Clear cell (glycogen rich) gastric adenocarcinoma: a distinct tubulo- papillary variant with a predilection for the cardia/gastro-oesophageal region

Aims To explore the clinicopathological and immunohistochemical profile of clear cell gastric cancers with a tubulo-papillary pattern. Methods Twelve cases of clear cell gastric cancer (containing a minimum of 10% of clear cells) were studied. The cases were stained with: CK7, CK20, CEA, AFP, cyclin D1, E-cadherin and CDX-2. Results There were nine males and three females with an age range of 62 to 82 years (mean 71.4 years). Ten cases were located in the gastric cardia with extension into the gastro-oesophageal junction and two were in the pylorus/pre-pyloric area. Tumours ranged from 2 to 9 cm (mean 4.5 cm), nine were polypoid, exophytic grossly and all had a tubulo-papillary histological pattern. Five cases contained intracytoplasmic hyaline globules. Lymph node involvement was present in eight cases. Eight cases were CK7 positive, four were CK20 positive and all 12 were CEA, cyclin D1, E-cadherin and CDX- 2 positive. All cases were AFP negative. Five patients had recurrence and/or metastasis within 6 months. Conclusion Clear cell gastric cancers have a predilection for the gastro-oesophageal junction, are polypoid, have a tubulopapillary pattern, and show over-expression of cyclin D1 but normal E-cadherin.