Molecular Pathology of Human Papilloma Virus-Negative Cervical Cancers

Cervical cancer is the fourth most common cancer in women worldwide and is predominantly caused by infection with human papillomavirus (HPV). However, a small subset of cervical cancers tests negative for HPV, including true HPV-independent cancers and false-negative cases. True HPV-negative cancers appear to be more prevalent in certain pathological adenocarcinoma subtypes, such as gastric- and clear-cell-type adenocarcinomas. Moreover, HPV-negative cervical cancers have proven to be a biologically distinct tumor subset that follows a different pathogenetic pathway to HPV-associated cervical cancers. HPV-negative cervical cancers are often diagnosed at an advanced stage with a poor prognosis and are expected to persist in the post-HPV vaccination era; therefore, it is important to understand HPV-negative cancers. In this review, we provide a concise overview of the molecular pathology of HPV-negative cervical cancers, with a focus on their definitions, the potential causes of false-negative HPV tests, and the histology, genetic profiles, and pathogenesis of HPV-negative cancers.

Atypical Renal Cyst (Clear Cell Type)

Background: Atypical cysts do not diagnostic criteria form classification as any of the variants of renal tumors, which have led to diagnostic difficulties. When these cysts have been encountered in surgical pathology practice it can be easily misdiagnosed as renal carcinoma and results in overtreatment. Case presentation: A 55-year-old Chinese woman with a right renal cystic mass came to our hospital. The computed tomography revealed bilateral cysts in both kidneys. In histology, the right renal cystic mass was arranged by stratified epithelium with short papillary projections and tufting. The covered epithelial cells were characterized by clear cytoplasm and small nuclei. Immunohistochemistry, these epithelial cells were diffusely positive for CK7, CK8, CK18, Vimentin and EMA, weakly positive for RCC and PAX-8, while diffusely negative for AMACR, CD10 and TFE-3. And the Ki-67 positive rate was 3%. Based on the immunohistochemical profile and histological features, the final diagnosis is an atypical renal cyst (clear cell type). The patient underwent right nephrectomy. The patient is alive and without any sign of subsequent renal cancer during 11 months of follow-up. Conclusion: Atypical renal cyst is extremely rare among the routine renal pathological diagnosis, we report this case to enhance the understanding and differential diagnosis of the atypical renal cyst and remind the pathologist of this precancerous lesion, and therefore, to avoid unnecessary or excessive treatment.

Clear-Cell Adenocarcinoma of the Gallbladder with Alpha-Fetoprotein Production: A Case Report and Review of the Literature

Gallbladder tumors are the fifth most common cancers of the gastrointestinal tract with poor prognosis and low survival. The most common type is adenocarcinoma of which the clear cell type is an unusual histologic variant with alpha-fetoprotein (AFP)-producing gallbladder carcinoma, reported extremely rarely, which makes the index case an uncommon entity. AFP secretion by gallbladder carcinomas may occur given the similar embryological origin of liver and gallbladder. Herein we report a case of an incidental carcinoma of the gallbladder in a 60-year-old woman with an elevated serum AFP concentration at presentation, who underwent cholecystectomy for cholelithiasis and was rendered the diagnosis of AFP-producing clear cell carcinoma of the gallbladder through histopathology and immunohistochemistry. Her postoperative laboratory tests showed a decline in AFP levels to normal respectively. The clinical and pathologic importance of AFP production by clear-cell adenocarcinoma of the gallbladder (CCG) has thus far remained completely obscure. However, we must recognize the entity of this tumor because accurate and early diagnosis of CCG is imperative to avoid misdiagnosis as possible secondary metastasis and consequent delay in appropriate surgical intervention. Relevant medical history of a patient, various imaging studies, foci of classical adenocarcinoma within the tumor, and an efficient immunohistochemical panel can be informative and assist in arriving at an accurate diagnosis.

Perihilar clear cell cholangiocarcinoma: an often-diagnostic challenge

Cholangiocarcinomas are rare and often diagnosed late. Clear cell histology is a rare variant of such cancers. We report one such case of a man in his late 60s, with a history of excess alcohol intake, who was found to have deranged liver biochemical tests incidentally during an admission for an allergic reaction. Subsequent imaging to investigate this suggested a diagnosis of perihilar cholangiocarcinoma (ultrasound, CT, MRI, cholangiogram). Biopsy confirmed this to be of clear cell type on histology and immunohistochemistry. Diagnosis and further management of this rare entity was conducted in multidisciplinary meetings with the regional hepatobiliary centre. The patient was deemed unsuitable for surgical resection, underwent chemotherapy but died 1 year later.

Renal Cell Carcinoma in 20 Years Old Female; A Diagnostic Dilemma

A 20 year old female was diagnosed, clinically, radiologically and by FNAC as a case of benign renal mass. She was observed for 5 months and on reevaluation by contract enhanced CT scan of abdomen revealed, contrast enhancing well demarcated mass with stable size. She was then planned for enucleation and frozen section biopsy. Per operatively, mass were easily enucleated but frozen section shows malignancy hence nephrectomy was done. Histopathological report showed; renal cell carcinoma, clear cell type and TNM staging; T1b Nx M0. Hence in this paper, we have reviewed the article regarding RCC in young age and a diagnostic dilemma of RCC in young age. Bangladesh Journal of Urology, Vol. 21, No. 1, January 2018 p.43-47

Intrahepatic cholangiocarcinoma with clear cell type following laparoscopic curative surgery

Background Intrahepatic cholangiocarcinoma (ICC) is the second most common malignancy of primary liver cancer. Among the several pathological types of ICC, only five cases of the clear cell type have been reported, including the one presented below. Here we report a unique case of clear cell type ICC following laparoscopic hepatectomy. Case presentation A 67-year-old woman had a history of hepatitis B virus. Computed tomography revealed a ring-like enhanced mass 35 mm in diameter at segment 7 in the early phase. The enhancement was prolonged to the late phase through the portal phase, while the shape was irregular. Ethoxybenzy magnetic resonance imaging revealed that the tumor had a low signal intensity on T1-weighted imaging and a high signal intensity on T2-weighted imaging. Diffusion-weighted images identified that the tumor had remarkably high signal intensity. Tumor enhancement was not detected throughout the tumor in the hepatocyte phase. Upon ICC diagnosis, a laparoscopic S7 subsegmentectomy was performed. The patient’s postoperative course was uneventful. An immunohistochemical examination revealed that the cells tested positive for cytokeratin 7 (CK7), CK19, and CD56 and negative for CK20, CD10, α-fetoprotein, thyroid transcription factor-1. At 2 years after surgery, the patient remains alive without recurrence. Conclusions Here we presented a case of clear cell ICC that was treated by laparoscopic hepatectomy. Immunological analysis, especially by CD56 and several CK markers, is helpful for diagnosing this disease.

Pericardial Effusion Caused by Renal Carcinoma of Clear Metastatic Cells: A Rare Cause of Cardiac Tamponade

Objective: To report the case of a patient with renal cell carcinoma of the clear cell type with the presence of metastatic disease at diagnosis, affecting the adrenal, lung and pericardium. Evolving with cardiac tamponade and need for urgent surgical intervention, being performed through thoracoscopy, a pericardiectomy for making a pericardial window. Method: The information was obtained by reviewing the medical record, interviewing the patient, photographic record of the diagnostic methods to which the patient was submitted and literature review. Final considerations: The reported case brings to light the description of a common clinical condition in medical centers in this case, cardiac tamponade, caused by renal carcinoma of which cardiac metastatic presentation represents a low index, and the need for urgent surgical intervention as an outcome.