Figures & data
Table 1 Characteristic morphology and diagnostically useful immunostains for renal cell carcinomas
Figure 1 (A–H) Morphological spectrum of RCC with clear-cell change. (A) Conventional clear-cell RCC, WHO/ISUP nuclear grade 2, with characteristic clear tu-mor cells (black arrow) in nests and sheets separated by a fine fibrovascular network (red arrow). (B) The clear-cell RCC demonstrated a glandular morphology (black arrow) with eosinophilic cytoplasm. Characteristic morphology of clear-cell RCC was seen in other areas. (C) Clear-cell RCC with cells with eosinophilic cytoplasm arranged in nests (black arrow). The fine fibrovascular network is retained (red arrow). (D) Clear-cell RCC with rhabdoid features. The cells have eosinophilic cytoplasm with eccentric nuclei (black arrow). (E) Characteristic pattern of clear-cell papillary RCC is seen in this case with cells with optically clear cytoplasm arranged in small nests. The nuclei are low grade and linearly arranged apically along the luminal side (black arrow). (F) In this case of RCC with leiomyomatous stroma neoplastic clear cells (black arrow) are seen in a dense fibromuscular stroma (red arrow). (G) Clear cells with vacuolated foamy cytoplasm (black arrow) are often also seen in MITF-associated RCCs, where they are often seen alongside cells with eosinophilic cytoplasm. 1 hour: Clear cells (black arrow) may be a prominent component of Chromophobe RCCs. Typical cellular and nuclear features of prominent cell borders (red arrow) and perinuclear halos and wrinkled nuclear membranes are helpful in making the diagnosis.
Figure 2 (A–C) Papillary RCCs. (A) Type 1 papillary RCC with papillae (black arrow) lined by small-to-medium-sized cells. (B) In this papillary type 2 pattern of RCC, cells have an oncocytic appearance (black arrow). Psammoma bodies (red arrow) are seen. (C) Type 2 papillary pattern seen in an MITF-RCC. A papillary architecture with cells having abundant eosinophilic cytoplasm (black arrow) is identified. (D–F) RCCs with oncocytic cytoplasm. (D) Chromophobe RCC with eosinophilic cytoplasm. Distinct cellular borders (black arrow) and wrinkled nuclei with perinuclear halos (red arrow) are seen. (E) Oncocytoma with small nests of cells (black arrow) with abundant eosinophilic cytoplasm and uniform round nuclei. (F) A succinate dehydrogenase-deficient RCC is also composed of oncocytic cells with eosinophilic cytoplasm (black arrow). Cytoplasmic vacuoles and eosinophilic globules (red arrow) are seen.
Figure 3 (A–D) RCCs with high-grade distal nephron adenocarcinoma morphology. (A) An intracystic papillary pattern with hyalinized cores (black arrow) is seen in this case of fumarate hydratase-deficient RCC. (B) Tubulocystic RCC with infiltrating tubules and cystic spaces (black arrow) lined by atypical cells. (C) A collecting duct carcinoma with infiltrating angulated glands (black arrow) in a desmoplastic stroma (red arrow). (D) Renal medullary carcinoma with a reticular yolk sac-like pattern (black arrow).
Table 2 Selected ongoing prospective clinical trials in non-clear-cell renal carcinoma