Therapeutic Significance of Comprehensive Lymphadenectomy in Early-stage Clear Cell Carcinoma of Ovary

Aim: This study aims to study the therapeutic significance of full lymphadenectomy in early-stage ovarian clear cell carcinoma.Methods: This prospective study was conducted in the patients with early-stage epithelial cell carcinoma. The followingprocedures were performed: Bilateral salpingo-oophorectomy and hysterectomy (if not previously performed), washing, randommultiple peritoneal biopsies, omentectomy, and systematic pelvic and para-aortic lymphadenectomy.Results: A total of 96 of 107 women with epithelial cell carcinoma were suitable for analysis. Endometrioid (35.5%), serous(22.4%), and clear cell (7.5%) cancers represented in the histological types. 12.5% rate of lymph node metastases in apparentepithelial cell carcinoma after lymph node assessment, no cases reported in clear cell carcinoma.Conclusion: The present results suggest that some patients with selected early-stage clear cell carcinoma may benefit fromfull lymphadenectomy

Therapeutic significance of full lymphadenectomy in early-stage ovarian clear cell carcinoma / 부인종양

OBJECTIVES: This study evaluated the therapeutic significance of full lymphadenectomy in early-stage ovarian clear cell carcinoma (OCCC). METHODS: We retrospectively reviewed records of 127 consecutive patients with pT1/pT2 and M0 OCCC who were treated between January 1995 and December 2015. We compared survival outcomes between those who did and did not undergo para-aortic lymph node dissection (PAND), and analyzed independent prognostic factors (Cox proportional hazards model with backward stepwise elimination). RESULTS: Of the 127 patients, 36 (28%) did not undergo lymphadenectomy; 12 (10%) patients underwent pelvic lymph node dissection (PLND) only; and 79 (62%) patients underwent both PLND and PAND. Of the 91 patients with lymphadenectomy, 11 (12%) had lymph node metastasis (LNM). The PAND− and PAND+ groups did not significantly differ in age, distribution of pT status, radiologically enlarged lymph nodes, positive peritoneal cytology, capsule rupture, peritoneal involvement, and combined chemotherapy. Cox regression multivariate analysis confirmed that older age (hazard ratio [HR]=2.1; 95% confidence interval [CI]=1.0–4.3), LNM (HR=4.4; 95% CI=1.7–11.6), and positive peritoneal cytology (HR=4.2; 95% CI=2.1–8.4) were significantly and independently related to poor disease-specific survival (DSS), but implementation of both PLND and PAND (HR=0.4; 95% CI=0.2–0.8) were significantly and independently related to longer DSS. CONCLUSION: Although few in number, there are some patients with early-stage OCCC who can benefit from full lymphadenectomy. Its therapeutic role should be continuously investigated in OCCC patients at potential risk of LNM.

Systemic Inflammatory Response Markers and CA-125 Levels in Ovarian Clear Cell Carcinoma: A Two Center Cohort Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We compared the predictive and prognostic values of leukocyte differential counts, systemic inflammatory (SIR) markers and cancer antigen 125 (CA-125) levels, and identified the most useful marker in patients with ovarian clear cell carcinoma (OCCC). MATERIALS AND METHODS: The study included 109 patients with OCCC who did not have any inflammatory conditions except endometriosis, and underwent primary debulking surgery between 1997 and 2012. Leukocyte differential counts (neutrophil, lymphocyte, monocyte, eosinophil, basophil, and platelet), SIR markers including neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), and platelet to lymphocyte ratio (PLR), and CA-125 levels were estimated to select potential markers for clinical outcomes. RESULTS: Among potential markers (neutrophil, monocyte, platelet, NLR, MLR, PLR, and CA-125 levels) selected by stepwise comparison, CA-125 levels were best at predicting advanced stage disease, suboptimal debulking and platinum-resistance (cut-off values, > or = 46.5, > or = 11.45, and > or = 66.4 U/mL; accuracies, 69.4%, 78.7%, and 68.5%) while PLR > or = 205.4 predicted non-complete response (CR; accuracy, 71.6%) most accurately. Moreover, PLR < 205.4 was an independent factor for the reduced risk of non-CR (adjusted odds ratio, 0.17; 95% confidence interval [CI], 0.04 to 0.69), and NLR < 2.8 was a favorable factor for improved progression-free survival (PFS; adjusted hazard ratio, 0.49; 95% CI, 0.25 to 0.99) despite lack of a marker for overall survival among the potential markers. CONCLUSION: CA-125 levels may be the most useful marker for predicting advanced-stage disease. Suboptimal debulking and platinum-resistance, and PLR and NLR may be most effective to predict non-CR and PFS in patients with OCCC.

Female Prostate? - Clear Cell Adenocarcinoma of Female Urethra

Clear cell adenocarcinoma of the female urethra is extremely rare. Because the primary urethral carcinomas are rare, standard diagnostic algorism and management has not been established yet. We report a case of clear cell adenocarcinoma of the proximal urethra in a 76-year-old female. She was presented with voiding difficulty for several years after pubovaginal sling operation due to stress urinary incontinence twelve years ago. Before this period, she had managed with medication for detrusor hypocontractility. Recently she complained bloody vaginal discharge, and her vaginal examination revealed palpable mass on the anterior vaginal wall. Pelvic MRI showed a 5×4.5cm sized tumor surrounding the proximal urethra which was mimicking prostate with no lymphadenopathy. Biopsy of the mass confirmed it to be clear cell adenocarcinoma. She underwent anterior pelvic exenteration and ileal conduit with bilateral pelvic lymph node dissection. The patient received adjuvant radiotherapy and chemotherapy as treatment. We should carefully evaluate patients with voiding symptom after anti-incontinence surgery and multimodal treatment should be applied for locally advanced urethral carcinoma.

Clear cell histology as a poor prognostic factor for advanced epithelial ovarian cancer: a single institutional case series through central pathologic review / 부인종양

OBJECTIVE: Compared with serous adenocarcinoma (SAC), clear cell carcinoma (CCC) often shows chemo-resistance, which would potentially lead to a poor prognosis. On the other hand, there have been arguments over prognoses of CCC and SAC disease. In the present study, multivariate analysis to compare prognosis of CCC patients with that of SAC was aimed for the patients selected from central pathologic review. METHODS: Between 1984 and 2009, a total of 500 ovarian cancer patients were treated at our university hospital. Among them, 111 patients with CCC and 199 patients with SAC were identified through central pathological review. Overall survival and progression-free survival were compared using Kaplan-Meier method, and prognostic factors were investigated by multiple regression analyses. RESULTS: Median age was 52 years for CCC and 55 years for SAC (p=0.03). The ratio of stage I patients were significantly higher in CCC compared with SAC (55% vs. 13%, p<0.01). Among evaluable cases, response rate was significantly lower in CCC than that in SAC (32% vs. 78%, p<0.01). No significant differences of progression-free survival and overall survival were observed in stage I patients; however, prognoses of CCC were significantly poorer than those of SAC in advanced-stage disease. In stage II-IV patients, not only residual tumors and clinical stages, but also clear cell histology were identified as predictors for poor prognosis. CONCLUSION: Clear cell histology was identified as a prognostic factor for advanced-stage ovarian cancers. Histologic subtypes should be considered in further clinical studies, especially for advanced epithelial ovarian cancers.

Clear cell adenocarcinoma of the male urethral tract.

We present a rare case of clear cell adenocarcinoma of the male bulbomembranous urethra. Mostly these tumors have been described in the female urethral tract with its possible origin from mullerian remnants, wolffian remnants or paraurethral glands. Histologically, these tumors have typically tubulocystic pattern comprising of hobnailed cells with clear glycogenated cytoplasm along with well-defined cytoplasmic membranes. This case is being presented due to its rarity, aggressive behavior and to discuss, trauma as its possible etiological factor

Rapid Progression of Metastatic Clear Cell Carcinoma in Thoracic Spine: A Case Report

Metastatic spinal cord compression is one of the most dreaded complications of metastatic cancer. This type of compression can lead to pain, neurological deficits and a reduction in the patient's quality of life. A case of rapid progression and extension of a metastatic epidural mass from clear cell adenocarcinoma of the kidney in a short period after surgical decompression is reported, along with a literature review.

Fertility-sparing radical abdominal trachelectomy for cervical clear cell adenocarcinoma unrelated to diethylstilbestrol exposure : A case report / 대한산부인과학회지

Clear cell adenocarcinoma (CCAC) is a rare cancer that comprises less than 9% of the cervical adenocarcinoma cases. We experienced a case of fertility-sparing radical abdominal trachelectomy for cervical clear cell adenocarcinoma (CCAC). Thus, reported it. A 27 year old female was diagnosed with clinical stage Ib cervical CCAC. She had no history of maternal exposure to diethylstilbestrol and had negative PAP cytology and HPV tests. She was treated with neoadjuvant chemotherapy followed by radical abdominal trachelectomy. After 2 cycles of postoperative adjuvant chemotherapy, the lesion disappeared completely in an imaging study, and potential fertility was preserved. Radical abdominal trachelectomy with chemotherapy may be a valuable approach for treating stage Ib cervical CCAC in women that wish to preserve potential fertility.

A relação do grau nuclear e o tamanho tumoral no carcinoma renal de células claras de estágio I e II / Association of nuclear grade and tumor size in stage I and II clear cell renal carcinoma

Introdução: O carcinoma de células renais é reconhecido como uma família de carcinomas que são originados do epitélio dos túbulos renais. Estes carcinomas apresentam diferentes achados morfológicos e originam-se através de diferentes lesões genéticas. Aproximadamente três quartos de todos os carcinomas renais são carcinomas de células claras. Se a cirurgia é a principal forma de tratamento, o estágio é o principal determinante do prognóstico. Entre grupos individuais de estadiamento, o grau nuclear, o tamanho do tumor, a invasão vascular e do tecido adiposo perirrenal e a presença de metástases são os principais fatores prognósticos. Metodologia: Com o objetivo de estimar a associação entre o sistema de graduação nuclear e o tamanho tumoral, os autores descrevem 35 casos de carcinoma renal de células claras em estágio I e II. Todos os pacientes foram submetidos a nefrectomia radical ou parcial entre 2002 e 2006. Resultados: O grau histológico 1 foi encontrado em 9 casos (25,7%), o grau 2 em 19 casos (54,3%), o grau 3 em 3 casos (8,6%) e o grau 4 em 04 casos (11,4%). O tamanho tumoral médio foi de 6,3cm, havendo 12 casos no grupo T1a (34,3%), 9 casos no grupo T1b (25,7%) e 14 casos no grupo T2 (40%). Conclusão: Os dados encontrados mostraram que o grau nuclear segundo Fuhrman está associado ao tamanho tumoral (p=0,0001). Esta associação poderia ser utilizada na estratificação de pacientes em grupos prognósticos individuais para o desenvolvimento de condutas clínicas pertinentes (AU)

Introduction: Renal cell carcinoma is recognized as a family of carcinomas which arise from the epithelium of the renal tubules. These carcinomas have distinct morphologic features and arise through different genetic lesions. Approximately three quarters of all renal cell carcinomas are clear cell carcinomas. As surgery is the main treatment, tumor stage is the main determinant of prognosis. Within individual stage groups, nuclear grade, tumor size, vascular and perinephric fat invasion and metastases are the main prognostic factors. Methodology: To determine the association between the nuclear grading system and tumor size, the authors reviewed 35 cases of clear cell renal carcinoma stages I and II. All patients underwent radical or partial nephrectomy between 2002 and 2006. Results: Histological grade 1 was found in 9 cases (25.7%), grade 2 in 19 cases (54.3%), grade 3 in 3 cases (8.6%) and grade 4 in 4 cases (11.4%). The mean tumor size was 6.3 cm, with 12 cases in the T1a stage, 09 cases in T1b stage, and 14 cases in the T2 stage. Conclusion: Our data showed that nuclear grading according to Fuhrman is associated with tumor size (p=0.0001). This association could be useful in the stratification of patients into individual prognostic groups for the development of clinical trials (AU)

Two cases of thromboembolism in clear cell ovarian adenocarcinoma / 대한산부인과학회지

High incidence of deep venous thrombosis after radical pelvic surgery is well known. Among gynecologic malignancies, ovarian cancer, especially clear cell adenocarcinoma is likely to develop thromboembolism. We report 2 cases of pulmonary thromboembolism and deep vein thrombosis in ovarian clear cell carcinoma with endometriosis and history of IVF-ET during cislatin-irinotecan chemotherapy following the surgery.

A case of clear cell adenocarcinoma of the uterine cervix in a 6-year-old girl / 대한산부인과학회지

The clear cell adenocarcinoma of uterine cervix is very rare tumor, and only 4-9% of entire adenocarcinoma appears to be diagnosed as clear cell adenocarcinoma. Its risk factor and pathogenesis are not exactly known, but intrauterine exposure to DES (diethyl stilbestrol) and associated non-steroidal estrogen during pregnancy before 18weeks is one known risk factor, and also hormonal change or genetic cause are suggested as the risk factors. The peak age of its occurrence has bimodal pattern, which are groups before 24 years-old and after 45 years-old, and clear cell adenocarcinoma arising in latter group is not associated with intrauterine DES exposure. It is also reported that 25% of young women who has clear cell adenocarcinoma had no history of hormonal exposure. The treatment and prognosis is similar to other kinds of uterine cervical adenocarcinoma. With a short literature review, we are reporting a case of 6-year-old girl who visited our clinic because of vaginal mass naturally fallen off with a minor bleeding which was finally diagnosed as clear cell adenocarcinoma, and had no maternal history of DES exposure during pregnancy.

Clear Cell Adenocarcinoma of the Urinary Bladder / 대한비뇨기과학회지

A case of a clear cell carcinoma of the urinary bladder is reported. A 48-year-old female was referred to our hospital complaining of gross hematuria and terminal dysuria. She had a nodular tumor, 3x4cm in diameter, located on the bladder neck, trigone and posterior urethra. The patient underwent anterior pelvic exenteration and urinary diversion with an ileal conduit. A histopathological examination revealed a tumor composed of cells with eosinophilic cytoplasm, and partly of cells with clear cytoplasm or hobnail-shaped cells, arranged in tubular and papillary architectures. This showed the findings of a clear cell adenocarcinoma of the bladder and urethra. The patient underwent 6 courses of adjuvant chemotherapy with cisplatin and 5-FU. The patient shows no evidence of recurrence or metastasis at the 8 month postoperative follow-up.

A Case of Clear Cell Adenocarcinoma of the Cervix Uteri and it's Diethylstillbestrol - related Maternal History / 대한부인종양콜포스코피학회잡지

A case of vaginal and cervical adenocarcinoma, mostly of clear cell type, in young women have been associated with intrauterine exposure to diethystillbestrol(DES) or other nonsteroidal estrogenic substances and vaginal adenosis. We have encountered a case of clear-cell adenocarcinoma of the cervix uteri of 27years young house wife, in which there was a history of intrauterine exposure to DES. We presented a case with a brief review of related literature.

Clear Cell Adenocarcinoma of the Female Urethra: 2 Cases / 대한비뇨기과학회지

Primary carcinoma of the urethra in women is extremely rare and most are reported to be either squamous or transitional carcinomas. Adenocarcinoma of the female urethra represents approximately 10% of primary urethral neoplasms and clear cell variant is a rare but histologically distinct tumor. We report two cases of clear cell adenocarcinoma of the female urethra.

A Case of Rapidly Progressive Glomerulonephritis in Henoch-Schonlein Purpura

A case of primary non-clear-cell adenocarcinoma of the vagina is reported occurring in a 65-year-old woman without exposure to diethylstilbestrol (DES) in utero. The adenocarcinoma did not appear to be associated with vaginal adenosis. It lacked clear cell component and interestingly composed of columnar epithelial cells of endocervical-type. Cytologically round to oval nuclei revealed one or more small nucleoli and fine granular chromatin pattern. Cytoplasm was plump, faintly basophilic and homogeneously stained. Histologically well differentiated columnar epithelial cells were arranged in trabecular pattern mainly, and also occasional glandular lumina and small solid sheets were found. Mitoses were hardly found.

Clear Cell Adenocarcinoma of the Bladder: Report of a Case / 대한비뇨기과학회지

No abstract available.

Clear Cell Adenocarcinoma of the Urinary Bladder Accompanied by Vesical Endometriosis

A case of clear cell adenocarcinoma arising in the female urinary bladder, which is accompanied by endometriosis of the urinary bladder and the uterus, is reported. The carcinoma protruded into the vesical lumen as a fungating mass, and had a tubulocyotic pattern. The tumor cell had intracytoplasmic glycogen and electron microscopically short microvilli on their surface, resembling clear cell acenocarcinoma of the female genital tract including ovary. This is the fourth case report of clear cell adenocarcinoma complicating vesical endometriosis, and may support the view that clear cell carcinome arises from endometriosis which, in turn, from the Mullerian remnant.

Clear Cell Adenocarcinoma of the Urinary Bladder Accompanied by Vesical Endometriosis

A case of clear cell adenocarcinoma arising in the female urinary bladder, which is accompanied by endometriosis of the urinary bladder and the uterus, is reported. The carcinoma protruded into the vesical lumen as a fungating mass, and had a tubulocyotic pattern. The tumor cell had intracytoplasmic glycogen and electron microscopically short microvilli on their surface, resembling clear cell acenocarcinoma of the female genital tract including ovary. This is the fourth case report of clear cell adenocarcinoma complicating vesical endometriosis, and may support the view that clear cell carcinome arises from endometriosis which, in turn, from the Mullerian remnant.