Undifferentiated Carcinoma

 Wide range of morphologic findings ranging from pleomorphic epithelioid cells to multinucleated giant cells to spindle cells






Clinical Issues




• Rare

• Prognosis is dismal, often < 1 year

• Surgical resection is treatment of choice


Macroscopic




• Large, fleshy mass, often with hemorrhage and necrosis, that invades adjacent organs

• Presentation as cystic mass has been reported


Microscopic




• Heterogeneous features consisting of anaplastic, giant cell and spindle cell components in varying proportions

• Variably present large, benign-appearing, multinucleated osteoclast-like giant cells


Ancillary Tests




• CK7, CK8, CK18, and CK19 can be positive but usually focal

• Neoplastic spindle cells may express smooth muscle actin but not desmin


Top Differential Diagnoses




• Melanoma

• Choriocarcinoma

• Metastatic undifferentiated carcinoma

• Other causes of multinucleated giant cells

image
Soft Fleshy Mass
Gross photograph of an undifferentiated carcinoma with osteoclast-like giant cells shows a soft, fleshy cut surface with prominent hemorrhage image and necrosis image. Some cases can have a cystic appearance.


image
Spindle Cell Area
This undifferentiated carcinoma has a prominent sarcomatoid component featuring plump spindle cells in a fascicular pattern. This tumor can have a variable mix of anaplastic, sarcomatoid, and giant cell components.

image
Giant Cells
Undifferentiated carcinoma with osteoclast-like giant cells contains 2 cell populations: Large atypical multinucleated or mononuclear malignant cells image and benign osteoclast-like giant cells image .

image
Keratin Immunohistochemistry
Undifferentiated carcinoma frequently demonstrates pankeratin expression in the large, atypical mononuclear cells. The positivity may be focal in some cases.


TERMINOLOGY


Synonyms




• Pleomorphic carcinoma, pleomorphic large cell carcinoma, pleomorphic giant cell carcinoma
• Undifferentiated carcinoma with osteoclast-like giant cells

image Giant cell tumor of pancreas

image Osteoclast-like giant cell tumor of pancreas

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Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Undifferentiated Carcinoma

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