Tissue and Molecular Diagnosis
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
The site of origin of a metastatic tumour may be suggested by H&E appearances. For example, an adenocarcinoma has several possible sources. A clear cell carcinoma (Figure16.17) is often of renal origin. Immunohistochemical stains may provide further information. Some are highly specific for an anatomical site, e.g. prostate-specific antigen (PSA) and thyroglobulin. Others are somewhat less specific, but still useful, e.g. thyroid transcription factor-1 (TTF-1), a marker of bronchogenic origin; HepPar, that suggests hepatocellular origin; and cytokeratin 20 and CDX2, typically expressed by colorectal carcinoma. Carcinoembryonic antigen (CEA) is seen in several types of carcinoma (Figure16.22b). However, some malignancies, especially poorly differentiated examples, do not conform to the typical patterns. Therefore, the clinical picture and imaging results should always be taken into account.
Malignant Epithelial Neoplasms
Philip T. Cagle, Timothy C. Allen, Mary Beth Beasley in Diagnostic Pulmonary Pathology, 2008
The current WHO classification identifies five variants of large cell carcinoma. When none of these characteristics are identified, a diagnosis of large cell undifferentiated carcinoma may be made. Clear cell carcinoma shows tumors with clear cytoplasm and are negative for mucin stains. Large cell neuroendocrine carcinoma shows characteristic morphology with tumor cells arranged in an organoid fashion and reveals neuroendocrine immunohistochemical markers (see chap. 34). Basaloid carcinoma of the lung shows tumor cell nests with peripheral palisading of cells with increased nuclear-to-cytoplasmic ratios, nuclear hyperchromasia, and inconspicuous nucleoli. Lymphoepithelial carcinoma shows sheets of large cell with prominent nucleoli within a dense lymphocytic background. Large cell carcinoma with rhabdoid phenotype shows at least 10% of cells containing large eosinophilic cytoplasmic inclusions composed of intermediate filaments (which may stain for vimentin or keratin).
Ovarian cancer
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
These tumours are histologically similar to clear cell tumours of the endometrium, cervix, and vagina but are not associated with exposure to diethylstilboestrol in utero. These tumours have a better prognosis as they are usually confined to the ovaries at diagnosis. Approximately 75% are stage I and over 85% are stage I or II at the time of diagnosis (32). Clear cell carcinoma may develop in patients with endometriosis (31,33). A chronic endometrioma developing or presenting with enhancing solid components or thickened enhancing walls with restricted diffusion should raise the suspicion of malignancy. Common imaging findings in clear cell carcinoma include a unilocular large cyst, with signal intensity on T1-weighted (T1W) MRI varying from low to very high and solid mural nodules protruding into the lumen (Figure 19.6).
Incidentally detected steroid cell tumour presenting with abnormal uterine bleeding: a rare case report with review of literature
Published in Journal of Obstetrics and Gynaecology, 2022
Priyanka Yadav, Navpreet Kaur, Shramana Mandal, Nita Khurana, Ashok Kumar
Steroid cell tumours are generally unilateral and varies in size from 1.2 to 45 cm. Grossly they are solid, cut surface from yellow-orange to red brown, areas of haemorrhage and necrosis can also been seen. Tumour in our case was solid and pale yellow. Microscopically, cells are arranged in nest or trabeculae, polygonal with eosinophilic granular or vacuolated cytoplasm. The differential diagnosis includes stromal luteoma, pregnancy luteoma, Leydig cell tumour. Clear cell carcinoma and Metastatic renal cell carcinoma. These can be differentiated from Steroid cell tumours NOS as Stromal luteoma occurs within the ovarian stroma and associated with stomal hyperthecosis, pregnancy leutomas occurs bilaterally and regresses after pregnancy, Leydig’s cell tumour contains Reinke crystals and associated with Leydig’s cell hyperplasia (Bhagat et al. 2016). This was absent in the present case. Both clear cell carcinomas and metastatic renal cell carcinoma show PAS positivity which is negative in Steroid cell tumours (Mehdi et al. 2011). On Immunohistochemistry these cells are immunoreactive for Inhibin and Calretinin.
Birt-Hogg-Dubé syndrome caused by a mutation of FLCN gene in a CVST patient: a case report
Published in International Journal of Neuroscience, 2020
Jingzhe Han, Jincui Hao, Ruqian Liu, Yanan Xie, Zhilei Kang
CVST is a special type of cerebrovascular disease with an incidence of less than 1% of all stroke, mainly includes thrombosis of transverse sinus, sigmoid sinus and superior sagittal sinus, etc. The clinical manifestations of CVST are closely related to the involvement of the venous sinus, and headache is the most common clinical manifestation. The right occipital subcranial high density lesions on head CT highly suggested the possibility of CVST, and the elevation of D-dimer also supported the diagnosis. Head MRI + MRV was definitely diagnosed as CVST. The main causes of CVST include hypercoagulable state (heredity and acquisition), infection, tumors, autoimmune diseases, hematological diseases, drugs and so on. However, there was no common cause of cardiovascular disease in this elderly male patient, and cancer screening was a key consideration. Large epidemiological studies have recognized that malignant tumor of the blood system, pancreas, stomach, ovary, uterus, lung and kidney are higher risk factors for the development of CVST [6]. The clear cell carcinoma of the left kidney was confirmed by enhanced CT and pathological investigation in this patient.
Effectiveness of oral etoposide in recurrent or refractory epithelial ovarian cancer, primary peritoneal cancer and fallopian tube cancer
Published in Journal of Obstetrics and Gynaecology, 2022
Chompunoot Kongsawatvorakul, Chuenkamon Charakorn, Suwicha Chittithaworn, Arb-Aroon Lertkhachonsuk
Compared with other study conducted in Thailand, Thavaramara et al. reported 4.8 months (range 3.3–6.4 months) of PFS for a daily dose of 75 mg of oral etoposide (Thavaramara et al. 2009). Besides the difference in dosage, other factors can also contribute to such difference. For example, 52% of their patients were prescribed oral etoposide as the second-line treatment, whereas around half of our patients were treated as the third-line chemotherapy. Our study included 13 patients who received one cycle of oral etoposide while Thavaramara et al. excluded them. Moreover, the majority of histopathological subtypes were different; serous carcinoma and clear cell carcinoma accounted for two-thirds of our included patients, but serous carcinoma and endometrioid carcinoma accounted for half of theirs. Also study of Bozkaya et al. with majority of serous papillary carcinoma subtypes has slightly longer OS and PFS (Bozkaya et al. 2017). We hypothesised that clear cell carcinoma which has a worse prognosis played an important role in this response. The comparison of previous retrospective studies to this study is shown in Table 3.
Related Knowledge Centers
- Carboplatin
- Carcinoma
- Cisplatin
- Paclitaxel
- Clear-Cell Adenocarcinoma
- Clear Cell
- Clear-Cell Renal-Cell Carcinoma
- Ovarian Clear-Cell Carcinoma
- Uterine Clear-Cell Carcinoma
- Irinotecan