A case of double primary gastric adenocarcinoma and duodenal carcinoma with osteoclast-like giant cells / 대한내과학회지

ABSTRACT

Osteoclast like giant cells (OGCs) are infrequently encountered in a number of malignancies in extraosseous sites, such as the breast, pancreas, liver, stomach, thyroid gland, and other organs. Immunohistochemical stains demonstrate that the OGCs are of monocytic or histiocytic origin and probably represent a distinctive host response to the tumor. The OGCs show strong reactivity with CD68, and no reactivity with cytokeratin or polyclonal antibody to carcinoembryonic antigen (CEA). We experienced a 70 year old man who presented with epigastric pain and weight loss, and found synchronous duodenal carcinoma with OGCs and gastric adenocarcinoma. Histological examination showed an undifferentiated carcinoma with evenly scattered OGCs in the duodenum and liver metastases. OGCs were never seen to undergo mitotic division or exhibit atypia. By immunohistochemistry, neoplastic cells were diffusely positive for vimentin and focally positive for CAM 5.2 (low molecular weight cytokeratin), but OGCs were positive for only vimentin. He underwent palliative gastrojejunostomy for intestinal obstruction due to a large duodenal neoplasm. We report a case of synchronous double primary cancer of gastric adenocarcinoma and duodenal carcinoma with OGCs in a 70 year old man which was proved histopathologically.