Primary clear cell carcinoma of nasal cavity: report of six cases and review of literature

Aims: This study is to retrospectively analyze the clinical and pathological data of six cases of primary nasal clear cell carcinoma in our hospital since 1992 and to review literatures on the clinical manifestations, pathological features, immunohistochemistry, diagnosis and treatment of the disease.

Methods: The pathological archives that were diagnosed as salivary gland nasal tumors in Shandong Cancer Hospital during 1992-2013 were reviewed. Careful review of sections was performed by two experienced pathologists. The samples were labeled using EnVision method. Immunostaining was performed using 3, 3'-diaminobenzidine reagent followed by counterstaining with hematoxylin. The immunohistochemical results were classified according to positive cells: no positive staining cells (-); positive cells <30% (+); positive cells between 30% and 50% (++); and positive cells >50% (+++).

Results: Among the 6 cases of primary nasal clear cell carcinoma in our hospital since 1992, 4 cases were diagnosed as clear cell carcinoma of nasal cavity after exclusion of other nasal cavity tumors with clear cells, and 2 cases were directly diagnosed as clear cell carcinoma of nasal cavity. Hyalinizing clear cell carcinoma of salivary gland (HCCC) tissues were mainly composed of polygonal epithelioid tumor cells arranged into the shapes of beehives, and separated by fibrous tissues containing rich thin-wall capillaries. The cytoplasm of HCCC cells was rich and translucent with some cells having multiple vacuoles. Reticular fiber staining showed that the tumor cells were arranged in shapes of beehives and separated by rich reticular fibers. HCCC tumor reacted differently on S-100 protein, glial fibrillary acidic protein, actin and vimentin. The ultrastructure of HCCC cells showed characteristics of ducts but no myoepithelial differentiation.

Conclusions: This study demonstrates that correct diagnosis, timely surgical resection and postoperative radiotherapy are effective in treating nasal clear cell carcinoma.