an undifferentiated pancreatic adenocarcinoma with OGCs. She survived 10 months after the operation. DISCUSSION Pancreatic undifferentiated carcinomas with OGCs are very rare neoplasms and can present with an atypical clinical picture. CONCLUSIONS A symptomatic cystic lesion of the pancreas, which is growing in size, should be investigated promptly in order to exclude the presence of malignancy.
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Affiliation(s)
- Georgios Κ Georgiou
- Department of Surgery, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece.
| | - Ephimia Balasi
- Department of Histopathology, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece
| | - Vasiliki Siozopoulou
- Department of Histopathology, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece
| | - Athina Tsili
- Department of Radiology, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece
| | - Michalis Fatouros
- Department of Surgery, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece
| | - Georgios Glantzounis
- Department of Surgery, University Hospital of Ioannina, Stavros Niarchos Avenue, 45 500 Ioannina, Greece
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Okazaki M, Makino I, Kitagawa H, Nakanuma S, Hayashi H, Nakagawara H, Miyashita T, Tajima H, Takamura H, Ohta T. A case report of anaplastic carcinoma of the pancreas with remarkable intraductal tumor growth into the main pancreatic duct. World J Gastroenterol 2014; 20:852-856. [PMID: 24574758 PMCID: PMC3921494 DOI: 10.3748/wjg.v20.i3.852] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/10/2013] [Accepted: 11/03/2013] [Indexed: 02/06/2023] Open
Abstract
We herein report a case of anaplastic carcinoma of the pancreas with remarkable intraductal tumor growth into the main pancreatic duct. A 76-year-old male was referred to our hospital for treatment of a pancreatic tumor. Preoperative examinations revealed a poorly defined tumor in the main pancreatic duct in the body of the pancreas, accompanied with severe dilatation of the main pancreatic duct, which was diagnosed as an intraductal papillary-mucinous neoplasm. We performed distal pancreatectomy and splenectomy. The pathological examination revealed that the tumor consisted of a mixture of anaplastic carcinoma (giant cell type) and adenocarcinoma in the pancreas. There was a papillary projecting tumor composed of anaplastic carcinoma in the dilated main pancreatic duct. The patient is now receiving chemotherapy because liver metastasis was detected 12 mo after surgery. In this case, we could observe a remarkable intraductal tumor growth into the main pancreatic duct. We also discuss the pathogenesis and characteristics of this rare tumor with specific tumor growth.
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