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Clear cell carcinoma

Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 5 November 2014, last major update August 2012
Copyright: (c) 2001-2014, PathologyOutlines.com, Inc.


● 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

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