P2072 - Clear Cells Outside Their Natural Habitat: Incidental Clear Cell Tubular Adenoma Found in Colonoscopy of a Young Woman

Chimsom Orakwue, MD, David Wan, MD
New York-Presbyterian / Weill Cornell Medical Center, New York, NY

Introduction: Clear cell carcinoma is a type of cancer composed of cells that look clear under the microscope. Most often cases are within the kidney or female genitourinary system, composing ~80% of malignant renal cell carcinoma cases¹. These organs originate from the Mullerian system, which may explain the correlational occurrence in these areas. Clear cell changes in tubular adenomas are rare (< 1%) and, therefore, not well characterized by the literature. We report a case of a young woman with a clear cell tubular adenoma found incidentally on colonoscopy.

Case Description/Methods: 48-year-old woman with a medical history of carcinoid lung tumor (with resection and mediastinal lymph node dissection, adjuvant chemotherapy), gastroesophageal reflux disease, choledocholithiasis with colectomy, colonic polyps, and family history of metastatic colon cancer presented for early followup at the request of her oncologist. She had her first colonoscopy in 2020. At that time, 1 polyp was removed, with pathology demonstrating lymphoid aggregate. Given her family history, she was told to repeat in 5 years (2025). However, her oncologist recommended early exam due to anemia. At the time of the colonoscopy, she was asymptomatic and did not endorse rectal bleeding or unintentional weight loss. A solitary polyp in the descending colon demonstrated a tubular adenoma with clear cell changes. She was advised to follow up in 7 years.

Discussion: Clear cell changes in tubular adenomas have been reported few times in the literature. Since first described by Hellstrom in 1964, less than 40 cases have been identified². Due to its unclear ontogeny, it is not certain if clear cell changes are distinct entities, variants of other colorectal carcinomas, or metastases^1,2. Risk factors, incidence, prevalence, and prognosis are also not well described. In this case, the patient had no documented recurrence of her prior malignancy nor evidence of other new malignancy. Additionally, clear cell pathology was not identified in her prior carcinoma. Presumed genesis of primary clear cell carcinoma of the colon may be due to alterations in the mucin core protein profile, however, there is still a paucity of literature adequately describing clear cell carcinoma in the colon.

1. Arora RD, et al. Renal Clear Cell Cancer. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
2. Remo, A, et al. Clear cell colorectal carcinoma: Time to clarify diagnosis, Pathology - Research and Practice, 213(5):447-452.2017.


Disclosures:


Chimsom Orakwue, MD, David Wan, MD. P2072 - Clear Cells Outside Their Natural Habitat: Incidental Clear Cell Tubular Adenoma Found in Colonoscopy of a Young Woman, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.