Case Of Clear Cell Adenocarcinoma Research Articles

Late Cervical And Vaginal Clear Cell Adenocarcinoma In Women Exposed In Utero To Diethylstilbestrol: Evaluation And Screening.

We aimed to evaluate the risk of cervical and vaginal clear cell adenocarcinoma (CCA) in women, aged 50 years or more, exposed in utero to diethylstilbestrol (DES) and contribute to a reevaluation of the recommendations for cervical and vaginal cancer and pre-cancer screening for these women. We carried out a retrospective review for patients received in a cancer institute. Two cohorts were consecutively studied, the first from 1970 to 2003 and the second from 2004 to 2021, and then linked. During the first period, we observed 61 CCA cases, with a mean age at diagnosis of 23 years (7-42), 36 (59%) following DES exposure in utero. During the second period, we found 27 cases, with one case of DES exposure (4%) for a women diagnosed at the age of 40 years. The mean age of the second cohort was 38 years (14-79). For the seven women aged 50 years or more at the time of CCA diagnosis, DES exposure was excluded for five and considered unlikely for the other two. In total, 88 cases of cervical or vaginal CCA were observed over a period of 51 years in a cancer center. The 37 cases associated with DES exposure represented approximatively one third of the CCA related to DES expected in France. DES exposure was improbable for the seven cases of CCA for women aged 50 years or more. These results do not support the hypothesis of late cervical or vaginal CCA in women exposed to DES in utero and indicate the need for larger multicentric studies. For the present, we propose specific screening for women exposed to DES in utero in terms of : 1) methods: association of cytology and hrHPV testing, with cervical and vaginal sampling, 2) timing : annual, or without exceeding a three-year interval, continuing after 65 years of age and after hysterectomy.

Clear Cell Adenocarcinoma of Urethra: Clinical and Pathologic Implications and Characterization of Molecular Aberrations.

This study aimed to evaluate the molecular features of clear cell adenocarcinoma (CCA) of the urinary tract and investigate its pathogenic pathways and possible actionable targets. We retrospectively collected the data of patients with CCA between January 1999 and December 2016; the data were independently reviewed by two pathologists. We selected five cases of urinary CCA, based on the clinicopathological features. We analyzed these five cases by whole exome sequencing (WES) and subsequent bioinformatics analyses to determine the mutational spectrum and possible pathogenic pathways. All patients were female with a median age of 62 years. All tumors were located in the urethra and showed aggressive behavior with disease progression. WES revealed several genetic alterations, including driver gene mutations (AMER1, ARID1A, CHD4, KMT2D, KRAS, PBRM1, and PIK3R1) and mutations in other important genes with tumor-suppressive and oncogenic roles (CSMD3, KEAP1, SMARCA4, and CACNA1D). We suggest putative pathogenic pathways (chromatin remodeling pathway, mitogen-activated protein kinase signaling pathway, phosphoinositide 3-kinase/AKT/mammalian target of rapamycin pathway, and Wnt/β-catenin pathway) as candidates for targeted therapies. Our findings shed light on the molecular background of this extremely rare tumor with poor prognosis and can help improve treatment options.

Ureteral Metastasis of Colonic Adenocarcinoma with Enteroblastic Differentiation: A Rare Case to be Distinguished from Clear Cell Adenocarcinoma of the Urinary Tract.

Adenocarcinomas with enteroblastic differentiation are rare clear cell tumors that are positive for enteroblastic markers. Enteroblastic differentiation is particularly uncommon in colorectal adenocarcinomas. Herein, we report a case of clear cell adenocarcinoma with enteroblastic differentiation in the sigmoid colon of a 38-year-old Japanese woman that metastasized to the lower left ureter. After neoadjuvant chemotherapy, the patient underwent low anterior resection. The tumor consisted of tubular, cribriform, and focal micropapillary proliferation of clear cells immunopositive for spalt-like transcription factor 4 (SALL4), glypican 3, and alpha-fetoprotein. Six months after the colonic resection, a tumor was found in the left lower ureter, which was resected. The ureteral tumor revealed clear cell adenocarcinoma, which was identical to the colonic tumor proliferating in the ureteral mucosa. Metastatic ureteral tumors are rare. We performed a literature search and found only 50 reported cases of ureteral metastases from colorectal cancer. Of these, only 10 metastatic tumors were identified in the ureteral mucosa. No case of ureteral metastasis of clear cell colorectal adenocarcinoma or colorectal adenocarcinoma with enteroblastic differentiation has been reported. Hence, it can be challenging to distinguish them from clear cell adenocarcinoma of the urinary tract and/or clear cell urothelial carcinoma. This paper discussed the differential diagnosis of these tumors and reviewed the clinicopathological features of colorectal carcinomas metastasizing to the ureter.

Primary Clear Cell of Abdominal Wall, A Case Report

Background: Endometriosis occurring in a surgical scar is well recognized and occurs mainly in patients with a history of hysterectomy or caesarean section. Scar endometriosis as well as endometriosis at other sites, can undergo malignant change. Clear cell carcinoma of the endometrium is a very rare and highly malignant neoplasm that accounts for less than 5% of endometrial carcinoma. Case presentation: We report a very rare case of clear cell adenocarcinoma arising from endometriosis of the abdominal scar. We must pay more attention on the following points in the surgical treatment of clear cell carcinoma: (1) Extensively resect tumors as far as possible: (2) Surgical treatment of clear cell carcinoma would easily result in poor wound healing especially in the patients receiving chemotherapy or radiotherapy because of extensive soft tissue stripping. Conclusion: The patient died only 25 months after she was first diagnosed with the cancer. Lessons: This case highlights the difficulties in preoperative diagnosis as well as the poor prognosis of these tumors. Accurate diagnosis of a lump within a scar is important to define the prognosis and treatment. These therapeutic principles are increasingly being applied to patients presenting with tumors greater than 5 cm and negative lymph nodes or even smaller tumors who are considered to have operable disease and a better outcome. Early recognition and prompt treatment can be essential to these patients' survival.

Clear Cell Adenocarcinoma in Men: A Series of 15 Cases.

Clear cell adenocarcinoma (CCA) is a rare tumor in the genitourinary tract with female predominance and few reports in men. We identified 15 cases of CCA in men evaluated at our institution. Five arose in the bladder, 7 in the prostate or prostatic urethra, 2 in the membranous urethra (1 multifocal in the prostatic and membranous urethra), 1 periprostatic (likely from an embryologic remnant), and 1 between rectum and bladder (likely in a prostatic utricle cyst). No cases showed associated Müllerian structures. One case showed separate foci of nephrogenic adenoma at diagnosis, and 1 case showed urothelial carcinoma in situ on a later follow-up biopsy. Four tumors extended into other organs (prostate to seminal vesicle and periprostatic soft tissue, periprostatic soft tissue to prostate, prostatic urethra to bladder and rectum, and prostate to bladder neck). One tumor showed extraprostatic extension alone. Four tumors metastasized to lymph nodes, with 3 also metastasizing to other sites (bladder, lung and adrenal, and right flank). Eleven patients underwent resection, including 3 transurethral resections. Seven underwent other treatments, including radiation (5 [1 for recurrence]), chemotherapy (3), hormonal therapy (3), immunotherapy with nivolumab (1), and targeted therapy with gefitinib (1). The mean follow-up was 35 months (range: 1 to 138 mo). At the last follow-up, 7 patients showed no evident disease and 3 were alive with disease. Four died with the cause of death unknown, with 2 cases having confirmed disease at the time of death and the remaining 2 dying less than a year after diagnosis. The mean time to death was 16 months (range: 6 to 39 mo). No follow-up was available on 1 patient. All patients who died in this series had CCA of the prostate or prostatic urethra. Pathologists need to be attuned to CCA occurring in males, given that the literature emphasizes its occurrence in females. In addition to established sites such as bladder and urethra, our series demonstrates that tumor may present in unusual adjacent sites, such as in periprostatic embryologic remnants or prostatic utricle.

Clear Cell Adenocarcinoma of the Urinary Bladder Is a Glycogen-Rich Tumor with Poorer Prognosis.

Clear cell adenocarcinoma (CCA) is a rare variant of urinary bladder carcinoma with a glycogen-rich phenotype and unknown prognosis. Using the National Cancer Institute’s surveillance, epidemiology, and end results (SEER) program database, we documented recent trends in incidence, mortality, demographical characteristics, and survival on this rare subtype of urinary bladder cancer. The overall age-adjusted incidence and mortality of CCA was 0.087 (95% confidence interval (CI): 0.069–0.107) and 0.064 (95% CI: 0.049–0.081) respectively per million population. In comparison to non-CCAs, CCAs were more commonly associated with younger age (<60 years old, p = 0.005), female (p < 0.001), black ethnicity (p = 0.001), grade III (p < 0.001), and higher AJCC 6th staging (p < 0.001). In addition, CCA patients more frequently received complete cystectomy (p < 0.001) and beam radiation (p < 0.001) than non-CCA patients. Our study showed a poorer prognosis of CCAs compared to all other carcinomas of the urinary bladder (p < 0.001), accounted for by higher tumor staging of CCA cases. This study adds to the growing evidence that glycogen-rich cancers may have unique characteristics affecting tumor aggressiveness and patient prognosis. Additional mechanistic studies are needed to assess whether it’s the excess glycogen that contributes to the higher stage at diagnosis.

Molecular profiling of clear cell adenocarcinoma of the urinary tract.

Clear cell adenocarcinoma (CCA) of the urinary tract is a rare type of malignancy whose molecular profiles remain undefined. Here we reported an integrated clinicopathologic and molecular profiling analysis of four cases of clear cell adenocarcinoma arising in the urethra or the bladder. Utilizing a clinically validated 130-gene exon-sequencing assay, we identified recurrent pathogenic PIK3CA (p. E545K) and KRAS (p.G12D) variants in three of four (75%) of the cases. In addition, an APC variant (P.S2310X), a TP53 variant (p.R273C), and a MYC amplification event were identified. The only CCA case without either PIK3CA or KRAS variants has a distinct pathogenesis through BK virus, demonstrated by positive BK virus PCR and SV40 immunohistochemistry. The novel finding of recurrent variants in the PI3K/AKT/mTOR pathway provides not only insights into oncogenesis but also potential clinical therapeutic targets for patients with clear cell adenocarcinoma of the urinary tract.

Clear cell carcinoma arising from abdominal wall endometriosis with lymph node metastasis – a rare case report and review of the literature

Abdominal wall endometriosis represents 1-2% of all endometriotic lesions. The malignant transformation of abdominal wall endometriosis is rare, though it can occur. Herein the authors report a rare case of clear cell adenocarcinoma arising from abdominal wall endometriosis with extensive lymph node metastasis. In this case, a 51-year-old woman presented with a growing mass in the right periumbilical area. Computed tomography scan revealed a 5-cm solid mass located on the right rectus muscle. A punch biopsy of the abdominal lesion was performed and histology showed metastatic adenocarcinoma of unknown origin. She had a surgical history of laparoscopic subtotal hysterectomy with right salpingo-oophorectomy. The patient underwent radical excision of the mass, trachelectomy, left salpingo-oophorectomy, and lymph node dissection. The abdominal wall mass showed clear cell adenocarcinoma arising from endometriosis on histology. There were extensive lymph node metastases. The patient underwent adjuvant chemotherapy. Both lymphatic and local invasion are key routes of clear cell adenocarcinoma arising from abdominal wall endometriosis. Extensive lymph node metastasis could be associated with poor prognosis.

Fairly rare clear cell adenocarcinoma mimicking liver cancer: a case report

BackgroundClear cell carcinoma commonly occurs in the ovary and kidney, and clear cell cholangiocarcinoma was rarely reported. Differential diagnosis which the origin of the tumor located on the liver surface is intrahepatic or extrahepatic was difficult. Herein, we report a case of clear cell adenocarcinoma mimicking liver cancer.Case presentationThis was a 55-year-old female who had the tumor with cystic component in the liver. She was performed hepatectomy and diagnosed as clear cell adenocarcinoma. Histopathological evaluation revealed intra-cystic clear cell adenocarcinoma. The tumor has ductal structure including mucin and atypical nuclear with clear cytoplasm. The tumor was separated from the liver and the diaphragm. The expression of Pax8 was positive, but the expression CK7 and HNF1β was positive and that of CD10 and ER was negative, which indicate that the tumor has the feature of clear cell carcinoma of ovary, not renal cell carcinoma nor cholangiocarcinoma.ConclusionsOur experience with this patient suggests that this tumor may originate from the endometriosis onto the diaphragm from the detailed results of immunohistochemical staining.

A Rare Case of Clear Cell Adenocarcinoma of the Cervix in a Neurologically Disabled Patient

A Rare Case of Clear Cell Adenocarcinoma of the Cervix in a Neurologically Disabled Patient

Incidence rates and risks of diethylstilbestrol-related clear-cell adenocarcinoma of the vagina and cervix: Update after 40-year follow-up

ObjectiveWomen exposed to diethylstilbestrol (DES) in utero are at increased risk for the development of vaginal and cervical clear cell adenocarcinoma (CCA) at younger age. It is unknown if a second peak will occur in later life, the ages when CCA developed spontaneously in the pre-DES era. The complete epidemiologic curve of CCA has not been reported, yet. MethodsWe reviewed 720 cases of CCA from the CCA registry at the University of Chicago through 2014. Incidence rates and cumulative risks for CCA were calculated based on white women born in the U.S. from 1948 through 1971. ResultsIn 420 CCA cases there was documented evidence of prenatal DES exposure. 80% were among those between ages 15 and 31 but some occurred as late as age 55. A small second peak occurred around age 42. The risk of DES-related CCA was highest in the 1951–1956 birth cohort and this birth cohort effect closely correlated with DES prescriptions over time in the U.S. (r=0.98, P=0.005). By age 50, the cumulative risk of CCA was 1 per 750 exposed women. CCA cases without evidence of DES exposure had similar ages, year of diagnosis, and birth cohort patterns as the documented DES-exposed cases, suggesting that some negative cases were exposed. Their inclusion raises the cumulative risk of CCA to 1 per 520. ConclusionWith the largest data available, our results confirmed the association between prenatal DES exposure and clear cell adenocarcinoma. The study also refines the risks of DES-related CCA.

Abstract 709: Incidence and mortality of diethylstilbestrol-related clear-cell adenocarcinoma of the vagina and cervix: 40 years of long-term follow-up

Abstract Objective: Women exposed to diethylstilbestrol (DES) in utero are at increased risk for the development of vaginal and cervical clear cell adenocarcinoma (CCA), and possibly of breast cancer, diabetes, and cardiovascular diseases as well. A peak in the age-incidence curve in DES- related CCA has been documented at ages 19 to 24. It is unknown if a second peak will occur in later life, the ages when CCA developed spontaneously in the pre-DES era. In addition, the long-term prognosis and health impact for adolescents and young adults who have DES-related CCA are unknown. Methods: 720 cases of CCA were reviewed from the CCA Registry at the University of Chicago through 2014. Rates and cumulative risks for CCA were calculated based on white women born in the U.S. from 1948 through 1971. Kaplan-Meier method was used to estimate survival probability among women with CCA. Cox models were used to identify independent prognostic factors. To gauge the relative impact of young-onset clear-cell adenocarcinoma on mortality, we compared their mortality hazards with mortality hazards of the U.S. female population, and calculated standardized mortality ratio (SMR). Results: In 420 CCA cases there was documented evidence of prenatal DES exposure. 80% patients had a CCA between ages 15 and 31 but some occurred as late as age 55. A small second peak occurred around age 40. The risk of U.S. born, white DES-related CCA was highest in the 1951-1956 birth cohort, and this birth cohort effect correlated with DES use in the U.S. By age 50, the cumulative risk of CCA was 1 per 750 exposed women. A total of 695 CCA patients were included in the survival analysis. After a median follow-up of 22.7 years (interquartile range: 10.8-35.1 years), 219 patients died. The 5-year, 10-year, and 20-year survival probabilities were 83%, 75%, and 69%, respectively. As expected, tumor stage was a strong prognostic factor for survival among DES-related CCA cases. Tubular-cystic histology was associated with better survival compared with papillary, solid, or a combination of these histological patterns. Adolescent patients (&amp;lt;18 years old) had worse survival than young adult patients. Compared with general U.S. female population, women with DES-related CCA had 27-fold increased risk of death between 10 and 35 year of age (SMR 27.06, 95% CI: 23.04-31.58), 5-fold increased risk between 35 and 50 year of age (SMR 5.07, 95% CI: 3.59-6.95), 2-fold increased risk after age 50 (SMR 2.03, 95% CI: 1.22-3.18). Conclusion: Our study drew a relatively complete epidemic curve of DES-related CCA. There existed late-onset CCA among women with prenatal exposure of DES. DES-related CCA increased mortality not only during early life among exposed women, but also impacted life after age 50. These results suggest continued close health follow-up of this population. Citation Format: Dezheng Huo, Diane Anderson, Arthur L. Herbst. Incidence and mortality of diethylstilbestrol-related clear-cell adenocarcinoma of the vagina and cervix: 40 years of long-term follow-up [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 709. doi:10.1158/1538-7445.AM2017-709

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 5x4.5cm 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.

Effect of ARID1A/BAF250a expression on carcinogenesis and clinicopathological factors in pure-type clear cell adenocarcinoma of the ovary.

Frequent mutation of the ARID1A gene has been recently identified in ovarian clear-cell adenocarcinoma (CCA); however, the clinical significance of BAF250a expression encoded by the ARID1A gene remains to be determined. The aim of the present study was to assess whether BAF250a expression had an impact on the clinical features of CCA. A total of 97 cases of CCA treated at a single institution were enrolled in the present study. The tissue samples were evaluated by immunohistochemical staining. BAF250a-deficient expression was observed in 30% (29/97) of all CCA cases. Of this, 19% of non-atypical endometriosis, 26% of atypical endometriosis, 39% of endometriosis-related CCA, 5% of benign clear-cell adenofibroma (CCAF), 5% of borderline CCAF and 10% of CCAF-related CCA. BAF250a-deficient expression was significantly more frequent in endometriosis-related CCA compared with that in CCAF-related CCA (P=0.02). No significant difference was observed in the response rate of primary chemotherapy according to BAF250a expression status (P=0.48). Additionally, BAF250a expression status was not significantly correlated with progression-free and overall survival in patients with CCA. Although loss of BAF250a expression was associated with early tumorigenesis in endometriosis-related CCA, this alteration was not significantly correlated with chemosensitivity and prognoses of CCA. Further biomarker analyses, including BAF250a expression, are required to improve the prognoses of CCA.

Clear cell adenocarcinoma of bladder expressing prostate-specific antigen, alpha-methylacyl-CoA racemase and CD10

Backgrounds: Clear cell adenocarcinoma (CCA) of urinary bladder (UB) is rare. Aims: To report a case of CCA of UB immunohistochemically expressing prostate-specific antigen (PSA), alpha-methylacyl-CoA racemase (AMACR) and CD10; thus this case was difficult to differentiate from metastasis from prostatic adenocarcinoma or renal cell carcinoma (RCC). Case: An 84-year-old man presented with dysuria and hematuria, and cystoscopy revealed a bladder tumor. The biopsy showed proliferation and invasion (more than pT2) of high-grade carcinoma cells focally forming glandular structures. Lymphovascular permeations were recognized. Focally, usual urothelial carcinoma (UC) was seen and there were gradual direct transitions between the clear cell carcinoma and UC. Immunohistochemically, the carcinoma cells were positive for PSA, AMACR, CD10, p53, Ki67 (labeling = 10%), uroplakin II, thrombomodulin, and cytokeratin (CK) 20, but negative for Hepatocyte-paraffin1 (HepPar1), CK7, PAX8, and TTF-1. Conclusions: A rare case of CCA of UB with immunoexpressions of PSA, AMACR and CD10 is reported. The aberrant expressions of these three antigens are only speculative. The gradual transitions between UC and CCA and the presence of urothelial antigens in this tumor suggest that the tumor might have originated from UC.

Distribution of human papillomavirus (HPV) among HPV positive cervical adenocarcinoma cases detected by laser capture microdissection(LCM)

To investigate the distribution of human papillomavirus (HPV) in the diseased areas cut from HPV-positive cervical adenocarcinoma (ADC) detected by laser capture microdissection (LCM). Paraffin-embedded specimens diagnosed as ADC between 2005 and 2010 were collected from 9 hospitals in 7 regions across China. HPV genotyping was conducted on paraffin sections using sandwich technique and LCM in order to identify HPV infection in the tumor tissues. HE and p16 immunohistochemistry staining were performed to make histological diagnosis. A total of 169 cervical adenocarcinoma cases were recruited, including 94 cases of mucinous adenocarcinoma (ADC-CX), 9 cases of adenosquamous carcinoma (ASC), 19 cases of minimal deviation adenocarcinoma (ADC-MIN), 14 cases of clear cell adenocarcinoma (ADC-CC), 8 cases of endometrioid adenocarcinoma (ADC-ENDO), 9 cases of serous adenocarcinoma (ADC-SER) and 16 cases of adenocarcinoma not otherwise specified (ADC-NOS). Fourteen types of high risk HPV were detected in the whole tissue section (WTS). HPV16 was the most common type, and the second was HPV18 and HPV52, respectively. Compared with WTS, the HPV-positive rate detected by LCM was lower. The HPV positive rates were significantly different among different subtypes of cervical adenocarcinoma (P<0.001). After LCM, the HPV positive rate was 50.8% and 66.7% in the single infection and multiple, infection groups respectively (P=0.14). The positive rates of p16 was significantly different among different subtypes of cervical adenocarcinoma (P<0.001). p16-positive rate was 73.9% in the HPV-positive samples after LCM, significantly higher than the 38.5% of negative samples (P<0.001). Laser capture dissection technique can more precisely reflect the HPV distribution in cervical adenocarcinomas. The etiological association between HPV infection and cervical adenocarcinoma occurrence is not as close as that reported in the literature.

Primary clear cell adenocarcinoma of duodenum

Backgrounds: Clear cell adenocarcinoma (CCA) of duodenum has not been reported. Aims: To report the first case of CCA of duodenum. Case: A 76-year-old woman presented epigastralgia, and upper GI endoscopy revealed an ulcerated tumor in the 1 st portion (next to stomach) of duodenum close to pylorus (remote from pylorus by 2 cm). No tumor was seen in duodenal papilla. Biopsy from the lesion showed proliferation and invasion of high-grade carcinoma cells with very clear cytoplasma but without glandular structures. No signet-ring carcinoma cells were seen. Histochemically, mucus stains showed no mucins but suggested glycogens. Immunohistochemically, tumor cells were positive for cytokeratin (CK)7, CK18, CK19, CEA, CA19-9, p53, MUC1, and Ki67 (labeling index = 36%), but negative for CD45, CK34BE12, CK5, CK6, CK20, vimentin, CA125, CDX-2, HepPar1, AFP, PSA, CD10, renal cell carcinoma (RCC) markers, PSA, AMACR, HER2, S100 protein, TTF-1, NSE, NCAM, synaptophysin, chromogranin, MUC2, MUC5AC, MUC6, estrogen receptor and progesterone receptor. Conclusion: The first case of primary CCA of duodenum is reported.

Clinicopathological features in endometrial carcinoma with mismatch repair deficiency among Chinese women younger than 50 years of age

Objective: Mismatch repair (MMR) deficiency can lead to genome instability and closely correlated with carcinogenesis of endometrial carcinoma and mainly caused by MMR gene germline mutation known as Lynch syndrome (LS) or epigenetic mechanisms of MLH1 promoter methylation. The main objective of the present study is to correlate the clinicopathological features in endometrial carcinoma from 92 Chinese women younger than 50 years of age with the MMR status. Methods: In total 92 cases of consecutive hysterectomy specimens with EC in patients younger than 50 years of age were analyzed. We performed immunohistochemistry staining for 4 MMR proteins and two groups (MMR deficiency group and MMR normal group) were subdivided according to the outcome of immunohistochemistry staining. Results: 38 cases (42%) with the negative expression of MMR proteins are selected for analysis of their clinical and pathological features. This group included 34 cases of endometrioid adenocarcinoma, one case of clear cell adenocarcinoma, three cases of the mixed types including clear cell, serous and neuroendocrine carcinoma mixed with classic endometrioid adenocarcinoma respectively. In addition to squamous differentiation, 29% cases also exhibit other differentiations including mucinous, clear cell, a lot of papillary structures, dedifferentiated, and secretory types. There are 10 cases showing features of peritumoral and tumor infiltrating lymphocytes. Seven cases have synchronous carcinoma of other sites besides the uterus. Conclusions: The MMR deficient group showed more morphological differentiations including mucinous differentiation, frequent tumor infiltrating lymphocytes, and more frequent synchronous carcinomas of other sites than tumors with a normal immunophenotype of the MMR genes. Features of dedifferentiated EC originated in the lower uterine segment were not identified in our study. Endometrial carcinoma in Chinese patients younger than 50 years of age is more likely to be LS associated carcinoma.

Primary Fallopian Tube Clear Cell Adenocarcinoma in Pregnancy: Case Presentation and Review of the Literature

Primary fallopian tube cancer in pregnancy is rare and is even more so for the clear cell variant. Our case is the third case of primary fallopian tube cancer in pregnancy and the first case of clear cell adenocarcinoma of the fallopian tube in pregnancy. The patient presented with increasing pelvic pain starting in the second trimester. Serial ultrasound evaluations were performed and revealed a rapidly growing complex adnexal mass adjacent to the uterus. Her pregnancy was further complicated by spontaneous preterm labor and she delivered prematurely per vaginam at 31 weeks. She underwent an urgent laparotomy in the immediate postpartum period for acute aggravation of her right pelvic pain and fever. The diagnosis of tubal clear cell adenocarcinoma was subsequently made on histopathology examination.

A Case of Clear Cell carcinoma of the Ovary

Although Clear cell carcinoma of ovary is a rare epithelial ovarian tumor, prevalence in Asian is higher than other ethnicity. Recently, Clear cell carcinoma has increased in its incidence. Clear cell carcinoma of the ovary constitutes 5-6% all ovarian malignancies. Clear cell carcinoma is frequently present at early stage with unilateral large pelvic mass, deep vein thrombosis, hyper kalemia. Atypical endometriosis is a malignant precursor which associated with clear cell carcinoma 35.9%. Microscopic feature are multiple papillae, densely hyaline basement membrane and hyaline bodies. Mitosis are less frequent than in other types of ovarian carcinomas. Clear cell carcinoma of ovary was known poor prognosis compared to other epithelial ovarian carcinoma because of Platinum based chemotherapy resistance. We experienced a case of clear cell adenocarcinoma of the ovary in 40 years old woman. Clinicopathologic findings of one case with a brief review related literatures are presented.