Pancreas - Clear cell carcinoma

Home Chapter Home Jobs Conferences Fellowships Books

Pancreas

Tumors

Clear cell carcinoma

Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 14 December 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
=========================================================================

● Variant of usual type ductal carcinoma (UDC) not well recognized in pancreas, with aggressive behavior
● Not a distinct WHO diagnosis (included under Miscellaneous)
● Clear cells are common in pancreatic adenocarcinoma (24%), due also to UDC with <75% clear cells or containing glycogen or mucin, sugar tumors, endocrine tumors, PEComa

Case reportsl
=========================================================================

● 66 year old woman (Cancer Res Treat 2009;41:175)

Micro description
=========================================================================

● Usual type ductal carcinoma with at least 75% clear cells in one study (Mod Pathol 2008;21:1075)
● Glandular, ductal or nested structures with single layer of polygonal cells, distinct cell borders and variable nuclear atypia
● Not due to accumulation of glycogen or mucin

Micro images
=========================================================================

Various images

66 year old woman

Well differentiated adenocarcinoma with glands lined by cells with clear cytoplasm and an occasionally condensed hyperchromatic nucleus (note: cause of cell clearing is not specified)

HNF1β staining of usual type ductal adenocarcinoma

Positive stains
=========================================================================

● Hepatocyte nuclear factor-1beta

Negative stains
=========================================================================

● PAS / PASD (glycogen), mucicarmine, HMB45, chromogranin, synaptophysin

Differential diagnosis
=========================================================================

● Clear cell endocrine tumor: clear cells in nests, cords and tubules with central hemorrhage and associated thin walled vessels; stains with neuroendocrine markers
● Clear cell "sugar" tumor: large epithelioid cells, clear or eosinophilic granular cytoplasm containing glycogen with nuclear pleomorphism but no mitotic activity
● Ductal adenocarcinoma, usual type, with clear cells due to glycogen or mucin: positive for mucin stains or glycogen (PAS, removed by diastase), see also University of Pittsburgh Case #384
● Foamy gland carcinoma: well formed glands with bland cells but subtle infiltration; cells have microvesicular (white and crisply foamy) cytoplasm with distinct pink brush border like zone at the luminal portion of the cell; nuclei are basal oriented, dense or wrinkled (raisinoid); tumor cells stain with mucicarmine and other mucin stains
● PEComa: large zones of necrosis and nests of malignant cells with marked cellular pleomorphism and mitotic activity; cells are epithelioid and spindled, have clear to eosinophilic cytoplasm, large vesicular nuclei, prominent eosinophilic nucleoli; HMB45+, MelanA+
● Renal cell carcinoma, metastatic:

End of Pancreas > Tumors > Clear cell carcinoma

This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).