Endometriosis y carcinoma de celulas claras. Reporte de caso / Endometriosis and clear cell carcinoma. Case report

RESUMEN La endometriosis corresponde a la presencia de glándulas endometriales o estroma en sitios distintos a la cavidad uterina. Afecta del 5 al 15% de las mujeres en edad reproductiva y se asocia a importante sintomatología. La teoría de la menstruación retrógrada propuesta por Sampson es la más aceptada para explicar su etiología. Varios estudios han asociado esta enfermedad a un riesgo aumentado de neoplasia, ésta entidad, denominada endometriosis asociada a malignidad, se localiza en sitios extra gonadales en un 20% de los casos, donde la pared abdominal no alcanza más de 30 casos reportados. Si bien no existe un tratamiento estándar, la mayoría de los autores han adaptado el protocolo de tratamiento para el cáncer de ovario asociado a endometriosis.

ABSTRACT Endometriosis corresponds to the presence of endometrial glands or stroma at sites other than the uterine cavity. It affects 5 to 15% of women of reproductive age and is associated with a significant symptomatology. The theory of retrograde menstruation proposed by Sampson is the most accepted to explain its etiology. Several studies have associated this disease with an increase in neoplasia, the entity, called endometriosis associated with malignancy, is located in extra gonadal sites in 20% of cases, where the abdominal wall does not reach more than 30 reported cases. Although there is no standard treatment, most authors have adapted the treatment for ovarian cancer associated with endometriosis.

Prognostic impact of lymphadenectomy in uterine clear cell carcinoma / 부인종양

OBJECTIVE: The aim of this study was to estimate the survival impact of lymphadenectomy in patients diagnosed with uterine clear cell cancer (UCCC). METHODS: Patients with a diagnosis of UCCC were identified from Surveillance, Epidemiology, and End Results (SEER) program from 1988 to 2007. Only surgically treated patients were included. Statistical analysis using Student t-test, Kaplan-Meier survival methods, and Cox proportional hazard regression were performed. RESULTS: One thousand three hundred eighty-five patients met the inclusion criteria; 955 patients (68.9%) underwent lymphadenectomy. Older patients (> or =65) were less likely to undergo lymphadenectomy compared with their younger cohorts (64.3% vs. 75.9%, p10 nodes removed) were 32% (HR, 0.68; 95% CI, 0.56 to 0.83; p<0.001) and 47% (HR, 0.53; 95% CI, 0.43 to 0.65; p<0.001) less likely to die, respectively. CONCLUSION: The extent of lymphadenectomy is associated with an improved survival of patients diagnosed with UCCC.

Carcinoma de células claras variedad no hialinizante de parótida: comunicación de dos casos con diferente grado de diferenciación / Non-hyalinizing clear cell carcinoma of the parotid: report of two cases with different grade of differentiation

El carcinoma de células claras es una neoplasia rara de bajo grado que se desarrolla casi exclusivamente en glándulas salivales menores humanas. El objetivo de esta comunicación es analizar las características estructurales, histoquímicas e inmunohistoquímicas (IHQ) de dos casos de carcinoma de células claras de parótida y realizar el diagnóstico diferencial con otros tumores salivales primarios y metastásicos que presentan células claras. Cortes de ambos tumores fueron procesados para H/E, tricrómicos de Masson y Dane, Azul de toluidina, Azul alciano, PAS y PAS/diastasa; marcaciones IHQ para citoqueratinas de bajo y alto peso molecular, ki67, HMB45, p63 y proteína S-100. El patrón estructural de estos tumores estaba determinado por nidos y cordones de células claras delimitados por un estroma no hialinizado. En un tumor se observó una neoplasia maligna a células claras con manifiesta anaplasia. La expresión de ki67 fue importante. El otro tumor estaba constituido por células claras monomorfas sin signos manifiestos de atipia y casi nula expresión de ki67. Con PAS se demostró la presencia de glucógeno y no se observó un desarrollo importante del estroma colágeno en ambas neoplasias. En ambos casos resultó francamente positiva la inmunomarcación para citoqueratinas de bajo y alto peso molecular. Por el contrario resultó negativa para HMB45 y p63. La proteína S-100 tuvo su expresión en células aisladas. Se concluye que los casos presentados son de localización poco común (parótida) según lo descripto en la bibliografía; corresponden a la variedad no hialinizante ya que no está presente un importante estroma colágeno hialinizado, y ambos tumores son primarios de glándulas salivales, de origen epitelial, no melanocítico ni hematopoyético (linfomas) como lo demuestran las marcaciones IHQ.

The clear cell carcinoma is a rare neoplam of low level grade that develops almost exclusively in human minor salivary glands. The objective of this present work is to analyze the structural, histochemical and inmunohistochemical (IHQ) characteristics of two cases of parotid clear cell carcinoma and make a differential diagnosis with other primary and metastatic salivary tumors that clear cells show. Serial cuts of both tumors were processed for H/E, Masson and Dane trichromes, Toluidine blue, Alcian blue, PAS and PAS/diastase; IHQ marking of both high-and low-molecular weight cytokeratins, ki67, HMB45, p63 and S-100 protein. The structural pattern of these tumors were determined by nests and cords of clear cells delimited by a stroma non hyaline. In a tumor a malign neoplasia was observed in clear cells with anaplasia. The ki67 expression was important. The other tumor was constitued of clear monomorph cells without manifestation signs of atypia and almost no ki67 expression. With PAS was confirmed the presence of glycogen and not observed an important development of the collagen stroma in both neoplasms. Both cases resulted very positive the immunostaining of both high and low molecular weight cytokeratins. It resulted negative for the HMB45 and p63. The protein S-100 has it´s expression in isolated cells. We conclude that: the presented cases are very uncommon localization (parotid) as described by the literature; it matches a non hyalinizing variety because a very important hyalinized collagen stroma is not present, both primary tumors of salivary glands, of epithelial origin, non melanocytic, renal or hematopoietic lymphomas which shows immunostaining IHQ.

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

Hyalinizing clear cell carcinoma of the base of tongue: A distinct and rare entity.

Hyalinizing clear cell carcinoma (HCCC) of tongue is a rare neoplasm originating from minor salivary glands. We present a case of HCCC involving the base of tongue, in a 73-year-old male, clinically diagnosed as fibroma. Laser excison of the mass was done. Histopathological examination showed an infiltrating lesion composed predominantly of clear clear. The differential diagnosis included other salivary gland lesions having a clear cell component and metastatic clear cell renal carcinoma. lmmunohistochemistry was useful in ruling out these lesions exhibiting clear cell component from clear cell carcinoma. imaging studies revealed no lesion in either kidney. Since, HCCC has a better prognosis and the adequate treatment is wide excision, it needs to be differentiated from other carcinomas with clear cells. No further therapy was given to the patient. One year after the surgery, the patient is symptom free without local recurrence and on regular follow up.

Uterine clear cell adenocarcinoma with adenomyosis: a case report with review of literature

Corpus cancer is the most frequently occurring female genital cancer. Clear cell carcinoma is a rare form of endometrial cancer accounting for 1-1.5% of all endometrial carcinomas and is often associated with an aggressive clinical behaviour and poor clinical outcome. The molecular pathways involved in development of clear cell carcinoma are still unclear with the present presumption that it arises from atrophic endometrium. Patients with clear cell carcinoma often experience relapse in pelvis, in para-aortic nodes and at distant sites. Total abdominal hysterectomy and bilateral salphingo-oopharectomy with comprehensive surgical staging is the standard surgical treatment of patients with clear cell carcinoma of endometrium, whereas pelvic irradiation, para-aortic irradiation, whole abdominal irradiation and chemotherapy have been widely employed as post operative therapy. This is a case report of a rare case of clear cell carcinoma of endometrium with adenomyosis. A 65 years menopausal lady presented with bleeding per vagina for the past 6 months. She was married and nulliparous. She was a hypertensive patient on irregular treatment. Physical examination was unremarkable. She was evaluated for her post menopausal bleeding. She had an unsatisfactory colposcopy. MRI showed a large polypoidal endometrial mass lesion with an impression of neoplastic endometrial growth. With a provisional diagnosis of endometrial polyp/ carcinoma endometrium she was planned for total abdominal hysterectomy and bilateral salphing-oopharectomy surgery. Following a difficult surgery for a suspected uterine malignancy she had a good post operative recovery. Histopathological report revealed a high grade endometrial clear cell carcinoma with focal papillary serous differentiation with adenomyosis and leiomyoma. In view of high grade invasive carcinoma of endometrium she was referred to a radiotherapy unit for post operative radiotherapy. This case was analyzed with review of other reported case. Review re-emphasised the need of accurate histopathological diagnosis in addition to clinical staging especially in rare variants of endometrial carcinomas like clear cell carcinoma and squamous carcinoma in optimizing the treatment. However the importance of myometrial invasion cannot be overlooked especially when adenomyosis co-exists with adenocarcinoma. It is important to have a clear distinction between a true myometrial invasion by adenocarcinoma and involment of adenomyotic foci by malignant cells without myometrail invasion in determining the staging and prognosis. In view of non-availability of commonly accepted guidelines for the management of patients with clear cell carcinoma of endometrium, and adequate molecular, characterization of clear cell carcinoma is strongly warranted in order to identify new biological prognostic variables of the disease and to develop novel molecular targeted therapies

Clear cell carcinoma of the gallbladder: a case report and review of the literature

Fifty-nine years old Sudanese woman from Aldamazeen-Southern Blue Nile region of the Sudan, died 2 months after she had been diagnosed histopathologically as a case of a primary clear cell carcinoma of the gallbladder. Gallbladder cancer is a relatively rare form of malignancy. As yet, the progress in its management is very slow, which leads to high mortality and very low survival. At present, the best chances for this disease are early radical surgery but, in patients with invasion of adjacent organs, extended surgery, excising the invaded tissue, may be justified. In patients with distant lymph-node metastasis, even without adjacent organ invasion, radical surgery may not achieve a good outcome

Clear cell adenocarcinoma of the maxillary sinus: a case report.

A variety of salivary gland tumours histologically show the presence of clear cells. Clear cell adenocarcinoma of salivary glands (CCASG) is a distinct clinico-pathologic entity arising in the minor salivary glands of mainly the oral cavity in elderly women and having a low grade malignant potential. A case occurring in the maxillary sinus and extending to the nasal cavity is reported.

Hallazgos con ecografía Doppler color y tomografía computada helicoidal en tumores renales: relación entre volumen y grado de neovascularización / Renal tumors: correlation of volume with neovascularity by means of color Doppler, US and helical CT

Entre julio de 1997 y agosto de 1998, se analizaron en nuestro Servicio 23 neoplasias renales de distinta histología que fueron estudiadas mediante ecografía convencional, Doppler color, Power Doppler y tomografía computada helicoidal, obteniéndose en todos los casos confirmación antomopatológica. Basándonos en sus características volumétricas, los tumores se clasificaron en tres grupos. A la vez, se utilizó Doppler color como power Doppler para caracterizar el tipo e intensidad de neuvascularización tumoral, para obtener distintos registros espectorales, arteriales y venosos, y para calcular las diferentes velocidades de flujo con sus índices de resistencia. Se realizó TC helicoidal, antes y después de la inyección de contraste yodado endovenoso, con el objeto de establecer una correlación entre el volumen ecográfico y el obtenido por tomografía, así como observar los diferentes tipos de realce vascular tumoral y entablar una relación con los hallazgos obtenidos mediante Doppler color y Power Doppler. Los hallazgos deberán ampliarse a un mayor número de casos pero los resultados iniciales indican una importante correlación entre el volumen tumoral y el grado de vascularización en el examen Doppler color, especialmente en tumores de pequeño volumen, con un predominio del patrón hipovascular de los mismos. También se observó un aporte importante de este último en la caracterización de los tumores renales en relación con su histopatología

Clear cell basal cell carcinoma

Os autores relatam um caso de carcinoma basocelular de células claras, que acreditam ser o primeiro caso brasileiro. A importância desta rara variante e seu diagnóstico diferencial histopatológico säo resaltados, após breve discussäo da literatura