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Pancreas

Tumors

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.

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

Micro description
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● 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
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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
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● Hepatocyte nuclear factor-1beta

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

Differential diagnosis
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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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