Clinical and pathological data of a case of primary clear cell carcinoma of nasal cavity
Description
Rhinoscopy revealed that there were neoplasms in the front of the right nasal cavity, and they grew backwards to obstruct the right nasal cavity. The patient was further assessed via a contrast enhanced computed tomographic scan of the nose and paranasal sinuses, revealing an intensely enhancing heterogeneous mass involving the right nasal cavity extending up to the posterior choana. Bone discontinuities and destruction were evident in the area of the right maxillary sinus. The patient did not report any previous tumors. To determine whether the observed tumor was a metastatic lesion arising from a case of primary renal cell carcinoma, the patient was examined via abdominal CT with dynamic contrast. This examination did not reveal any evidence of lesions within the kidneys, and further assessment via abdominal ultrasound similarly failed to detect any evidence of tumors within the liver, gallbladder, spleen, pancreas, kidney, or bladder. Pathological examination of the tumor tissue was next performed, with hematoxylin and eosin (H&E) tissue samples revealing tumor cells beneath the mucosal epithelium in nests of polygonal and rounded cells that did not appear glandular in nature. The shape of the tumor cells was relatively uniform, with a large clear or foam-like cytoplasm. There were additional fibrous structures between these tumor cells. Cells had small nuclei located in various positions throughout the cell, and only a few cells exhibited an eosinophilic cytoplasm. There was no evidence of significant necrosis or mitosis. Immunohistochemical staining revealed the tumor to be CK and CK7 positive, and PSA, CEA, PAX-8, P63, GPC-3, vimentin , TTF-1, and arginase-1 negative. Criteria which must be taken into account when diagnosing primary HCCC of the nasal cavity include tumor cell morphology, immunohistochemical staining, and clinical examinations to rule out the possibility of the tumor being a metastatic lesion secondary to a primary tumor. Such HCCC tumors can often manifest in the kidneys, lungs, thyroid, or other organs. Renal cell carcinoma (RCC) tissues most often present with tumor cells exhibiting clear cytoplasm, a distinct membrane around the cytoplasm, and pleomorphic nuclei. These RCC cells are also usually CK7 and CK negative, as well as vimentin and PAX-8 positive. As such, the immunohistochemical staining in the present case, together with a negative abdominal CT examination, enables us to favor a diagnosis of primary HCCC of the nasal cavity rather than metastatic RCC. Consistent with this, no evidence of RCC has manifested during the patient follow up period. Tumor cells in this patient stained negative for P63, Arginase-1, GCP-3, TTF-1, CEA, and PSA, and there was no evidence of any tumors in the abdomen or pelvis upon abdominal ultrasound examination. In light of all of this evidence, we were able to finally diagnose this patient as suffering from primary HCCC of the right nasal cavity.
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We obtained the patient's outpatient and inpatient examinations after his consent