Difference between revisions of "Clear cell carcinoma of the uterine cervix"
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Clear cell carcinoma - gynecologic tract -- very high mag.jpg | |||
| Width = | |||
| Caption = Clear cell carcinoma of the gynecologic tract with focal clear cells. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = cells with clear cytoplasm (may be focal), hobnail pattern), moderate-to-severe [[nuclear pleomorphism]], usu. tubular and/or cystic morphology (may be (simple) papillary and/or solid) | |||
| Subtypes = | |||
| LMDDx = [[clear cell carcinoma of the vagina]], [[clear cell carcinoma of the endometrium]], [[serous carcinoma of the endometrium]], [[serous carcinoma]] of the uterine cervix, [[mesonephric adenocarcinoma]], other [[clear cell tumours]] | |||
| Stains = PAS +ve, PASD -ve | |||
| IHC = CK7 +ve, ER -ve, PR -ve, CA-125 +ve, CEA -ve | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Staging = | |||
| Site = [[uterine cervix]] | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = +/-diethylstilbestrol (DES) exposure, "young" (median age ~38 years old) | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = rare | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = | |||
| Other = | |||
| ClinDDx = | |||
| Tx = | |||
}} | |||
'''Clear cell carcinoma of the uterine cervix''', also '''cervical clear cell carcinoma''', is a rare malignancy of the [[uterine cervix]] that classically is associated with diethylstilbestrol (DES) exposure. It typically occurs in younger women. | |||
==General== | |||
*Associated with ''diethylstilbestrol'' exposure ''in utero''.<ref name=pmid19857300>{{Cite journal | last1 = van Dijck | first1 = JA. | last2 = Doorduijn | first2 = Y. | last3 = Bulten | first3 = JH. | last4 = Verloop | first4 = J. | last5 = Massuger | first5 = LF. | last6 = Kiemeney | first6 = BA. | title = [Vaginal and cervical cancer due to diethylstilbestrol (DES); end epidemic] | journal = Ned Tijdschr Geneeskd | volume = 153 | issue = | pages = A366 | month = | year = 2009 | doi = | PMID = 19857300 }}</ref> | |||
*Less common in the cervix - when compared to other gynecologic sites.<ref name=Ref_WMSP442>{{Ref WMSP|442}}</ref> | |||
**More common in the [[clear cell carcinoma of the endometrium|endometrium]].<ref>{{Cite journal | last1 = Babić | first1 = D. | last2 = Kos | first2 = M. | last3 = Jukić | first3 = S. | last4 = Ilić | first4 = J. | last5 = Vecek | first5 = N. | last6 = Kos | first6 = M. | last7 = Mahnik | first7 = N. | title = [Clear cell carcinoma of the female genital tract]. | journal = Jugosl Ginekol Perinatol | volume = 31 | issue = 3-4 | pages = 102-4 | month = | year = | doi = | PMID = 1749271 }}</ref> | |||
*Typical young women - median age ~38 in one series.<ref name=pmid24470762>{{Cite journal | last1 = Jiang | first1 = X. | last2 = Jin | first2 = Y. | last3 = Li | first3 = Y. | last4 = Huang | first4 = HF. | last5 = Wu | first5 = M. | last6 = Shen | first6 = K. | last7 = Pan | first7 = LY. | title = Clear cell carcinoma of the uterine cervix: clinical characteristics and feasibility of fertility-preserving treatment. | journal = Onco Targets Ther | volume = 7 | issue = | pages = 111-6 | month = | year = 2014 | doi = 10.2147/OTT.S53204 | PMID = 24470762 }}</ref> | |||
Note: | |||
*[[HPV]] does '''not''' appear to be important in the oncogenesis;<ref name=pmid21620450>{{Cite journal | last1 = Kocken | first1 = M. | last2 = Baalbergen | first2 = A. | last3 = Snijders | first3 = PJ. | last4 = Bulten | first4 = J. | last5 = Quint | first5 = WG. | last6 = Smedts | first6 = F. | last7 = Meijer | first7 = CJ. | last8 = Helmerhorst | first8 = TJ. | title = High-risk human papillomavirus seems not involved in DES-related and of limited importance in nonDES related clear-cell carcinoma of the cervix. | journal = Gynecol Oncol | volume = 122 | issue = 2 | pages = 297-302 | month = Aug | year = 2011 | doi = 10.1016/j.ygyno.2011.05.002 | PMID = 21620450 }}</ref> however, this is not completely settled.<ref name=pmid22885379/> | |||
==Microscopic== | |||
Features:<ref name=pmid22885379/> | |||
*Cells with clear cytoplasm - '''key feature'''. | |||
**May be focal/absent! | |||
**Cells have large free/luminal surface area (hobnailing pattern) and small non-free surface. | |||
*Moderate-to-severe [[nuclear pleomorphism]]. | |||
*Tubular and/or cystic morphology. | |||
**May be (simple) papillary and/or solid. | |||
*Adenosis - typically adjacent. | |||
DDx: | |||
*[[Clear cell carcinoma of the endometrium]] - diagnosis based on clinico-radiologic correlation (IHC & histology not useful).<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> | |||
*[[Serous carcinoma of the endometrium]]. | |||
*[[Serous carcinoma]] of the uterine cervix. | |||
*[[Mesonephric adenocarcinoma]]. | |||
===Images=== | |||
www: | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891640/figure/f1-ott-7-111/ Cervical CCC (nih.gov)].<ref name=pmid24470762/> | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862311/figure/f0010/ Cervical CCC (nih.gov)]. | |||
==IHC== | |||
Features:<ref>{{Ref_GP|120}}</ref> | |||
*CK7 +ve. | |||
*ER -ve. | |||
*PR -ve. | |||
Others - one case only:<ref>{{Cite journal | last1 = Terada | first1 = T. | title = Clear cell adenocarcinoma of the uterine cervix in a young pregnant woman: a case report with immunohistochemical study. | journal = Med Oncol | volume = 28 | issue = 1 | pages = 290-3 | month = Mar | year = 2011 | doi = 10.1007/s12032-009-9410-x | PMID = 20054717 }}</ref> | |||
*CA-125 +ve. | |||
*p53 +ve. | |||
*CEA -ve. | |||
*CK34betaE12 -ve. | |||
==See also== | |||
*[[Uterine cervix]]. | |||
*[[Clear cell carcinoma]]. | |||
*[[Clear cell carcinoma of the vagina]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Uterine cervix]] | |||
Latest revision as of 06:45, 30 December 2015
| Clear cell carcinoma of the uterine cervix | |
|---|---|
| Diagnosis in short | |
 Clear cell carcinoma of the gynecologic tract with focal clear cells. H&E stain. | |
|
| |
| LM | cells with clear cytoplasm (may be focal), hobnail pattern), moderate-to-severe nuclear pleomorphism, usu. tubular and/or cystic morphology (may be (simple) papillary and/or solid) |
| LM DDx | clear cell carcinoma of the vagina, clear cell carcinoma of the endometrium, serous carcinoma of the endometrium, serous carcinoma of the uterine cervix, mesonephric adenocarcinoma, other clear cell tumours |
| Stains | PAS +ve, PASD -ve |
| IHC | CK7 +ve, ER -ve, PR -ve, CA-125 +ve, CEA -ve |
| Site | uterine cervix |
|
| |
| Clinical history | +/-diethylstilbestrol (DES) exposure, "young" (median age ~38 years old) |
| Prevalence | rare |
Clear cell carcinoma of the uterine cervix, also cervical clear cell carcinoma, is a rare malignancy of the uterine cervix that classically is associated with diethylstilbestrol (DES) exposure. It typically occurs in younger women.
General
- Associated with diethylstilbestrol exposure in utero.[1]
- Less common in the cervix - when compared to other gynecologic sites.[2]
- More common in the endometrium.[3]
- Typical young women - median age ~38 in one series.[4]
Note:
- HPV does not appear to be important in the oncogenesis;[5] however, this is not completely settled.[6]
Microscopic
Features:[6]
- Cells with clear cytoplasm - key feature.
- May be focal/absent!
- Cells have large free/luminal surface area (hobnailing pattern) and small non-free surface.
- Moderate-to-severe nuclear pleomorphism.
- Tubular and/or cystic morphology.
- May be (simple) papillary and/or solid.
- Adenosis - typically adjacent.
DDx:
- Clear cell carcinoma of the endometrium - diagnosis based on clinico-radiologic correlation (IHC & histology not useful).[6]
- Serous carcinoma of the endometrium.
- Serous carcinoma of the uterine cervix.
- Mesonephric adenocarcinoma.
Images
www:
IHC
Features:[7]
- CK7 +ve.
- ER -ve.
- PR -ve.
Others - one case only:[8]
- CA-125 +ve.
- p53 +ve.
- CEA -ve.
- CK34betaE12 -ve.
See also
References
- ↑ van Dijck, JA.; Doorduijn, Y.; Bulten, JH.; Verloop, J.; Massuger, LF.; Kiemeney, BA. (2009). "[Vaginal and cervical cancer due to diethylstilbestrol (DES); end epidemic]". Ned Tijdschr Geneeskd 153: A366. PMID 19857300.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 442. ISBN 978-0781765275.
- ↑ Babić, D.; Kos, M.; Jukić, S.; Ilić, J.; Vecek, N.; Kos, M.; Mahnik, N.. "[Clear cell carcinoma of the female genital tract].". Jugosl Ginekol Perinatol 31 (3-4): 102-4. PMID 1749271.
- ↑ 4.0 4.1 Jiang, X.; Jin, Y.; Li, Y.; Huang, HF.; Wu, M.; Shen, K.; Pan, LY. (2014). "Clear cell carcinoma of the uterine cervix: clinical characteristics and feasibility of fertility-preserving treatment.". Onco Targets Ther 7: 111-6. doi:10.2147/OTT.S53204. PMID 24470762.
- ↑ Kocken, M.; Baalbergen, A.; Snijders, PJ.; Bulten, J.; Quint, WG.; Smedts, F.; Meijer, CJ.; Helmerhorst, TJ. (Aug 2011). "High-risk human papillomavirus seems not involved in DES-related and of limited importance in nonDES related clear-cell carcinoma of the cervix.". Gynecol Oncol 122 (2): 297-302. doi:10.1016/j.ygyno.2011.05.002. PMID 21620450.
- ↑ 6.0 6.1 6.2 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.
- ↑ Nucci, Marisa R.; Oliva, Esther (2009). Gynecologic Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 120. ISBN 978-0443069208.
- ↑ Terada, T. (Mar 2011). "Clear cell adenocarcinoma of the uterine cervix in a young pregnant woman: a case report with immunohistochemical study.". Med Oncol 28 (1): 290-3. doi:10.1007/s12032-009-9410-x. PMID 20054717.