Primary Clear Cell Carcinoma of Exocrine Pancreas: A Case Report

Abstract

Context According to WHO classification, primary clear cell carcinoma of the pancreas is rare and it is classified as a “miscellaneous” carcinoma. There is not an adequate systematic overview of this entity and the few reports lack detailed morphological and immunocytochemical data. Case report A 65-year-old man presented in March 2009 with dyspepsia and a feeling of epigastric mass since two months, with an increase of serum amylase and lipase. The US showed a hypoechoic mass of the pancreatic head (3 cm), confirmed by the abdominal MR, which also detected a solid hepatic lesion, without encasement of the mesenteric vessels. At the ¹⁸FDG-PET the lesion of the head of the pancreas had an increased tracer uptake (SUV_max 9.2; SUV_med 5.3) and CA 19-9 was 1,726 U/L. The patient underwent a palliative biliary and gastric bypass surgery and the histology of the hepatic lesion showed a metastasis of a clear cell adenocarcinoma. The post-operative course was uneventful. Then the patient received palliative radiotherapy and chemotherapy with gemcitabine and carboplatin. The patient died 23 months later of pancreatic cancer progression. Conclusion We presented a case of clear cell carcinoma of the pancreas with a single hepatic metastasis. Only few cases of clear cell carcinoma have been reported in the English literature. Clinical features and survival data were not significantly different from that of ductal adenocarcinoma.