Clear Cell Carcinoma of the Pancreas Infiltrating Duodenum: A Case Report of a Multiface Aspect of an Intriguing Entity

Background: Although Clear-cell carcinoma has been found in various organs as a variant of ductal carcinoma of the pancreas, it still hasn’t been well recognized. According to the WHO classification, primary Clear-cell carcinoma of the pancreas is rare, and it is classified as a “miscellaneous” carcinoma. To date it has been poorly characterized and only few cases have been reported in the literature [1]. Case presentation: We report here an unusual case of Clear-cell carcinoma in a 59-year-old man involving the head of the pancreas and the second part of the duodenum initially misconceived as pyloric gland adenoma, a rare duodenal entity. Nevertheless, duodenal sub stenosis was suspected of malignancy, so further investigations were made. Subsequent abdominal computed tomography (CT) detected not only a duodenal vegetation but also an alteration of the duodenal-pancreatic interface with thickening of the duodenal wall and a common bile duct dilatation. The malignant clinical aspect and behavior of the lesion, associated to the impossibility of further investigations due to the duodenal sub stenosis, led to an exploratory laparotomy.The laparotomy revealed a retracting area straddling the duodenum and the pancreatic head. A duodenum pancreatectomy of the head of the pancreas with extended lymphadenectomy was performed and the histological evaluation showed a ductal Clear-cell adenocarcinoma of the pancreas infiltrating the duodenum. The postoperative course was characterized by a pancreatic fistula grade B. At 6 months from the surgery, the patient hasn’t had recurrence.Conclusion: Because it is a rare tumor with very few cases reported previously, the incidence and prognosis are not well known for this neoplasm. The report of our case would aid in the identification of this rare neoplasm. Further studies and more case reports are needed to clarify the diagnosis and prognostic significance of the clear cell differentiation of these tumors.

Clear cell urethral adenocarcinoma – a case report of an exceptional response to immunotherapy in a metastatic rare tumour

Primary clear cell adenocarcinoma of the urethra is extremely rare. Given the rarity of these tumours there is no high-level evidence available to guide treatments. Localized disease is typically treated with primary surgery or concurrent chemo-radiotherapy. In the advanced disease setting treatment options are limited and decisions are based on evidence in disease subtypes where similarities exist. Immuno-oncology and the use of checkpoint inhibitors, particularly for metastatic disease has transformed clinical practice over the past few years and patient outcomes continue to improve as a result of their introduction. Here we report the first case, to our knowledge, of a patient with advanced primary clear cell adenocarcinoma of the urethra who had a dramatic and almost complete response to anti-PD-1 therapy in the fourth line setting. Level of evidence: 4

Clear Cell Adenocarcinoma of the Ureter Similar to Clear Cell Renal Cell Carcinoma Histology

A 70-year-old woman was referred to our hospital with gross hematuria and diagnosed with right invasive ureteral cancer and bladder urothelial carcinoma in situ. Intravesical BCG therapy and neoadjuvant chemotherapy with carboplatin and gemcitabine were performed at the same time. Subsequently, laparoscopic right nephroureterectomy was performed. Urothelial carcinoma in situ persisted; however, most of the tumor was clear cell carcinoma. The clear cell carcinoma lesion had clear cytoplasm with round nuclei and visible nucleoli in an insular arrangement as is the case with clear cell renal cell carcinoma. No transitional lesion between clear cell adenocarcinoma and urothelial carcinoma was presented. The clear cell carcinoma lesion was GATA3 negative and HNF4α positive; however, the urothelial cancer lesion was GATA3 positive and HNF4α negative. Clear cell carcinoma was diagnosed as clear cell adenocarcinoma similar to clear cell renal cell carcinoma histology.

The Nomograms for Predicting Cancer-specific Survival in Patients With Ovarian Cancer After Surgery

Objectives: Clear cell adenocarcinoma of the ovary (CCAO) and mixed cell adenocarcinoma of the ovary (MACO) were one of the gynecological malignancies.Methods: Univariate and multivariate cox regression analysis were used to determine prognostic factors. Drawing nomograms, the receiver operating characteristic (ROC) curve and the calibration curve was applied to evaluate the agreement of the nomogram. The survival analysis was constructed to the high-risk factors.Results: The nomogram was constructed and had a better discrimination. The calibration curves indicated that the nomograms had good calibration capabilities.4 or more regional lymph nodes removed by surgery was beneficial to the patient's prognosis. Conclusions: Our study analyzed the prognosis of CCAO or MACO patients, and constructed a predictive nomogram with good accuracy.

Primary Abdominal Wall Clear Cell Carcinoma: Case Report and review of literature

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 5cm 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.