胰腺肉瘤样未分化癌亚型与伴有破骨样巨细胞未分化癌亚型的临床病理学分析

Sarcomatoid undifferentiated carcinoma subtype and undifferentiated carcinoma subtype with osteoclast-like giant cells of the pancreas:a clinicopathological analysis

目的探讨胰腺肉瘤样未分化癌与伴有破骨样巨细胞未分化癌临床病理特征、鉴别要点、治疗及预后。方法应用HE染色及免疫组化方法分析2例胰腺未分化癌的病理特征及免疫表型,并总结相关文献。结果例1,男性,65岁,镜下见肿瘤实性片状生长,由未分化肿瘤细胞和少量高分化导管腺癌组成,未分化区域肿瘤细胞失黏附性,核圆形或梭形,胞质中等,嗜伊红或嗜双色性,核分裂象多见,坏死明显。免疫组化示未分化区域:PCK(部分+)、VIM(弥漫+)、Ki-67(+,约40%)、P53(弥漫+,突变型),高分化导管腺癌区域:PCK(弥漫+)、EMA(弥漫+)、VIM(-)。例2,男性,43岁,镜下见肿瘤实性片状生长,由单核样细胞及丰富的破骨样多核巨细胞组成,组织学形态似骨巨细胞瘤,免疫组化示单核样细胞:PCK(-)、Vimentin(+)、Ki-67(+,约40%)、CD68(部分+);破骨样多核巨细胞:PCK(-)、CD68(+)、CD163(+)。结论胰腺肉瘤样未分化癌与伴有破骨样巨细胞未分化癌具有相似的临床症状,但后者在影像学常显示边界清楚的肿块,具有更好的预后。

Obiective To explore the clinicopathological features,differentiation,treatment and prognosis of sarcomatoid undifferentiated carcinoma and undifferentiated carcinoma with osteoclast-like giant cells of the pancreas.Methods The pathological features and immunophenotype of 2 cases of undifferentiated pancreatic carcinoma were analyzed by HE staining and immunohistochemistry,and the related literatures were summarized.Results Case 1 was a 65-year-old male.Microscopically,the tumor showed a solid flaky growth pattern,and was composed of undifferentiated tumor cells and a small amount of well-differentiated ductal adenocarcinoma.The undifferentiated tumor cells lost adhesion,with round or spindle nuclei,medium,eosinophilic or bichromatic cytoplasm,obvious mitosis and necrosis.Immunohistochemistry showed that in the undifferentiated regions,PCK was partial positive,VIM was diffuse positive,Ki-67 was positive(about 40%),and P53 was diffuse positive(mutant).In the well differentiated ductal adenocarcinoma,PCK and EMA was diffuse positive,while VIM was negative.Case 2 was a 43-year-old male.The tumor showed a solid flaky growth pattern,and was composed of monocyte-like cells and abundant osteoclast-like multinucleated giant cells.The histological morphology was similar to that of giant cell tumor of bone.Immunohistochemistry showed that mononuclear-like cells were positive for vimentin,Ki-67,and partially positive for CD68,while negative for PCK.Osteoclast-like multinucleated giant cells were positive for CD68 and CD163,while negative for PCK.Conclusion Sarcomatoid undifferentiated carcinoma of the pancreas has similar clinical symptoms to undifferentiated carcinoma with osteoclast-like giant cells,but the latter often shows well-defined masses on imaging and has a better prognosis.