Abstract
Primary clear cell carcinoma of the urinary bladder (PCCUB) is rare. Literature review has revealed 47 cases of PCCUB which commonly affects women. The histogenesis of PCCUB is not certain and Müllerian origin and urotheilal origin have been postulated. The microscopic characteristics of PCCUB include cells with abundant clear cytoplasm, arranged in a solid, glandular, tubulocystic, or papillary pattern. The cells may be flat or cuboidal with abundant clear eosinophilic cytoplasm. Hobnailing may be evident. PCCUB, on immunohistochemistry, stain positively with pan-cytokeratin, cytokeratin 7, and CA 125. PCCUB may manifest with visible haematuria, lower urinary tract symptoms, and discharge. There is no consensus opinion regarding the best treatment option for PCCUBs and patient outcomes are not very clear. Surgery has been the adopted treatment of choice. Differential diagnoses of PCCUB include nephrogenic metaplasia, urothelial carcinoma with clear cell cytoplasm, diffuse large B-cell lymphoma, and metastatic clear cell carcinoma with the primary originating elsewhere. Conclusions. A thorough radiological imaging assessment is required in cases of PCCUB to exclude a primary tumour elsewhere. Urologists and oncologists should report cases of PCCUB they encounter and should enter them into a multicentric trial to ascertain the best management option.
Highlights
Clear cell carcinomas of the urinary bladder are uncommon; most clinicians would be unfamiliar with their clinical features and diagnostic characteristics which are summarized in the overview which constitutes the first part of the paper
Clear cell carcinoma of the urinary bladder has been defined as a morphological variant of adenocarcinoma of the urinary bladder which mimics the Mullerian type of clear cell carcinoma of the female genital tract [1]
(a) They are often papillary or tubulocystic lesions [5]. (b) They are seen as flat or cuboidal neoplastic cells which have abundant clear or eosinophilic cytoplasm with glycogen and frequent hobnailing [1]. (c) They exhibit more pleomorphic cells and more mitotic figures than adenomatoid tumour and variable necrosis exists in them [1]. (d) They resemble urothelial carcinomas more than adenocarcinoma [1]. (e) The papillae of clear cell carcinomas of the urinary bladder at times have hyalinized cores [1]. (f) Myxoid stroma may be seen in the tumours [1]
Summary
Clear cell carcinomas of the urinary bladder are uncommon; most clinicians would be unfamiliar with their clinical features and diagnostic characteristics which are summarized in the overview which constitutes the first part of the paper. Miscellaneous narrations from a number of reported cases of primary clear cell carcinoma of the urinary bladder have been summarized in the second part of the paper in order to vividly elucidate further details of the biological behavior of the tumour
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