Primary Clear Cell Carcinoma of the Pancreas: A Rare Case Report

Abstract

Most pancreatic carcinoma is ductal adenocarcinoma. Primary pancreatic clear cell carcinomas composed almost entirely of clear tumor cells are very rare. We present a case of a 72-year-old man with a pancreatic mass, which was detected on abdominal computed tomography (CT). He had no symptoms and no abnormal findings on physical examination; however, he had a history of hepatitis B, hepatitis C, and hepatocellular carcinoma. He had received anti-viral treatment and radiofrequency ablation twice until 2 years prior. One year prior, follow-up contrast-enhanced abdominal CT revealed a newly developed pancreatic mass. Laparoscopic radical antegrade modular pancreato-splenectomy was performed. An ill-defined white-to-tan firm solid mass was observed in the pancreas, approximately 4.3 cm in diameter. The tumor cells showed >95% clear cell features, with a large round to oval nuclei and abundant clear cytoplasms, and well-defined cell membranes. Immunohistochemical staining revealed that the tumor cells were positive for cytokeratin 7, cytokeratin 19, HNF-1β, MUC-1, and p53. We excluded the possibility of metastatic clear renal cell carcinoma, neuroendocrine carcinoma, perivascular epithelioid cell tumor, malignant melanoma, and sarcoma because of the negativity for vimentin, chromogranin, synaptophysin, and HMB45. Consequently, he was diagnosed as having primary clear cell carcinoma of the pancreas and was treated with postoperative radiotherapy. Two months later, abdominal CT was suspicious for local recurrence at the resection margin. Additional adjuvant FOLFIRINOX chemotherapy was carried out 12 times. The patient is still alive after his third radiofrequency ablation for the newly-developed hepatic mass. Immunohistochemical staining for MUC-1 and HNF-1β, as well as histologic feature is very helpful for the diagnosis of primary pancreatic clear cell carcinoma with imaging methods for metastasis exclusion.

Metastatic Renal Cell Carcinoma to Pancreas: Case Series and Review of the Literature

“…Finally, a very rare encounter is that of primary clear cell carcinoma of the pancreas [ 79 ]. Differential diagnosis with IPMN has been reported in some cases also [ 80 ].…”

Metastatic clear cell sarcoma of the pancreas: From diagnosis to treatment

“…Furthermore, pancreatic carcinoma poses a high mortality risk, as the malignancy typically remains asymptomatic until it reaches an advanced stage. Therefore, precise diagnosis and early detection are imperative[ 2 ]. The authors report, for the first time, a case of CCS with pancreatic metastasis that exhibited favourable treatment outcomes following surgical intervention.…”