Very aggressive gastric adenocarcinoma with rare osteoclast — like giant cells: a case report and review of the literature

Abstract

Extraskeletal carcinomas with osteoclast-like giant cells (OGC) constitute a rare type of malignant tumors, usually located in the pancreas, gall bladder, breast and kidney. Histologically they are characterized by the presence of mul­tinucleated giant cells that resemble osteoclasts mixed with poorly differentiated adenocarcinoma cells. This paper reports a case of primary gastric adenocarcinoma with osteoclast-like giant cells in a 75-year-old woman who suffered from epigastric pain, nausea, vomiting and weight loss. Histological examination of the tissue obtained during initial surgery (subtotal palliative Billroth II resection) revealed poorly differentiated adenocarcinoma with an infiltrate of osteoclast-like giant cells and no EBV immunostaining (non-lymphoepithelioma-like carcinoma, stage pT4aN3a). The tumor progressed rapidly with extensive perigastric involvement, infiltration of the paraaortic lymph nodes and the head of the pancreas. Poor general condition (WHO 3) prevented postoperative chemotherapy. The patient died 5 months after surgery due to rapid relapse. There is still a lack of knowledge to determine the prognosis for patients with OGC carcinomas. In this study, we report a case of gastric adenocarcinoma with OGC and review the previously published literature clinical and pathologic data on this rare neoplasm.