Osteoclast-Like Giant Cell Carcinoma of the Pancreas: Case Series: 1375

INTRODUCTION: Osteoclast-like giant cell carcinoma of the pancreas (OGCP) is an extremely rare type of pancreatic neoplasm representing less than 1% of all pancreatic cancers. Due to its rarity, sufficient knowledge is lacking regarding the natural history of the tumor, its prognosis, and treatment recommendations. CASE DESCRIPTION/METHODS: We were respectively able to identify four confirmed cases of OGCP at our institution. Table 1 provides details of each case. Case 1: A 69 year-old male presented with left lower quadrant pain similar to prior pain associated with diverticulitis. The pain did not resolve with antibiotics. Imaging revealed a 1.2-cm non-enhancing mass in the pancreatic tail. Case 2: A 77 year-old male presented with a 7-month history of epigastric discomfort and weight loss. Imaging revealed a 9-cm pancreatic head mass. Case 3: A 65 year-old male had a PET scan for diagnosis of sarcoidosis. A new 1-cm pancreatic tail nodule was revealed. He denied GI symptoms. Case 4: A 65 year-old male reported 8-weeks of abdominal cramps, loss of appetite, and weight loss. CT imaging revealed a 13-cm pancreatic mass with extension into his liver. DISCUSSION: OGCs resemble giant cell tumors of the bone. OGCs are non-neoplastic cells that are reactive in nature and are massively recruited to the neoplasm which is a hallmark of this tumor. Patients typically present in their sixth to eight decades of life. The clinical presentation is like that of other large pancreatic masses. These masses typically occur in the body and tail of the pancreas; they are well vascularized and frequently hemorrhagic. They can be diagnosed by image-guided FNA or biopsy. Surgery remains first-line therapy for OGCP's. Unfortunately, once the tumor invades surrounding organs, such as the liver, the mortality rate significantly increases. Treatment is difficult in these patients as they are typically not healthy enough to begin chemotherapy. Gemcitabine remains the chemotherapy agent of choice, as most physicians treat OGCPs similarly to adenocarcinomas given the lack of literature guidance.