Clear-cell adenocarcinoma

Epithelial ovarian tumors are composed of cells that cover the surface of the ovary, such as serous, mucinous, endometrioid, clear cell, and poorly differentiated adenocarcinomas. 

Diethylstilbestrol All Vaginal adenosis, clear cell vaginal adenocarcinoma... 

Clear cell adenocarcinomas of the vagina and cervix induced by prenatal exposure to this drug metastasize to the lungs. The secondaries generally appear within 2-3 years of the initial diagnosis. Unusually, a case has been reported in which pulmonary metastases occurred more than 15 years after presentation of the primary tumor (14). This makes it clear that patients of this type should be followed up in the very long term. 

Evidence has also emerged on long-term survival in young women with a clear-cell adenocarcinoma of the vagina, 20% of whom had been exposed to diethylstilbestrol and 80% had not (33). The probabilities of survival at 5 and 10 years for diethylstilbestrol-associated cases were 84 and 78% respectively, compared with 69 and 60% for those not associated with diethylstilbestrol. These differences were not due to differences in clinical prognostic factors, but suggest differences in tumor behavior for as yet undetermined reasons. 

Hall WB, Detterbeck FC, Livasy CA, Fowler WC Jr. Endobronchial clear cell adenocarcinoma occurring in a patient 15 years after treatment for DES-associated vaginal clear cell adenocarcinoma. Gynecol Oncol 2004 93 708-10. 

Melnick S, Cole P, Anderson D, Herbst A. Rates and risks of diethylstilbestrol-related clear-cell adenocarcinoma of the vagina and cervix. An update. N Engl J Med 1987 316(9) 514-6. 

Waggoner SE, Mittendorf R, Biney N, Anderson D, Herbst AL. Influence of in utero diethylstilbestrol exposure on the prognosis and biologic behavior of vaginal clear-cell adenocarcinoma. Gynecol Oncol 1994 55(2) 238-44. 

Keller C, Nanda R, Shannon RL, Amit A, Kaplan AL. Concurrent primaries of vaginal clear cell adenocarcinoma and endometrial adenocarcinoma in a 39-year old woman with in utero diethylstilbestrol exposure. Int J Gynecol Cancer 2001 ll(3) 247-50. 

In utero exposure of men to DES, a synthetic non-steroid estrogen, has been linked to increased incidence of meatal stenosis, epididymal cysts, testicular hypoplasia, cryptorchidism, microphallus, and sperm abnormalities (Henderson et al., 1976 Gill et al., 1977, 1979 Stillman, 1982). In females, adenosis, clear cell adenocarcinoma, and structural defects of the cervix, vagina, uterus, and fallopian tubes have been linked to in utero exposure to DES (Stillman, 1982). 

In 1971/ Herbst et al. (93) reported the unusual occurrence of vaginal clear cell adenocarcinoma in eight young women. The precipitating factor appeared to be the fact that their mothers had been treated with diethylstilbestrol (DES) in order to prevent spontaneous abortion and premature delivery in what were deemed to be high-risk pregnancies. Estimates place the incidence of clear cell adenocarcinoma of the vagina at 1.5 per 1000 women who were exposed in utero to DES (94). 

Waggoner SE, Anderson SM, Luce MC, Takahashi H, Boyd J. p53 protein expression and gene analysis in clear cell adenocarcinoma of the vagina and cervix. Gynecol Oncol 1996 60 339-44. 

Boyd J, Takahashi H, Waggoner SE, Jones LA, Hajek RA, Wharton JT et al. Molecular genetic analysis of clear cell adenocarcinomas of the vagina and cervix associated and unassociated with diethylstilbestrol exposure in utero. Cancer 1996 77 507-13. 

Clear cell adenocarcinoma (40 times more likely than unexposed women), a rare kind of vaginal and cervical cancer. 

Hormones of both synthetic and biological origin are known endocrine disruptors. The best known of these is diethylstilbesterol (DES), a synthetic estrogen that was prescribed by physicians to prevent spontaneous abortions in women from 1948 to 1971. Daughters of women who took DES have suffered a host of reproductive problems including a reduction in fertility, abnormal pregnancies, immune system disorders, periods of depression, and early onset of vaginal clear-cell adenocarcinomas and reproductive tract cancer. Known hormonal endocrine disruptors are listed in Table 4.5. 

Rezende RB, Drachenberg CB, Kumar D, et al. Differential diagnosis between monomorphic clear cell adenocarcinoma of salivary glands and renal (clear) cell carcinoma. Am J Surg Pathol. 1532 23(12) 1532-1538. 

CLEAR CELL ADENOCARCINOMA Most dear Cell adenocarcino-mas are immunophenotypically identical to usual-type colorectal adenocarcinomas.Rare cases of primary colonic, clear cell carcinoma stain with alpha fetoprotein. 

Luttges J, Vogel I, Menke M, et al. Clear cell carcinoma of the pancreas an adenocarcinoma with ductal phenotype. Histopa-thology. 1998 32 444-448. 

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