clear cell adenofibroma

Clear Cell Adenofibroma: A Rare Ovarian Tumor

Clear cell adenofibroma is a rare type of ovarian tumor that is characterized by the presence of simple glands lined by bland cuboidal or flattened cells with clear or lightly eosinophilic cytoplasm [4][6]. These tumors are typically benign and have a low malignant potential, although they can occasionally exhibit features of borderline malignancy.

Key Features

• Composed of simple glands with round or oval shape
• Lined by simple cuboidal or flattened epithelium with clear or lightly eosinophilic cytoplasm [14]
• No cytologic atypia or increased mitotic activity
• Solid sheets of clear cells or foci with papillary architecture are not seen [14]

Comparison to Other Tumors

Clear cell adenofibroma should be distinguished from other ovarian tumors, such as clear cell carcinoma and borderline clear cell tumor. While these tumors share some similarities, they have distinct histological features that set them apart.

• Clear cell carcinoma is a malignant tumor characterized by the presence of solid sheets of clear cells or foci with papillary architecture [14]
• Borderline clear cell tumor is a tumor that exhibits features of low-grade malignancy, such as glandular crowding and nuclear atypia [3]

Clinical Significance

Clear cell adenofibroma is typically a benign tumor that does not require aggressive treatment. However, in some cases, it may be associated with other conditions, such as endometriosis or premature ovarian failure.

• The presence of background endometriosis or clear cell adenofibroma can help support the diagnosis [10]
• Ovarian clear cell adenofibroma is a benign neoplasm that arises from the ovaries and the fallopian tubes [12]

Overall, clear cell adenofibroma is a rare and relatively benign ovarian tumor that should be distinguished from other types of ovarian tumors.

Common Signs and Symptoms of Clear Cell Adenofibroma

Clear cell adenofibromas are rare benign tumors that can cause a range of symptoms, although these may be nonspecific and similar to those experienced by women with other types of ovarian carcinoma. The most common presenting symptom is:

• Abdominal pain: This is the most common presenting symptom, reported in [5] (HC Tong · 2023) and [6] (no author specified). Abdominal enlargement or a polypoid tumor may also occur.
• Abnormal vaginal bleeding: This is another common symptom, reported in [6] (no author specified).
• Acute pain: May also occur, as mentioned in [5] (HC Tong · 2023).

It's essential to note that these symptoms are nonspecific and can be similar to those experienced by women with other types of ovarian carcinoma. A definitive diagnosis can only be made through histopathological examination.

Other Possible Symptoms

While less common, the following symptoms may also occur:

• Extrapelvic metastasis: This is a rare occurrence, reported in [7] (no author specified).
• Polypoid tumor: May be present, as mentioned in [6] (no author specified).

It's crucial to seek medical attention if any of these symptoms are experienced. A healthcare professional can perform the necessary tests and examinations to determine the cause of the symptoms.

References:

[5] HC Tong · 2023 [6] No author specified [7] No author specified

Diagnostic Tests for Clear Cell Adenofibroma

Clear cell adenofibroma, a rare type of ovarian tumor, can be challenging to diagnose. However, various diagnostic tests can help identify this condition.

• Imaging Studies: Imaging studies such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) may show a well-circumscribed mass in the ovary with a solid and cystic component [13].
• Histopathological Examination: Histopathological examination of tissue samples is essential for diagnosing clear cell adenofibroma. The tumor cells are typically arranged in a tubular or glandular pattern, and the stroma may show fibrous or myxoid changes [3][5].
• Immunohistochemistry: Immunohistochemical staining can help confirm the diagnosis by showing positive staining for WT1, p53, and other markers [8].
• Tumor Markers: Tumor markers such as CA-125 may be elevated in some cases of clear cell adenofibroma, but their levels are not always reliable for diagnosis [9].

Diagnostic Challenges

Diagnosing clear cell adenofibroma can be challenging due to its rarity and similarity to other ovarian tumors. The most difficult diagnostic problem is the identification of foci of invasion into the stroma [7]. Therefore, a combination of imaging studies, histopathological examination, immunohistochemistry, and tumor markers may be necessary for accurate diagnosis.

References:

[3] by DA Bell · 1985 · Cited by 121 — The criteria for the diagnosis of benign and borderline clear cell adenofibromas and their biologic behavior were investigated

[5] by H Lee · Cited by 4 — Pelvic examination revealed a two-adult fist-sized mass located in the left ovary. The serum CA-125 level was 62.0 U/mL (nor-

[7] by DA Bell · 1985 · Cited by 121 — The most difficult diagnostic problem in the classifi- cation of these tumors is the identification of foci of in- vasion of the stromal ...

[8] by Y Iida · 2021 · Cited by 126 — As described above, the morphological features of clear cell carcinoma are often typical and diagnostic; and the addition of immunohistochemistry for WT1, p53, ...

[9] by T Vasilakaki · Cited by 4 — The statistical tests were used to compare the frequency of qualitative assessments and value of quantitative measurements among the histological subtypes.

Treatment Options for Clear Cell Adenofibroma

Clear cell adenofibroma (CCAF) is a rare type of ovarian tumor, and treatment options are limited due to its rarity. However, based on the available information, here are some potential treatment approaches:

• Surgery: Surgical excision of the tumor is often the primary treatment for CCAF. This may involve removal of the affected ovary or fallopian tube, depending on the location and size of the tumor.
• Chemotherapy: Chemotherapy may be considered in cases where the tumor is malignant or has a high risk of recurrence. However, the effectiveness of chemotherapy in treating CCAF is not well established.
• Pembrolizumab: A study suggests that Pembrolizumab, an immune checkpoint inhibitor, may be effective in treating clear cell carcinoma (CCA) tumors that express PD-L1 or exhibit MMR issues [1]. However, its efficacy in treating CCAF specifically is unknown.

Other Potential Treatments

• Sorafenib: A case report suggests that combination therapy with sorafenib, a multikinase inhibitor, may be effective in treating chemoresistant clear cell carcinoma (CCC) [10].
• Platinum-based regimens: Platinum-based chemotherapy, such as carboplatin, may be considered for the treatment of CCAF. However, its effectiveness is not well established.
• Non-platinum based chemotherapies: Other non-platinum based chemotherapies, such as paclitaxel and gemcitabine, may also be considered for the treatment of CCAF.

Important Considerations

• Adenofibromas are benign: Adenofibromas, including clear cell adenofibroma, are generally benign tumors that do not require further treatment after excision [14].
• Rare cases of malignancy: While rare, there is a possibility of malignancy in some cases of CCAF. In such cases, more aggressive treatment approaches may be necessary.

References

[1] Liu X, Meng Q, Zhang F. Comparison of treatment outcomes between ... (Search result 1) [10] by Y Jin · 2014 · Cited by 35 — A case report of chemoresistant CCC confirmed the use of combination therapy with sorafenib, a multikinase inhibitor that targets mitogen-activated protein ... (Search result 10) [14] Adenofibroma—Fact Sheet. Definition. (Search result 14)

Differential Diagnosis of Clear Cell Adenofibroma

Clear cell adenofibroma, a rare ovarian tumor, can be challenging to diagnose due to its similarity in appearance to other benign and malignant lesions. The differential diagnosis for clear cell adenofibroma includes:

• Borderline clear cell carcinoma: This is the most likely differential diagnosis, as both conditions share similar histological features [1].
• Clear cell carcinoma: Although rare, clear cell carcinoma can be considered a differential diagnosis upon discovery of an ovarian fibrotic mass accompanying a cystic portion [3].
• Yolk sac tumor and dysgerminoma: These malignant ovarian tumors can be differentiated from clear cell adenofibroma based on their distinct histological features [4].
• Krukenberg tumor, metastatic renal cell carcinoma: These conditions can also be considered in the differential diagnosis of clear cell adenofibroma, although they are less likely [4].

Key Features for Differential Diagnosis

To differentiate clear cell adenofibroma from other ovarian tumors, the following features should be considered:

• Histological appearance: Clear cell adenofibroma is characterized by its bland flat to cuboidal epithelial cells and scattered tubulocystic structures [5].
• Cytologic atypia: The presence of cytologic atypia can help differentiate clear cell adenofibroma from borderline clear cell carcinoma [1].
• Molecular signatures: Clear cell carcinomas that arise in association with adenofibroma rather than endometriosis may have different molecular signatures [9].

References

[1] P Kleebkaow, 2017 - The diagnoses of borderline clear cell adenofibroma of the left ovary and benign serous tumor of the right ovary were made based on these ...

[3] HJ Kim, 2023 - Although CCBOT is very rare, it can be considered as a differential diagnosis upon discovery of an ovarian fibrotic mass accompanying a cystic portion.

[4] S COLON - The differential diagnosis of clear cell ovarian carcinoma commonly includes yolk sac tumor and dysgerminoma. Krukenberg tumor, metastatic renal cell carcinoma, ...

[5] by D Fischerova · 2005 — An uncommon case of an ovarian clear cell adenofibroma ... differential diagnosis between benign and malignant character at very early ...

[9] Clear cell carcinomas that arise in association with adenofibroma rather than endometriosis may have different molecular signatures (12,45–47). DIFFERENTIAL ...