FNA diagnosis of osteoclast-like giant cell tumor of the pancreas
A 58-year-old female presented with the complaints of dull aching abdominal pain in and around the umbilicus for about 18 months. Pain was not related to food intake and was not radiating to the back. She was a known diabetic and hypertensive. Clinical examination revealed a firm to hard tender mass involving left hypochondrium, epigastrium, umbilical and left lumbar regions. The laboratory investigations including carcinoembryonic antigen and carbohydrate antigen (CA19-9) were within normal limits.\nPlain and intravenous contrast-enhanced computed tomography (CT) of the abdomen revealed a heterogeneous cystic pancreatic lesion abutting major regional vascular structures and gastric antrum suggesting the possibility of a pancreatic malignancy. Small lymph nodes were seen in the lesser sac.\nEndoscopic ultrasound-guided fine-needle aspiration was done from the cystic pancreatic mass and from the lymph node. Smears aspirated from the pancreatic mass were cellular and showed mononuclear stromal cells along with numerous multinucleated osteoclastic type giant cells having 10 to 20 centrally placed, overlapping nuclei with smooth delicate nuclear membranes, finely granular evenly distributed chromatin and small nucleoli [Figures and ]. Smears from the lymph node were cellular and showed features of reactive lymphadenitis. Owing to the absence of nuclear atypia, a cytological diagnosis of osteoclastic giant cell tumor of the pancreas was offered. Histopathological confirmation could not be done as the patient was lost for follow-up.