Clear cell carcinoma of the nasal cavity: A case report from histopathological viewpoint

doi:10.1016/j.anl.2015.06.002

Auris Nasus Larynx

Volume 43, Issue 1, February 2016, Pages 108-111

https://doi.org/10.1016/j.anl.2015.06.002 Get rights and content

Abstract

We report an extremely rare case of primary clear cell carcinoma (CCC), not otherwise specified (NOS) of the nasal cavity. An 80-year-old woman was referred to our hospital with left nasal obstruction caused by a nasal cavity tumor. The tumor was resected completely with lateral rhinotomy approach. Histopathological examination revealed CCC. CCC metastasis from renal cell carcinoma (RCC), which is at the top of differential diagnosis, was ruled out by the absence of renal tumor at computed tomography (CT). Also, immunohistochemical results of the specimen with vimentin negative and CK7 focally positive excluded the possibility of RCC metastasis. The patient is free from recurrence 1 year after the surgery, and there is no evidence of RCC. In this report histopathological characteristics, especially immunohistochemical properties of primary CCC, NOS of the nasal cavity are presented together with some clinical features of this rare tumor. Also, we refer to histopathogenesis of primary CCC of nasal cavity in relation to myoepithelial carcinoma. Histopathological discussion is further extended to include other CCC and CCC-resembling histologies to confirm the uniqueness of the present case.

Introduction

Sinonasal cancers, which account for 3% of all head and neck cancers, have their origin in the nasal cavity in 20–30% of cases [1]. Secondary or metastatic tumors to the sinonasal tract are rarely seen constituting only 1.5% of all sinonasal cancers [2]. Renal cell carcinoma (RCC), of which the typical histopathology is “clear cell carcinoma (CCC)”, is the most frequent primary tumor metastasizing to the sinonasal tract [3]. While most of the primary sinonasal cancers are of squamous cell carcinoma [4], there are a wide variety of histologies including CCC, not otherwise specified (NOS) which is quite rare with only 12 cases reported in English literature [5], [6], [7], [8], [9]. Therefore, in spite of its rarity, when the histopathology of a sinonasal tumor proves to be CCC, it is mandatory to determine the nature of the tumor, i.e. whether it is primary, metastatic or even clear-cell like carcinomas, in order to proceed to the further treatment and make the correct prognosis. Recently we experienced a case of primary CCC, NOS of the nasal cavity, the diagnosis of which was established by in-depth examinations of immunohistochemistry and electron microscopy. In this report, the results of those examinations together with interesting radiological findings are presented. We further deepened the discussion on histopathological characteristics of clear-cell type cancers in the head and neck region.

Section snippets

Case report

An 80-year-old woman was referred to our hospital for further diagnosis and treatment of her right nasal cavity tumor. She had been suffering from right nasal obstruction for 4 months and purulent nasal discharge for 2 months. At inspection a tumor with a reddish white tint was seen filling the right nasal cavity (Fig. 1a). Computed tomography (CT) (Fig. 1b) and magnetic resonance imaging (MRI) (Fig. 1c and d) demonstrated a tumor, measuring 57 mm in diameter, occupying the nasal cavity and

Discussion

In sinonasal tract, salivary gland-type cancers are second in frequency to squamous cell carcinoma accounting for 4–8% of all sinonasal malignancies [13], and they are considered to originate from submucosal exocrine glands such as nasal glands. Primary CCC, NOS is a subtype of salivary gland-type cancers which is extremely rare with only 12 cases reported in English literature [5], [6], [7], [8], [9]. On the other hand, although uncommon, there are secondary or metastatic CCCs of the sinonasal

Conflict of interest statement

The authors declare that they have no conflict of interest.

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Clear cell carcinoma: a comprehensive literature review of 254 cases
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These articles were then cross-referenced and used to search for other reported cases and review articles. Finally, 97 reports detailing 254 cases, published between 1983 and 2020, were retrieved, resulting in a total of 254 cases used in the analysis2,3,5,6,10–102. Five additional case reports did not specifically report the diagnosis of the presenting case as CCC and therefore were excluded from the cases analyzed2,14,18,53.
This comprehensive literature review represents a summary of all cases of clear cell carcinoma (CCC) of the salivary glands that are documented in the literature. PubMed was used to collect available reports of CCC; 97 reports detailing 254 cases, published between 1983 and 2020, were retrieved. Clinically the tumor manifests most commonly as a painless mass or swelling on the palate, and the duration of symptoms prior to seeking care ranges from 1 week to 6 years. Metastasis, both local and distant, was reported in 13.9% of 202 total cases. Local tumor recurrence was present in 18.8% of the cases. By histopathology, CCC shows a mixture of growth patterns including solid (25.1%), nested (78.6%), sheet-like (23.5%), cords (46.1%), and trabeculae (42.4%). Immunohistochemical studies are positive for one or more cytokeratins (99.1%), PAS (95.1%), EMA (77.8%), and p63 (96.3%), but negative for S-100 (96.3%), PASD (91.1%), SMA (91.0%), and calponin (95.1%). Molecular features were reported in 115 cases; 96.0% were positive for an EWSR1 rearrangement by EWSR1 break apart FISH testing and 14.8% were positive for the rearrangement EWSR1–ATF1 tested by qPCR or targeted RNA sequencing. Clinical patterns and genetic studies imply that this tumor is the extraosseous counterpart of clear cell odontogenic carcinoma, an intraosseous odontogenic tumor of the jaws.
A contemporary update on hyalinizing clear cell carcinoma: compilation of all in-house cases at our institution and a literature review spanning 2015–2020
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Thus, we focused our attention toward the years 2015–2020 to gather additional data. We identified 52 cases from 28 articles [7–31]. Details of these findings are found in Tables 3–5.
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Clear cell carcinoma of the nasal cavity: A case report from histopathological viewpoint

Abstract

Introduction

Section snippets

Case report

Discussion

Conflict of interest statement

Clin Lab Med

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Carcinoma of the nasal cavity and paranasal sinuses: incidence and presentation of different histological types

Clin Otolaryngol Allied Sci

Malignant tumors of the paranasal sinuses: radiologic, clinical, and histopathologic evaluation of 200 cases

Head Neck Surg

Metastatic tumors to the maxilla, nose, and paranasal sinuses

Laryngoscope

Incidence and survival in patients with sinonasal cancer: a historical analysis of population-based data

Head Neck

Sinonasal renal cell-like adenocarcinoma: a report on four patients

Head Neck Pathol