Uterus - Clear cell carcinoma

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Uterus

Epithelial tumors

Clear cell adenocarcinoma

Reviewer: Jamie Shutter, M.D., University of South Florida

Revised: 21 September 2012, last major update June 2010

Definition

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● Tumor of post-menopausal patients that histologically resembles ovarian clear cell carcinoma with clear or hobnail cells

● ICD-O: 8310/3

Terminology

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● Also called clear cell carcinoma

Epidemiology

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● 1–5% of all endometrial adenocarcinoma

● Usually older, post-menopausal women

Etiology

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● A type II tumor (estrogen independent)

● Arises from atrophic endometrium (not endometrial hyperplasia), similar to serous carcinoma

Clinical features

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● High grade tumors (automatically FIGO grade III) with aggressive behavior

● Poorer prognosis than high grade (grade 3) endometrioid adenocarcinoma (Br J Cancer 2006;94:642)

● If confined to corpus, has better prognosis than serous carcinoma of same stage

Case reports

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● 73 year old woman with tumor arising from adenomyosis (Int J Gynecol Pathol 2009;28:262)

Micro description (Histopathology)

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● Papillary, tubular, tubulocystic or sheet-like architecture

● Large, clear to rarely eosinophilic cells with glycogen, distinct margins and hobnail cells

● May have colloid-like material in tubules

● Enlarged angulated nuclei with enlarged irregular nucleoli

● Usually associated with a putative precursor lesion of isolated glands or surface epithelium (within an otherwise normal endometrial region) that displays cytoplasmic clarity or eosinophilia with varying degrees of nuclear atypia (Am J Surg Pathol 2006;30:1519)

● Benign endometrium is usually atrophic, not hyperplastic

Micro images

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Solid sheet of tumor cells with Predominantly papillary growth

voluminous clear cytoplasm

Tubuloglandular growth with nuclear Tubuloglandular growth (left) blends

pleomorphism. Both clear and hobnail with a more solid pattern (right).

cells are present.

A solid focus of tumor is composed of This field shows cellular stratification, voluminous

cells with pleomorphic, hyperchromatic clear cytoplasm, and bizarre, occasionally

nuclei, each with one or more prominent multiple nuclei resembling Arias-Stella

nucleoli. Voluminous clear cytoplasm is change. At lower magnification, this was an

present. obviously invasive malignant tumor.

p53 staining (figure 6)

Positive stains

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● Hepatocyte nuclear 1 beta (Hum Pathol 2007;38:1074), Ki-67 (Hum Pathol 1998;29:551)

Differential Diagnosis

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● Clear cell carcinoma of ovarian origin

● Clear cell change: no invasion, no atypia

● Endometrial EIN / atypical hyperplasia with clear cell change: not invasive, clear cells lack atypia (Ann Diagn Pathol 2003;7:381)

● Metastatic renal cell carcinoma

End of Uterus > Epithelial tumors > Clear cell carcinoma

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