Difference between revisions of "Clear cell carcinoma of the ovary"

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#redirect [[Ovarian_tumours#Clear_cell_carcinoma_of_the_ovary]]
'''Clear cell carcinoma of the ovary''', also '''ovarian clear cell carcinoma''' (abbreviated '''OCCC''', is an aggressive [[malignant]] [[ovarian tumours|tumour of the ovary]].
 
It often forms glands; thus, it is also known as '''ovarian clear cell [[adenocarcinoma]]''', and '''clear cell adenocarcinoma of the ovary'''.
 
==General==
Prognosis:
* Worse prognosis versus other surface epithelial tumours.<ref name=pmid18035678>{{cite journal |author=Hauptmann S, Köbel M |title=[Prognostic factors in ovarian carcinoma] |language=German |journal=Verh Dtsch Ges Pathol |volume=89 |issue= |pages=92-100 |year=2005 |pmid=18035678 |doi= |url=}}</ref>
**Poor response to platinum-based chemotherapy.<ref name=pmid22885379/>
**~2.5x risk for thromboembolism compared to other ovarian carcinomas.<ref name=pmid19922988>{{Cite journal  | last1 = Duska | first1 = LR. | last2 = Garrett | first2 = L. | last3 = Henretta | first3 = M. | last4 = Ferriss | first4 = JS. | last5 = Lee | first5 = L. | last6 = Horowitz | first6 = N. | title = When 'never-events' occur despite adherence to clinical guidelines: the case of venous thromboembolism in clear cell cancer of the ovary compared with other epithelial histologic subtypes. | journal = Gynecol Oncol | volume = 116 | issue = 3 | pages = 374-7 | month = Mar | year = 2010 | doi = 10.1016/j.ygyno.2009.10.069 | PMID = 19922988 }}</ref>
 
Epidemiology:
* Asians appear to be at an increased risk.<ref name=pmid22885379>{{Cite journal  | last1 = Offman | first1 = SL. | last2 = Longacre | first2 = TA. | title = Clear cell carcinoma of the female genital tract (not everything is as clear as it seems). | journal = Adv Anat Pathol | volume = 19 | issue = 5 | pages = 296-312 | month = Sep | year = 2012 | doi = 10.1097/PAP.0b013e31826663b1 | PMID = 22885379 }}</ref>
* Thought to be related to endometrioid carcinoma.<ref name=Ref_PBoD1098>{{Ref PBoD |1098}}</ref>
*Association with endometriosis:<ref name=pmid22885379/>
** Increased risk of ovarian clear cell carcinoma ~ 3x.
** Seen in 50-70% of ovarian CCC.
 
==Gross==
Features:<ref name=pmid22885379/>
*Usually unilateral (unlike [[serous carcinoma of the ovary|serous carcinoma]]).
*Yellow colour.
 
==Microscopic==
Features:
*Cystic/tubular architecture - important low power feature.
**May be papillary and/or solid.
*Clear cells - cytoplasm is clear - '''key feature'''. †
*[[Hobnail morphology]] - apical surface larger than basal surface.
**"Nuclei bulge into the lumen".
*Hyaline droplets -- common, as in ''[[clear cell renal cell carcinoma]]''.
**Eosinophilic bodies within lumen.
**Seen in approximately 1/4 of cases.<ref name=pmid22885379/>
*Nucleoli - prominent.
 
Note:
*† Clear cell adenocarcinoma does not have to have clear cells. Yes, this is stupid; it is like ''[[papillary thyroid carcinoma]]'' -- which often isn't papillary -- see ''[[no truth in names]]''.
**The ''hobnail morphology'' is important if this is the case.
 
DDx:
*[[Serous carcinoma of the ovary]] - have larger papillae +/- branching +/-multilayered epithelium, more mitotic activity,<ref name=pmid22885379/> more group pleomorphism.
*[[Serous borderline tumour of the ovary]].
*High-grade [[endometrioid carcinoma of the ovary]].
*[[Metastasis|Metatstatic]] [[clear cell carcinoma]], esp. [[clear cell renal cell carcinoma]].
*Borderline clear cell lesion of the ovary - very rare; an under sampled carcinoma considered more probable.<ref name=pmid22885379/>
*[[Arias-Stella reaction]] within [[endometriosis]].
 
===Images===
<gallery>
Image:Ovarian_clear_cell_carcinoma_-a-_very_high_mag_-_cropped.jpg | Clear cell carcinoma - very high mag. - cropped (WC)
Image:Ovarian_clear_cell_carcinoma_-a-_intermed_mag.jpg | Clear cell carcinoma - intermed. mag. (WC)
Image:Ovarian_clear_cell_carcinoma_-_low_mag.jpg | Clear cell carcinoma - low mag. (WC)
Image:Ovarian clear cell carcinoma - intermed mag.jpg | Clear cell carcinoma - intermed. mag. (WC)
Image:Ovarian clear cell carcinoma - high mag.jpg | Clear cell carcinoma - high mag. (WC)
Image:Ovarian clear cell carcinoma - very high mag.jpg | Clear cell carcinoma - very high mag. (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case343.html Clear cell carcinoma of the ovary - several images (upmc.edu)].
 
==IHC==
*HNF-1beta +ve.<ref>{{Cite journal  | last1 = Tsuchiya | first1 = A. | last2 = Sakamoto | first2 = M. | last3 = Yasuda | first3 = J. | last4 = Chuma | first4 = M. | last5 = Ohta | first5 = T. | last6 = Ohki | first6 = M. | last7 = Yasugi | first7 = T. | last8 = Taketani | first8 = Y. | last9 = Hirohashi | first9 = S. | title = Expression profiling in ovarian clear cell carcinoma: identification of hepatocyte nuclear factor-1 beta as a molecular marker and a possible molecular target for therapy of ovarian clear cell carcinoma. | journal = Am J Pathol | volume = 163 | issue = 6 | pages = 2503-12 | month = Dec | year = 2003 | doi =  | PMID = 14633622 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892387/?tool=pubmed }}</ref><ref name=omim189907>{{OMIM|189907}}</ref>
**Usu. -ve in serous carcinoma.
*WT-1 -ve.
**Usu. +ve in serous carcinoma.
 
Panel for high grade serous vs. clear cell:<ref name=pmid18830127>{{cite journal |author=Köbel M, Kalloger SE, Carrick J, ''et al.'' |title=A limited panel of immunomarkers can reliably distinguish between clear cell and high-grade serous carcinoma of the ovary |journal=Am. J. Surg. Pathol. |volume=33 |issue=1 |pages=14–21 |year=2009 |month=January |pmid=18830127 |doi=10.1097/PAS.0b013e3181788546 |url=}}</ref>
*ER (+ve in serous),<ref name=pmid21164285>{{Cite journal  | last1 = DeLair | first1 = D. | last2 = Oliva | first2 = E. | last3 = Köbel | first3 = M. | last4 = Macias | first4 = A. | last5 = Gilks | first5 = CB. | last6 = Soslow | first6 = RA. | title = Morphologic spectrum of immunohistochemically characterized clear cell carcinoma of the ovary: a study of 155 cases. | journal = Am J Surg Pathol | volume = 35 | issue = 1 | pages = 36-44 | month = Jan | year = 2011 | doi = 10.1097/PAS.0b013e3181ff400e | PMID = 21164285 }}</ref> HNF-1beta (+ve in clear cell), WT-1 (+ve in serous).
 
Others:<ref name=pmid22885379/>
*CK7 +ve -- may be focal.
*CK20 -ve.
*CD10 -ve.
**Often +ve in [[clear cell renal cell carcinoma]].
 
==See also==
*[[Serous carcinoma]].
*[[Ovarian tumours]].
*[[Ovary]].
*[[Clear cell tumours]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Ovarian tumours]]

Revision as of 02:29, 9 January 2014

Clear cell carcinoma of the ovary, also ovarian clear cell carcinoma (abbreviated OCCC, is an aggressive malignant tumour of the ovary.

It often forms glands; thus, it is also known as ovarian clear cell adenocarcinoma, and clear cell adenocarcinoma of the ovary.

General

Prognosis:

  • Worse prognosis versus other surface epithelial tumours.[1]
    • Poor response to platinum-based chemotherapy.[2]
    • ~2.5x risk for thromboembolism compared to other ovarian carcinomas.[3]

Epidemiology:

  • Asians appear to be at an increased risk.[2]
  • Thought to be related to endometrioid carcinoma.[4]
  • Association with endometriosis:[2]
    • Increased risk of ovarian clear cell carcinoma ~ 3x.
    • Seen in 50-70% of ovarian CCC.

Gross

Features:[2]

Microscopic

Features:

  • Cystic/tubular architecture - important low power feature.
    • May be papillary and/or solid.
  • Clear cells - cytoplasm is clear - key feature. †
  • Hobnail morphology - apical surface larger than basal surface.
    • "Nuclei bulge into the lumen".
  • Hyaline droplets -- common, as in clear cell renal cell carcinoma.
    • Eosinophilic bodies within lumen.
    • Seen in approximately 1/4 of cases.[2]
  • Nucleoli - prominent.

Note:

  • † Clear cell adenocarcinoma does not have to have clear cells. Yes, this is stupid; it is like papillary thyroid carcinoma -- which often isn't papillary -- see no truth in names.
    • The hobnail morphology is important if this is the case.

DDx:

Images

  • Clear cell carcinoma - very high mag. - cropped (WC)

  • Clear cell carcinoma - intermed. mag. (WC)

  • Clear cell carcinoma - low mag. (WC)

  • Clear cell carcinoma - intermed. mag. (WC)

  • Clear cell carcinoma - high mag. (WC)

  • Clear cell carcinoma - very high mag. (WC)

www:

IHC

  • HNF-1beta +ve.[5][6]
    • Usu. -ve in serous carcinoma.
  • WT-1 -ve.
    • Usu. +ve in serous carcinoma.

Panel for high grade serous vs. clear cell:[7]

  • ER (+ve in serous),[8] HNF-1beta (+ve in clear cell), WT-1 (+ve in serous).

Others:[2]

See also

References

  1. ↑ Hauptmann S, Köbel M (2005). "[Prognostic factors in ovarian carcinoma]" (in German). Verh Dtsch Ges Pathol 89: 92-100. PMID 18035678.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Offman, SL.; Longacre, TA. (Sep 2012). "Clear cell carcinoma of the female genital tract (not everything is as clear as it seems).". Adv Anat Pathol 19 (5): 296-312. doi:10.1097/PAP.0b013e31826663b1. PMID 22885379.
  3. ↑ Duska, LR.; Garrett, L.; Henretta, M.; Ferriss, JS.; Lee, L.; Horowitz, N. (Mar 2010). "When 'never-events' occur despite adherence to clinical guidelines: the case of venous thromboembolism in clear cell cancer of the ovary compared with other epithelial histologic subtypes.". Gynecol Oncol 116 (3): 374-7. doi:10.1016/j.ygyno.2009.10.069. PMID 19922988.
  4. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1098. ISBN 0-7216-0187-1.
  5. ↑ Tsuchiya, A.; Sakamoto, M.; Yasuda, J.; Chuma, M.; Ohta, T.; Ohki, M.; Yasugi, T.; Taketani, Y. et al. (Dec 2003). "Expression profiling in ovarian clear cell carcinoma: identification of hepatocyte nuclear factor-1 beta as a molecular marker and a possible molecular target for therapy of ovarian clear cell carcinoma.". Am J Pathol 163 (6): 2503-12. PMID 14633622. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892387/?tool=pubmed.
  6. ↑ Online 'Mendelian Inheritance in Man' (OMIM) 189907
  7. ↑ Köbel M, Kalloger SE, Carrick J, et al. (January 2009). "A limited panel of immunomarkers can reliably distinguish between clear cell and high-grade serous carcinoma of the ovary". Am. J. Surg. Pathol. 33 (1): 14–21. doi:10.1097/PAS.0b013e3181788546. PMID 18830127.
  8. ↑ DeLair, D.; Oliva, E.; Köbel, M.; Macias, A.; Gilks, CB.; Soslow, RA. (Jan 2011). "Morphologic spectrum of immunohistochemically characterized clear cell carcinoma of the ovary: a study of 155 cases.". Am J Surg Pathol 35 (1): 36-44. doi:10.1097/PAS.0b013e3181ff400e. PMID 21164285.
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