Case Study
Clear Cell Carcinoma of the Base of the Tongue
Carcinoma de células claras en la base de la lengua
Soraya Moreno Zafra
, Marcelino Rodríguez Verdugo, Rafael Hernández López
Corresponding author
Servicio de Otorrinolaringología, Hospital Juan Ramón Jiménez, Huelva, Spain
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Likewise, the patient presented nocturnal dyspnoea in supine dorsal decubitus position.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the clinical examination, a vegetative lesion was observed by indirect and fibre laryngoscopy; it was smooth and vascularized, without erosions or ulcers, on the base of the tongue, predominantly on the left side and more than 4<span class="elsevierStyleHsp" style=""></span>cm in diameter. Cervical palpation revealed no lateral cervical adenopathy or thyroid goitre.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Cervical CAT scan showed a 4.4<span class="elsevierStyleHsp" style=""></span>cm×4.5<span class="elsevierStyleHsp" style=""></span>cm×2.6<span class="elsevierStyleHsp" style=""></span>cm mass on the left side of the base of the tongue, with caudal extension to the pre-epiglottic space. No adenopathy or other lesions were seen.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The NMR indicated oropharyngeal tumour in the posterior section of the base of the tongue, of the same dimensions as in the CAT scan. Radiologically, it gave the impression of having a low level of aggressiveness with well-defined margins; there were no defined areas of central necrosis and adenopathy was absent (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Two biopsy samples were taken from the lesion. The histopathological report indicated “epithelial carcinoma compatible with hyalinizing clear cell carcinoma”; in the lesion there was an epithelial carcinoma with malignant characteristics, consisting of clear cell niches and cords, of scant mitotic activity, with abundant content of glycogen PAS (+)/PAS-distase (−) and of somewhat eccentric nuclei with moderately dense chromatin (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Faced with this diagnosis, an abdominal sonogram was performed to rule out kidney involvement (renal cell carcinoma).</p><p id="par0035" class="elsevierStylePara elsevierViewall">The mass was removed using approach through the suprahyoid pharyngotomy. There were no complications in the postoperative period.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The histopathological study of the specimen confirmed the diagnosis as clear cell carcinoma, with tumour-free margins.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The patient is asymptomatic after 3 years of follow-up. There are no functional sequelae or signs of tumour relapse in either the physical examination or control NMR imaging test.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Hyalinizing clear cell carcinoma (HCCC) was described by Milchgrub et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> as a low-grade tumour, although with the capacity for slow-growing lymphatic spread.</p><p id="par0055" class="elsevierStylePara elsevierViewall">It is a good idea to emphasize the highly unusual nature of this type of carcinoma, which originates in any of the salivary glands, with an incidence of less than 1% of all salivary gland tumours.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Most clear cell carcinomas occur in the oral cavity, with the greater salivary glands and soft palate being the most common location, followed by the lips and the buccal mucosa. Having an oropharyngeal location (and consequently a location at the base of the tongue) is extremely rare. They are more frequent in middle-aged women. The proposed treatment is local excision with margins and functional lymphatic neck dissection.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">It is difficult to diagnose, because it shares or overlaps immunohistological characteristics with other malignant tumours of the salivary glands. It must be differentiated from, among others, mucoepidermoid carcinoma, oncocytic clear cell tumours and metastasis of renal cell or other clear cell carcinomas.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Our clinical case, within the rarity of these tumours, falls within the most frequent parameters in its presentation, such as: middle-aged woman and located on the tongue. Likewise, its range of symptoms is among the most frequent for this disease.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Its low-grade, non-specific clinical presentation causes HCCC diagnosis to be delayed and, although metastasis is rarely produced,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> some can become locally aggressive. Tumour recurrence in extensive series (considering the number of cases described) is approximately 12%.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">There is some controversy over the need to perform prophylactic ganglion removal. Given the rarity of HCCC, this decision should depend on the individual case. Our patient rejected this part of the surgery and, 3 years later, has no ganglion involvement or metastasis.</p><p id="par0080" class="elsevierStylePara elsevierViewall">With this case, we provide details on a tumour rare in this location, but that should be taken into consideration in differential diagnosis of tumours of the base of the tongue.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of Interests</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical Case" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of Interests" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Moreno Zafra S, Rodríguez Verdugo M, Hernández López R. Carcinoma de células claras en la base de la lengua. Acta Otorrinolaringol Esp. 2014;65:133–134.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 864 "Ancho" => 999 "Tamanyo" => 120921 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">NMR, sagittal cut: mass of 4.4<span class="elsevierStyleHsp" style=""></span>cm×4.5<span class="elsevierStyleHsp" style=""></span>cm×2.6<span class="elsevierStyleHsp" style=""></span>cm in the base of the tongue, mildly aggressive, with well-defined margins and lacking areas of necrosis.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 753 "Ancho" => 999 "Tamanyo" => 287039 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histological image of clear cell carcinoma with highly limited mitotic activity.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyalinizing clear cell carcinoma of salivary gland" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Milchgrub" 1 => "D.R. Gnepp" 2 => "F. Vuitch" 3 => "R. Delgado" 4 => "J. Albores-Saavedra" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "1994" "volumen" => "18" "paginaInicial" => "74" "paginaFinal" => "82" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7506496" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyalinizing clear cell carcinoma of the base of the tongue" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Balakrishnan" 1 => "D.R. Nayak" 2 => "S. Pillai" 3 => "L. 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Jordan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/cncr.23974" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "2009" "volumen" => "115" "paginaInicial" => "75" "paginaFinal" => "83" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18980290" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyalinizing clear cell carcinoma of minor salivary gland: case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Manoharan" 1 => "N.H. Othman" 2 => "A.R. 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| 2020 November | 0 | 2 | 2 |
| 2020 July | 0 | 1 | 1 |
| 2020 May | 0 | 1 | 1 |
| 2020 March | 30 | 4 | 34 |
| 2020 February | 28 | 14 | 42 |
| 2020 January | 23 | 10 | 33 |
| 2019 December | 26 | 11 | 37 |
| 2019 November | 22 | 5 | 27 |
| 2019 October | 20 | 1 | 21 |
| 2019 September | 25 | 12 | 37 |
| 2019 August | 12 | 5 | 17 |
| 2019 July | 16 | 6 | 22 |
| 2019 June | 34 | 39 | 73 |
| 2019 May | 84 | 45 | 129 |
| 2019 April | 43 | 35 | 78 |
| 2019 March | 9 | 8 | 17 |
| 2019 February | 11 | 5 | 16 |
| 2019 January | 8 | 14 | 22 |
| 2018 December | 5 | 3 | 8 |
| 2018 November | 6 | 1 | 7 |
| 2018 October | 13 | 1 | 14 |
| 2018 May | 1 | 0 | 1 |
| 2018 April | 2 | 4 | 6 |
| 2018 March | 7 | 6 | 13 |
| 2018 February | 4 | 2 | 6 |
| 2018 January | 4 | 0 | 4 |
| 2017 December | 6 | 1 | 7 |
| 2017 November | 4 | 0 | 4 |
| 2017 October | 8 | 2 | 10 |
| 2017 September | 4 | 1 | 5 |
| 2017 August | 15 | 1 | 16 |
| 2017 July | 10 | 4 | 14 |
| 2017 June | 19 | 6 | 25 |
| 2017 May | 19 | 2 | 21 |
| 2017 April | 13 | 2 | 15 |
| 2017 March | 27 | 26 | 53 |
| 2017 February | 24 | 3 | 27 |
| 2017 January | 11 | 0 | 11 |
| 2016 December | 17 | 12 | 29 |
| 2016 November | 29 | 13 | 42 |
| 2016 October | 21 | 9 | 30 |
| 2016 September | 12 | 6 | 18 |
| 2016 August | 18 | 7 | 25 |
| 2016 July | 13 | 4 | 17 |
| 2016 June | 19 | 12 | 31 |
| 2016 May | 19 | 17 | 36 |
| 2016 April | 20 | 21 | 41 |
| 2016 March | 16 | 19 | 35 |
| 2016 February | 26 | 19 | 45 |
| 2016 January | 18 | 19 | 37 |
| 2015 December | 20 | 14 | 34 |
| 2015 November | 18 | 15 | 33 |
| 2015 October | 21 | 18 | 39 |
| 2015 September | 17 | 17 | 34 |
| 2015 August | 6 | 10 | 16 |
| 2015 July | 13 | 4 | 17 |
| 2015 June | 7 | 1 | 8 |
| 2015 May | 12 | 6 | 18 |
| 2015 April | 13 | 1 | 14 |
| 2015 March | 23 | 4 | 27 |
| 2015 February | 5 | 4 | 9 |
| 2015 January | 12 | 3 | 15 |
| 2014 December | 16 | 5 | 21 |
| 2014 November | 11 | 5 | 16 |
| 2014 October | 16 | 4 | 20 |
| 2014 September | 18 | 2 | 20 |
| 2014 August | 33 | 7 | 40 |
| 2014 July | 31 | 10 | 41 |
| 2014 June | 25 | 10 | 35 |
| 2014 May | 34 | 10 | 44 |
| 2014 April | 13 | 7 | 20 |
Show all