A case of primary lung cancer in which almost all of the tumor contained glycogen-rich clear cytoplasm

DOI IR 13 References
  • Matsumoto Isao
    Department of cardiovascular and thoracic surgery, Yokohama Sakae Kyousai hospital
  • Oda Makoto
    Department of general and cardiothoracic surgery, Kanazawa University
  • Yoshida Masayuki
    Department of surgery, Komatsu Municipal Hospital
  • Sawa Shigeharu
    Department of cardiovascular and thoracic surgery, Yokohama Sakae Kyousai hospital
  • Fujii Susumu
    Department of cardiovascular and thoracic surgery, Yokohama Sakae Kyousai hospital
  • Saito Kenichiro
    Department of cardiovascular and thoracic surgery, Yokohama Sakae Kyousai hospital

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Other Title
  • 腫ようのほとんどが淡明な胞体を有する原発性肺癌の１例
  • 腫瘍のほとんどが淡明な胞体を有する原発性肺癌の1例

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Abstract

We report a case of primary lung cancer in which almost all of the tumor contained glycogen-rich clear cytoplasm. The patient, a 73-year-old male, suffered from von Recklinghausen disease. A chest X-ray taken in lung cancer mass screening detected an abnormal shadow in the right lower lung field. The results of analysis of tumor markers were normal, but chest CT examination showed an irregularly shaped tumor with a diameter of about 5 cm at S6 to S9 of the right lung. The tumor was adjacent to the thoracic wall without infiltration. A pulmonary needle-biopsy taken under ultrasonic guidance yielded tumor cells with clear cytoplasm. Pulmonary metastasis of renal cancer was suspected, so a detailed examination was conducted, but no abnormalities were found in areas other than the lung. Therefore, the right lower lobectomy and ND2a lymph node dissection were performed.<BR>Resection yielded a grayish fragile tumor measuring 50×45×45 mm at the periphery of right lower pulmonary lobe S9. Microscopic examination revealed proliferation of large filled tumor cells. Their nuclei were large and some cells were polynucleated, and the cytoplasm was eosinophilic in some areas and contained clear cytoplasm in others, with the latter being dominant. The clear cytoplasm was PAS-positive and digested by diastase, suggesting that the contents were rich in glycogen. The tumor was devoid of elements specific to an adenocarcinoma or squamous cell carcinoma, therefore, the diagnosis was large cell carcinoma originating in the lung and presenting feature of clear cell carcinoma.<BR>There is still a controversy about whether or not a clear cell cancer is an independent histological entity. It was difficult to decide if our case represented a subtype of large cell carcinoma or clear cell carcinoma. In either instance, it seems that there are several histological types among those containing glycogen rich cells, and further analysis of additional cases is awaited.

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