A Case report on Clear cell adenocarcinoma of the colon, a unique morphological variant of intestinal

carcinoma

For question number 1:

Clear cell adenocarcinoma of the colon is a well-recognized but exceedingly rare subtype of colorectal
cancer with only a handful of cases reported in literature. Its true incidence and prevalence are unknown.
In a study by Domoto et.al involving 3,486 cases of colon cancer, only 0.086% had clear cell changes. Since
first described by Hellstrom and Fisher in 1964, only 15 such cases have been reported in the English
literature. According to published reports, elderly male patients are more affected and tumor tends to be
located on the left colon. Clear cell adenocarcinomas usually develop in the organs of Müllerian origin,
and the occurrence of an isolated clear cell carcinoma of the colon is unclear.

In the Philippines, colorectal cancer is gaining unwanted ground and is now the third leading type of
cancer, especially that less focus is given to this cancer as compared to that of Lung and Breast Cancer.
According to the latest cancer database of the Philippines, cancers of the colon and rectum combined was
estimated to rank 3rd for both sexes (9%), 4th among males (11%) and 3rd among females (7%). There is
an estimated 9,625 new cases in both sexes, 5,250 in males and 4,375 in females with an estimated 5,523
deaths in both sexes, 3,040 in males and 2,483 among females, the most common histologic subtype being
Adenocarcinoma. There was no mention however of any case reports on Clear Cell subtype.

Question number 2: Management of Renal Cell Ca

A clear cell adenocarcinoma generally develops in the kidneys, ovaries, extraovarian endometriosis,
uterine cervix, upper vagina, or lower genital tract. These organs originate from the mullerian system,
which may explain the occurrence of clear cell adenocarcinoma in these systems. An isolated clear cell
adenocarcinoma of the colon however is a rare malignancy and its ontogeny remains unclear.

Comparison on the treatment of localized and locally advanced disease of these different entities is
therefore important. Recommendations on systemic treatment of Renal cell carcinoma mainly relate to
clear cell histology, since most of the pivotal trials have been done in this common histological subtype.
Among the first, second, and third line systemic treatments of patients with good, intermediate, or poor
prognosis in patient with Renal Cell carcinoma, only Bevacizumab plus interferon, and Cabozantinib, a
tyrosine kinase inhibitor have been shown to demonstrate benefit for both Clear Cell Renal and Colorectal
Carcinoma. A strong preclinical rationale for studying mammalian target of rapamycin (mTOR) inhibitors
such as Everolimus as single agents or in combination have been suggested, however, clinical
trials demonstrate limited clinical activity of everolimus for the treatment of advanced colorectal cancer
and have been complicated by increases in toxicity.