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Journal of Medical Case Reports

, 8:275

First Online: 14 August 2014Received: 01 May 2014Accepted: 03 July 2014DOI: 10.1186-1752-1947-8-275

Cite this article as: Knez, V.M., Barrow, W., Lucia, M.S. et al. J Med Case Reports 2014 8: 275. doi:10.1186-1752-1947-8-275


IntroductionThe occurrence of clear cell tumors in the bladder is not uncommon. Clear cell dysplasia is well-described and characterized by focal replacement of transitional mucosa by cells with abundant clear cytoplasm, nuclear enlargement, and a granular chromatin pattern. Clear cells can also be seen in clear cell adenocarcinoma, which is rare, comprising 0.5% to 2.0% of the reported bladder carcinomas. Other clear cell tumors found in the bladder to be considered in the differential diagnosis are tumors of Müllerian origin and metastatic lesions, such as renal cell carcinoma, clear cell sarcoma, and malignant melanoma. Clear cell urothelial carcinoma is exceedingly rare, with only nine clinical cases described in the literature.

Case presentationWe report the case of a 75-year-old Caucasian man who presented with intermittent hematuria, in whom a bladder tumor was identified. A final histopathology examination of a cystoprostatectomy specimen revealed a pT3b, G3 urothelial carcinoma of clear cell type >90% clear cells and a prostatic adenocarcinoma of Gleason grade 3+3 score=6. The bladder tumor consisted of sheets of malignant cells with severe nuclear atypia and abundant clear cytoplasm; no glandular or tubular structures were identified. Tumor cells were periodic acid-Schiff positive and negative after diastase treatment; additional mucicarmine and oil red O stains were negative. Immunohistochemical stains showed the tumor cells positive for cytokeratin 7 CK7, p63 >80% nuclei, p53 about 30% nuclei, vimentin, E-cadherin, cluster of differentiation CD10, and Ki-67 >70% nuclei. Stains for cell adhesion molecule 5.2 CAM 5.2, CD117, cytokeratin 20 CK20, human melanoma black 45 HMB-45, paired box protein PAX 8, placental alkaline phosphatase PLAP, prostate specific antigen PSA, renal cell carcinoma RCC, cancer antigen 25 CA25, leukocyte common antigen LC, S-100 protein, and uroplakin III were all negative.

ConclusionsThe tumor marker profile was consistent with clear cell type carcinoma of urothelial origin. Within the differential diagnoses, we ruled out other possible tumor types such as urothelial carcinoma with focal clear cell differentiation, clear cell adenocarcinoma, Müllerian tumors, and metastatic disease.

KeywordsClear cell Cancer Urinary bladder Urothelial carcinoma AbbreviationsCAMCell adhesion molecule

CDCluster of differentiation


HMBHuman melanoma black

PASPeriodic acid-Schiff


PAXPaired box protein

PLAPPlacental alkaline phosphatase

PSAProstate-specific antigen

RCCRenal cell carcinoma

CACancer Antigen.

Electronic supplementary materialThe online version of this article doi:10.1186-1752-1947-8-275 contains supplementary material, which is available to authorized users.

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Author: Virginia M Knez - Willis Barrow - M Scott Lucia - Shandra Wilson - Francisco G La Rosa


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