Clear cell carcinoma (adenocarcinoma)

Authors: Branko Perunovic , M.D., Ashwyna Sunassee, M.D. (see Authors page)
Editor: Ryan Askeland, M.D.

Revised: 3 November 2017, last major update May 2007

Copyright: (c) 2007-2017, PathologyOutlines.com, Inc.

PubMed Search: Clear cell carcinoma [title] cervix

Cite this page: Cervix - Clear cell carcinoma (adenocarcinoma) . PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/cervixclearcell.html. Accessed December 14th, 2017.
Definition / general
  • Uncommon adenocarcinoma of Mullerian origin (Cytojournal 2013;10:17)
  • 4 - 9% of cervical adenocarcinomas (Gynecol Obstet Invest 2014;77:64)
  • Most common form of cervical carcinoma in young women, but less common in cervix than ovary and endometrium
  • Good survival - 55% at 5 years and 40% at 10 years
  • Associated with in uterine DES exposure (women born in 1950's, N Engl J Med 1987;316:514); also older women without DES exposure; rare in children
  • Historically ages 14 to 22 years at diagnosis versus non-DES associated: ages 13-80 years
  • Not related to high risk HPV (Int J Gynecol Cancer 2013;23:1084, Gynecol Oncol 2011;122:297)
  • Due to ban on DES use in pregnancy, DES associated clear cell carcinoma is extremely rare and generally affects older women
  • Recommended to obtain annual cervical and vaginal smears for DES exposed women, even after menopause (Gynecol Oncol 1999;75:338)
Case reports
Gross description
  • Involvement of ectocervix (if DES exposure) or endocervical canal (no DES exposure)
  • May resemble cervical polyp
Microscopic (histologic) description
  • Tubulocystic, solid, papillary or microcystic patterns of cells with abundant clear or eosinophilic cytoplasm, large irregular nuclei
  • Hobnailing of cells (nuclei protrude into lumina)
  • Intraglandular papillary projections
  • In situ changes at squamocolumnar junction
  • May have hyalinized stroma or papillary cores, may have eosinophilic material within tubules or cysts
Microscopic (histologic) images

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Tubulocystic pattern

Approaching mesonephric remnants

Clear cell carcinoma

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Various images

Clear cell carcinoma

Cytology description
  • Pap test:
    • Cells are arranged in sheets, clusters or papillae
    • Cells have delicate vacuolated glycogen rich cytoplasm that may show naked nuclei and a tigroid background
    • Nuclei are large, pale, round with prominent nucleoli
  • FNA:
    • Loose, three dimensional clusters and sheet arrangement of atypical cells
    • Atypical cells are large with abundant, weakly stained cytoplasm
    • Round or oval nuclei with large nucleoli (Acta Cytol 2000;44:251)
Cytology images

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Missing Image

Conventional Pap test

Electron microscopy description
  • Continuous lamina densa, numerous mitochondria and rough endoplasmic reticulum, abundant glycogen and blunt microvilli
  • Vesicular aggregates in nucleoplasm, perinuclear cytoplasm or between membranes of nuclear envelope (Acta Cytol 1976;20:262)
Electron microscopy images

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Clear cell carcinoma

Positive stains
Differential diagnosis
Additional references