Department of Gynaecological Oncology, Queens Hospital, London, United Kingdom.
Med Hypotheses. 2013 Feb;80(2):167-71. doi: 10.1016/j.mehy.2012.11.021. Epub 2012 Dec 21.
A literature search was carried out for clinical observations that could explain the possible aetiology of primary peritoneal clear cell carcinoma (CCC) including diagnostic dilemmas, various theories of origin, oestrogen dependence and genetic association. It was found to be an extremely rare tumour (CCC) arising in the peritoneum and is often misdiagnosed as mesothelioma or serous carcinoma or metastatic adenocarcinoma due to overlapping morphological features. The awareness of such dilemmas is important even before making a diagnosis. Clinicopathological features and immunohistochemical studies like WT1, CK20 and calretinin are usually helpful in differentiating CCC from serous carcinoma, metastatic carcinoma from bowel and mesothelioma. (CK7 is common to all epithelial tumours, CEA can be expressed in clear cell carcinoma, WT1 is normally expressed in serous carcinoma, calretinin is expressed in mesothelioma and CK20 in colon carcinoma). The distinction between the above tumours is important as correct diagnosis is required in initiating appropriate treatment. Less than ten cases have been reported in the English language medical literature. Mullerian metaplasia and malignant transformation in endometriosis are two theories proposed for its existence. Peritoneal CCC can be oestrogen dependent in view of association with oestrogen dependent conditions which include endometriosis, adenomyosis and endometrial carcinoma. A genetic ascertain is difficult to be associated and needs further evaluation in a research setting in the familial cancer genetic clinics.
进行了文献检索，以寻找可以解释原发性腹膜透明细胞癌（CCC）可能病因的临床观察结果，包括诊断难题、各种起源理论、雌激素依赖性和遗传关联。它是一种非常罕见的肿瘤（CCC），起源于腹膜，由于形态学特征重叠，常被误诊为间皮瘤、浆液性癌或转移性腺癌。在做出诊断之前，意识到这些难题是很重要的。临床病理特征和免疫组织化学研究，如 WT1、CK20 和钙视网膜蛋白，通常有助于将 CCC 与浆液性癌、转移性癌与肠道和间皮瘤区分开来。（CK7 存在于所有上皮性肿瘤中，CEA 可在透明细胞癌中表达，WT1 通常在浆液性癌中表达，钙视网膜蛋白存在于间皮瘤中，CK20 存在于结肠癌中）。区分上述肿瘤很重要，因为需要正确诊断才能开始适当的治疗。在英语医学文献中，仅报道了不到 10 例病例。Müllerian 化生和子宫内膜异位症中的恶性转化是其存在的两种理论。鉴于与子宫内膜异位症、子宫腺肌病和子宫内膜癌等雌激素依赖性疾病的关联，腹膜 CCC 可能依赖于雌激素。遗传鉴定很难与家族性癌症遗传诊所的研究环境中的相关性相关，需要进一步评估。
