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RESIDENT CASE STUDIES

Week 1 April 21-25, 2003: Case 1 Discussion

Table of Contents | List of Diagnoses | Case 1 | Case 2 | Case 3

60-year-old female with right ovarian mass

Discussion
Clear cell adenocarcinoma of the ovary is usually a disease of post-menopausal women (similar to the other epithelial carcinomas of the ovaries), and it is rarely bilateral. Like endometrioid ovarian carcinoma, it is often associated with endometriosis. Different patterns exist – diffuse, tubulocystic, papillary and trabecular. The most common cell types are clear , hobnail (prominent bulbous nuclei that protrude into the lumens of tubules and cysts). The papillae of clear cell carcinomas are often complex and often contain hyalinized cores. Clear cell adenocarcinoma may contain hyaline bodies.
The lumens of the tubules and cysts usually contain mucin, confined to the luminal tips of the cells. Signet ring cells may be present, but very rarely predominate. Occasionally oxyphilic cells (cells with abundant eosinophilic cytoplasm) are present. 

Differential diagnosis include: dysgerminoma, yolk sac tumor, papillary serous carcinoma, metastatic renal cell carcinoma

Ordi et al. reported that while metatstatic renal cell carcinomas, dysgerminomas, yolk-sac tumors and Sertoli-Leydig cell tumors were often positive for CD10, all ovarian clear cell carcinomas are negative (1). 

Reference
Ordi J, Romagosa C, Tavassoli FA, et al. CD10 expression in epithelial tissues and tumors of the gynecologic tract: A useful marker in the diagnosis of mesonephric, trophoblastic and clear cell tumors. Am J Surg Pathol 2003;27(2): 178-186.