Uterine Clear Cell Carcinoma (UCCC)
Overview
UCCC (Uterine Clear Cell Carcinoma) is a rare, high-grade endometrial carcinoma subtype with clear-cell histology, classified as a child of UCEC in OncoTree. It is histologically distinct from endometrioid (UEC) and serous (USC) endometrial carcinomas but overlaps with both molecularly; approximately one-third of CCECs show serous-like profiles (TP53/PPP2R1A co-mutation) and one-fifth show endometrioid-like profiles (PTEN/KRAS/ARID1A mutations). MSI is present in ~11% of cases. The largest exome-scale characterization was the NIH study (uccc_nih_2017, n=63) that nominated TAF1 and KMT2C as novel candidate drivers.
Cohorts in the corpus
- uccc_nih_2017 — 63 clinically diagnosed CCEC cases (16 paired exomes, 47 Sanger-validated); NIH, Le Gallo et al. 2017.
Recurrent alterations
- TP53 — 39.7% of CCEC; enriched in serous-like profiles (group 1). PMID:28485815
- PIK3CA — 23.8%; part of the PI3K axis mutated in 34.9% of CCECs. PMID:28485815
- PIK3R1 — 15.9%. PMID:28485815
- ARID1A — 15.9%. PMID:28485815
- PPP2R1A — 15.9%; co-enriched with TP53 in serous-like profiles. PMID:28485815
- SPOP — 14.3%. PMID:28485815
- TAF1 — 9.5% (6/63); 5 mutations in the putative HAT domain including recurrent Arg843 and Ala850; nominated as a novel CCEC candidate driver. PMID:28485815
- FBXW7 — 7.9%. PMID:28485815
- KMT2C (MLL3) — 7.9%; 3 frameshift mutations N-terminal to the SET domain; nominated as a novel CCEC candidate driver. PMID:28485815
- MSI — 11.3% of CCECs; MSI-high tumors carry markedly elevated mutational loads (>400 somatic calls). PMID:28485815
- No POLE exonuclease-domain hotspot mutations identified in CCEC (contrasting with favorable-prognosis EEC subset). PMID:28485815
Subtypes
- Serous-like (group 1): TP53 + PPP2R1A co-mutation; 27.0% of CCECs; resembles USC.
- Mixed (group 2): 19.1%; intermediate molecular features.
- Endometrioid-like (group 3): PTEN/KRAS/ARID1A enrichment; 20.6%; resembles UEC.
- No detectable alteration across the 7-gene + MSI panel: 33.3% — likely harbor drivers outside the surveyed loci.
Therapeutic landscape
- 11.3% MSI rate supports consideration of anti-PD-1 therapy (pembrolizumab); two MSI endometrial cancer patients responded to pembrolizumab in a phase 2 trial (Le Gallo et al.). PMID:28485815
- 34.9% PI3K-axis mutation rate (PIK3CA/PIK3R1/PTEN) implies potential vulnerability to PI3K/AKT/mTOR-axis inhibitors. PMID:28485815
Sources
- PMID:28485815 — Le Gallo et al., whole-exome sequencing of 63 uterine clear cell carcinomas (uccc_nih_2017).
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