Effective Use of Gemcitabine in the Treatment of Undifferentiated Carcinoma with Osteoclast-Like Giant Cells of the Pancreas with Portal Vein Tumor Thrombus

Abstract

A 74-year-old woman had an undifferentiated carcinoma with osteoclast-like giant cells (UCWOGC) in the body of the pancreas with massive portal vein tumor thrombus (PVTT). Because the PVTT progressed so rapidly into the right portal branch, the patient first underwent distal pancreatectomy and tumor thrombectomy to prevent life-threatening portal venous obstruction. Although a recurrent PVTT had developed early postoperatively, systemic gemcitabine treatment was so effective that it induced complete remission 5 months after the initiation of chemotherapy. The patient continued to be in complete response for 12 months, and has survived for 19 months since surgery.

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

“…The role of adjuvant treatment, either chemotherapy or radiotherapy, has not yet been clearly established, in part due to the rarity of this pathological entity. There are reports on the use of chemotherapeutic agents (such as cis-platin, paclitaxel and gemcitabine) with favorable outcome, given the epithelial origin of the tumor [9] , [18] , [19] . On the other hand, radiotherapy has been applied on the basis of radiosensitivity of giant-cell tumors of the bones [4] or as a means of eliminating any remnant cancer cells in the tumor bed after positive-margin excision [15] , sometimes with satisfactory results [20] .…”

Undifferentiated carcinoma with osteoclast-like giant cells of the ampullary region: Short term survival after pancreaticoduodenectomy

“…Although there is no standard chemotherapy for UC-OGCs of the ampullary region and related metastases, gemcitabine induced a complete response in a patient with recurrent liver and para -aortic lymph node lesions following surgical resection of a UC-OGCs of the ampullary region [14] . In addition, gemcitabine was found effective in a patient with UC-OGC of the pancreas [16] , suggesting that gemcitabine would be feasible in patients with unresectable or recurrent UC-OGCs of the ampullary region. Larger case series and longer term follow-up are necessary to clarify the clinicopathological features, surgical outcome and effects of chemotherapy in patients with UC-OGCs of the ampullary region.…”

An undifferentiated carcinoma at Klatskin-position with long-term complete remission after chemotherapy

“…This treatment approach seems to be ineffective, since all patients had no disease control [ 17 ]. In contrast, undifferentiated carcinomas of the pancreas have been successfully treated with Gemcitabine leading to a long-term remission [ 18 ]. Those few reports with contrary outcome emphasize the complexity and singularity of undifferentiated carcinomas probably depending on the affected organ system, proliferation and cell of origin.…”