Clear cell renal cell carcinoma: Difference between revisions

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| Micro      = solid or [[trabecular]] pattern, polygonal cells usually with clear cytoplasm (may be eosinophilic - esp. in high grade tumours), central nucleus, delicate branching vasculature (chicken wire-like), +/-hyaline bodies
| Micro      = solid or [[trabecular]] pattern, polygonal cells usually with clear cytoplasm (may be eosinophilic - esp. in high grade tumours), central nucleus, delicate branching vasculature (chicken wire-like), +/-hyaline bodies
| Subtypes  =  
| Subtypes  =  
| LMDDx      = [[chromophobe renal cell carcinoma]], [[clear cell papillary renal cell carcinoma]], [[Xp11.2 translocation carcinoma]], [[adrenocortical carcinoma]], [[alveolar soft part sarcoma]]
| LMDDx      = [[chromophobe renal cell carcinoma]], [[clear cell papillary renal cell tumour]], [[Xp11.2 translocation carcinoma]], [[ELOC-mutated renal cell carcinoma]], [[renal cell carcinoma with fibromyomatous stroma]], [[benign clear cell clusters of the kidney]], [[alveolar soft part sarcoma]], [[adrenocortical carcinoma]], [[hemangioblastoma of the kidney]]
| Stains    = [[Hale's colloidal iron stain]] -ve
| Stains    = PAS +ve, PAS-D -ve, [[Hale's colloidal iron stain]] -ve
| IHC        = [[CA9]] +ve, CK7 -ve, CK20 -ve, TFE3 -ve, PAX8 +ve, vimentin +ve
| IHC        = [[CA9]] +ve, CK7 -ve, CK20 -ve, TFE3 -ve, PAX8 +ve, vimentin +ve
| EM        =
| EM        =
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DDx:
DDx:
*[[Chromophobe renal cell carcinoma]].
*[[Chromophobe renal cell carcinoma]].
*[[Clear cell papillary renal cell carcinoma]].
**Chromophobe: "translucent" (NOT quite clear), reticulated, Hale's colloidal iron stain+, CK7+ (cell membrane).
*[[Clear cell papillary renal cell tumour]].
*[[ELOC-mutated renal cell carcinoma]].
*[[Xp11.2 translocation carcinoma]].
*[[Xp11.2 translocation carcinoma]].
*[[Adrenocortical carcinoma]] (ACC)
*[[Adrenocortical carcinoma]] (ACC).
**EMA -ve, CKs mostly -ve, inhibin +ve (neg. in RCC).<ref name=Ref_GUP285>{{Ref GUP|285}}</ref>
**EMA -ve, CKs mostly -ve, inhibin +ve (neg. in RCC).<ref name=Ref_GUP285>{{Ref GUP|285}}</ref>
*[[Alveolar soft part sarcoma]].
*[[Alveolar soft part sarcoma]].
*[[Adrenal gland]], normal cortex - wispy, vacuolated.
*[[Adrenal gland]], normal cortex - wispy, vacuolated.
*[[Epithelioid angiomyolipoma]].
*[[Epithelioid angiomyolipoma]].
*[[Benign clear cell clusters of the kidney]].
*[[Renal cell carcinoma with fibromyomatous stroma]].
*[[Hemangioblastoma of the kidney]] - especially in [[von Hippel-Lindau disease]].
**S-100 +ve, inhibin +ve, PAX-8+ve, EMA -ve, CA9 -ve.


===Images===
===Images===
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==Stains==
==Stains==
*PAS +ve.
*PAS-D -ve.<ref>{{cite journal |authors=Kolečková M, Tichý T, Melichar B, Veverková L, Hes O, Kolek V, Kolář Z |title=Metastatic Clear Cell Renal Carcinoma Without Evidence of a Primary Renal Tumour Mimicking Advanced Stage of Malignant Lung Tumour |journal=Klin Onkol |volume=32 |issue=Supplementum1 |pages=154–156 |date=2019 |pmid=31064187 |doi= |url=}}</ref><ref>{{cite journal |authors=Liu S, Liu H, Weng B, Hou S |title=Case report: Tongue metastasis as an initial sign of clear cell renal cell carcinoma and its prognosis |journal=Front Oncol |volume=14 |issue= |pages=1473211 |date=2024 |pmid=39931206 |pmc=11807832 |doi=10.3389/fonc.2024.1473211 |url=}}</ref>
*Hale's colloidal iron -ve.  
*Hale's colloidal iron -ve.  
**+ve in [[chromophobe RCC]].
**+ve in [[chromophobe RCC]].


Note: ''[[Hale's colloidal iron]]'' does not stain iron... it stains hemosiderin.<ref>Latta. 27 January 2009.</ref>
Note:  
 
*''[[Hale's colloidal iron]]'' does not stain iron... it stains hemosiderin.<ref>Latta. 27 January 2009.</ref>
Clear cell vs. chromophobe:
*Chromophobe: "translucent" (NOT quite clear), reticulated, Hale's colloidal iron stain+, CK7+ (cell membrane).


==IHC==
==IHC==
*CAIX (also CA9) +ve (47/59 cases ~ 94%).<ref name=pmid36340463>{{cite journal |authors=Yousef A, Kim SS, Krizova A |title=CAIX Immunostaining in Non-neoplastic Renal Diseases |journal=Cancer Diagn Progn |volume=2 |issue=6 |pages=661–667 |date=2022 |pmid=36340463 |pmc=9628162 |doi=10.21873/cdp.10157 |url=}}</ref>
*CD10 +ve.
*CD10 +ve.
*Vimentin +ve.
*Vimentin +ve.
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*Glut-1 >85% of CCRCC (membranous pattern).<ref name=pmid17638658>{{Cite journal  | last1 = Ozcan | first1 = A. | last2 = Shen | first2 = SS. | last3 = Zhai | first3 = QJ. | last4 = Truong | first4 = LD. | title = Expression of GLUT1 in primary renal tumors: morphologic and biologic implications. | journal = Am J Clin Pathol | volume = 128 | issue = 2 | pages = 245-54 | month = Aug | year = 2007 | doi = 10.1309/HV6NJVRQKK4QHM9F | PMID = 17638658 }}</ref>
*Glut-1 >85% of CCRCC (membranous pattern).<ref name=pmid17638658>{{Cite journal  | last1 = Ozcan | first1 = A. | last2 = Shen | first2 = SS. | last3 = Zhai | first3 = QJ. | last4 = Truong | first4 = LD. | title = Expression of GLUT1 in primary renal tumors: morphologic and biologic implications. | journal = Am J Clin Pathol | volume = 128 | issue = 2 | pages = 245-54 | month = Aug | year = 2007 | doi = 10.1309/HV6NJVRQKK4QHM9F | PMID = 17638658 }}</ref>
*E-cadherin +ve - usually weak, often -ve in higher stage tumours.<ref name=pmid23939157>{{Cite journal  | last1 = Hu | first1 = H. | last2 = Chen | first2 = JW. | last3 = Xu | first3 = KX. | last4 = Wang | first4 = D. | last5 = Wang | first5 = Y. | last6 = Wang | first6 = GW. | last7 = Zhang | first7 = SY. | last8 = Wang | first8 = XF. | title = [Expressions of CMTM8 and E-cadherin in primary and metastatic clear cell renal cell carcinoma]. | journal = Beijing Da Xue Xue Bao | volume = 45 | issue = 4 | pages = 537-41 | month = Aug | year = 2013 | doi =  | PMID = 23939157 }}</ref>
*E-cadherin +ve - usually weak, often -ve in higher stage tumours.<ref name=pmid23939157>{{Cite journal  | last1 = Hu | first1 = H. | last2 = Chen | first2 = JW. | last3 = Xu | first3 = KX. | last4 = Wang | first4 = D. | last5 = Wang | first5 = Y. | last6 = Wang | first6 = GW. | last7 = Zhang | first7 = SY. | last8 = Wang | first8 = XF. | title = [Expressions of CMTM8 and E-cadherin in primary and metastatic clear cell renal cell carcinoma]. | journal = Beijing Da Xue Xue Bao | volume = 45 | issue = 4 | pages = 537-41 | month = Aug | year = 2013 | doi =  | PMID = 23939157 }}</ref>
*CAIX (also CA9) +ve.
 


A panel to confirm the diagnosis:
A panel to confirm the diagnosis:
*CK7 (-ve), CD10 (+ve), PAX8 (+ve), vimentin (+ve).
*CAIX (+ve), CK7 (-ve), CD10 (+ve), PAX8 (+ve), vimentin (+ve).


===CCRCC versus [[chromophobe RCC]]===
===CCRCC versus [[chromophobe RCC]]===
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*The surgeon wants the diagnosis and margin status; thus, these are included in the diagnosis line with the tumour stage.
*The surgeon wants the diagnosis and margin status; thus, these are included in the diagnosis line with the tumour stage.


<pre>
Left Kidney, Radical Nephrectomy:
    - CLEAR CELL RENAL CELL CARCINOMA.
    -- Margins clear.
    -- Please see synoptic report.
</pre>
====Block letters====
<pre>
<pre>
KIDNEY, LEFT, NEPHRECTOMY:
KIDNEY, LEFT, NEPHRECTOMY:
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