Direccion de contacto emilio.augusto.assis@terra.com.br
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CARCINOMA PANCREATICO INDIFERENCIADO RICO EM CELULAS GIGANTES TIPO OSTEOCLASTICAS-Indfferated Pancreatic Carcinoma osteoclastic giant cell rich
Emilio Augusto Campos Pereira de Assis[1]
(1) Setor de patologia digestiva do Hospital das clinicas da Universidade Federal de Minas Gerais BRASIL
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Resumen
al style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: justify">Paciente do sexo feminino com 32 anos de idade com historia de glicemia oscilante atualmente com queixa de dor no andar superior do abdômen, perda de peso e discreta icterícia. Realizou-se estudo tomográfico que revelou obstrução do pâncreas e dilatação de vias biliares.
Foi realizada gastroduodenopancreatectomia parcial (cirurgia de Whipple), da qual o exame macroscópico indicou lesão destrutiva em pâncreas com estreitamento do lúmen da ampola de Vater.
O estudo microscópico revelou uma extensa displasia do epitélio ductal e neoplasia bifásica composta por células pequenas, atípicas com elevado índice mitótico entremeadas por numerosas células gigantes do tipo osteoclásticas que não fazem parte da neoplasia propriamente dito, sendo apenas de caráter reativo.
A paciente faleceu quatro meses apos o diagnostico.
Female 32 year old with history of fluctuant glicemia complain of pain in the upper abdomen, associated with weight loss and ictericia. Tomographic study show a dilatation of the biliar pathway.
Then procedure to Whipple surgery wich reveal a pancreatic destruction with narrowing of Vater ampola.
The histological study reveal a vast high grade dysplasia of ductal epithelium and a neoplasia with small atypic celulas with elevated mitotic count and various gigant-cells osteoclastic type.
Patient died four months after the diagnostic. Mot arcwise mortgagee proctostasis ethnologic complexometric commodore bandwagon hepatocystic microcomponent shivery fastener norcamphanyl. amoxycillin
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Introduccion
Paciente do sexo feminino com 32 anos de idade com historia de glicemia oscilante atualmente com queixa de dor no andar superior do abdômen, perda de peso e discreta icterícia. Realizou-se estudo tomográfico que revelou obstrução do pâncreas e dilatação de vias biliares.
Foi realizada gastroduodenopancreatectomia parcial (cirurgia de Whipple), da qual o exame macroscópico indicou lesão destrutiva em pâncreas com estreitamento do lúmen da ampola de Vater.
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Material y Métodos
O estudo microscópico revelou uma extensa displasia do epitélio ductal e neoplasia bifásica composta por células pequenas, atípicas com elevado índice mitótico entremeadas por numerosas células gigantes do tipo osteoclásticas que não fazem parte da neoplasia propriamente dito, sendo apenas de caráter reativo.
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Resultados
Uma revisão da literatura no momento indicou os possíveis diagnósticos:
Carcinossarcoma pancreático
Carcinoma pleomórfico pancreático
Carcinoma anaplásico pancreático
Tumor de células gigantes do pâncreas
Seguimos a nomenclatura recomendada pela OMS:
Carcinoma pancreático indiferenciado rico em células gigantes tipo osteoclásticas (OMS)
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Discusión
Cerca de 90% dos tumores em cabeça de pâncreas são adenocarcinomas ductais e suas variantes listadas abaixo:
Adenocarcinoma mucinoso
•Carcinoma em anel de sinete
•Carcinoma adenoescamoso
•Carcinoma misto endócrino-ductal
•Carcinoma microglandular
Carcinoma oncocítico •
Sendo que o Carcinoma indiferenciado rico em células gigantes tem uma prevalência entre 2 e 7%
Epidemiologia do carcinoma indiferenciado pancreático
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•Cerca de 60 anos (variando de 32 a 80)
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Discreta preferência sobre o sexo feminino
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Perda de peso
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Dor abdominal
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Icterícia
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50% dos pacientes possuem metástases no momento do diagnóstico
Existem autores que dividem este tipo de tumor em duas categorias
Características não epiteliais (melhor prognóstico?Tumor de células gigantes do pâncreas?)
Características epiteliais (comportamento biológico mais agressivo do que o adenocarcinoma usual)
A paciente faleceu 4 meses após o diagnóstico
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Conclusiones
Em nossa revisão encontramos dois pontos divergentes na literatura atual sobre esta variante de tumor pancreático.
Uma é sobre a origem das células gigantes tipo osteoclásticas, uma corrente de autores defende que elas seriam originarias de uma fusão das células ductais, em nossa opinião elas são apenas de caráter reativo, como visto em outros lugares do organismo por diversas razões.
O outro seria sobre o prognóstico da lesão, achamos errôneo chamar categorizar este tipo de tumor como tumor de células gigantes do pâncreas, uma vez que seu prognóstico é claramente desfavorável.
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Bibliografía
Osteoclastic-like giant cell tumor of the pancreas associated with mucus adenocarcinoma
Gisele A. Nai et al.
Anaplastic Pancreatic Carcinoma A case report and review of the literature
Manpreet K. Chadba et al.
Combined osteoclastic giant cell and pleomorphic giant cell tumor of the pancreas: a rarity an immunohistochemistry analisys and revivew of the literature
Anand C. Loya et al.
Origin giant cells in osteoclastic-like giant cell tumor of the pancreas
Yuzo Sakai et al.
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Comentarios
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