Chromophobe renal cell carcinoma

Chromophobe renal cell carcinoma
	Diagnosis in short
	; Eosinophilic variant of chromophobe renal cell carcinoma. H&E stain.
LM	pale cytoplasm, with wisps of eosinophilic material, perinuclear clearing (a pale halo surrounds the nucleus), periphery of cell distinct (cell membrane is easy to discern -- plant cell-like)
Subtypes	eosinophilic variant
LM DDx	clear cell renal cell carcinoma (classic), renal oncocytoma, clear cell renal cell carcinoma eosinophilic variant
Stains	Hale's colloidal iron +ve
IHC	CK7 +ve cell membrane, CD117 +ve, vimentin -ve
Site	kidney - see renal tumours
Syndromes	Birt–Hogg–Dubé syndrome
Prevalence	relatively common

Chromophobe renal cell carcinoma, abbreviated ChRCC, is a relatively common form of renal cell carcinoma.

General

Least common of the common types of RCC (clear cell RCC, papillary RCC, chromophobe RCC).
Fuhrman grading for this entity is controversial, as it does not appear to have any predictive value.^[1]
May be associated with Birt–Hogg–Dubé syndrome.^[2]

There are two subtypes:^[3]

Classic.
Eosinophilic variant.

Gross

Tan, light-brown.
Solitary.
Well-circumscribed.

Image:

Chromophobe RCC (flickr.com).

Microscopic

Classic

Features - classic type (3 P's mnemonic):^[4]^[3]

Pale cytoplasm, with wisps of eosinophilic material; the cells are not completely clear, they have "cobwebs".
Perinuclear clearing, i.e. a pale halo surrounds the nucleus - key feature.
Periphery of cell distinct, i.e. cell membrane is easy to discern.

Notes:

May have psammoma bodies.
May be described as "plant-like"; plant cells have (thick) cell walls.
The perinuclear clearing is often somewhat patchy, i.e. it is usually not present in very tumour cell.

DDx:

Clear cell RCC (classic).
- Perinuclear clearing is not seen in clear cell RCC.
- ChRCC has wisps in the cytoplasm.

Eosinophilic variant

Features - eosinophilic variant:^[3]

Eosinophilic (finely granular) cytoplasm.
Perinuclear clearing - key feature.
Periphery of cell distinct.
Smaller cells than classic subtype.

Notes:

May have psammoma bodies.

DDx:

Oncocytoma - particularly the eosinophilic variant.
- IHC may be useful to differentiate (CK7: oncocytoma = cytoplasm +ve, chromophobe = cell membrane +ve).
- A comparison based on histomorphology: Tabular comparison between ChRCC & oncocytoma.
  - Oncocytoma typically has: no perinuclear clearing, no raisinoid nuclei, no binucleation.
Clear cell RCC, eosinophilic variant.
- Perinuclear clearing is not seen in clear cell RCC.
- ChRCC has wisps in the cytoplasm.

Image

Eosinophilic chromophobe RCC. (WC/Nephron)

www:

Chromophobe RCC - several images (upmc.edu).

Stains

Hale's colloidal iron +ve (blue granular cytoplasmic).

Images:

IHC

CK7 +ve cell membrane.^[3]
CD117 +ve.
Vimentin -ve.

Molecular

Extensive aneusomy (monosomy?):^[6]
- Loss of chromosomes: 1, 2, 6, 10, 13, 17, 21.

Sign out

KIDNEY, RIGHT UPPER POLE, PARTIAL NEPHRECTOMY:
- CHROMOPHOBE RENAL CELL CARCINOMA.

COMMENT:
The sections show a mix of clear cells with wispy cytoplasm, and cells with eosinophilic
cytoplasm and perinuclear halos. There are no true papillae. 

Stains and immunostains:
Positive: CK7, CAM5.2, EMA, pankeratin, CD117, colloidal iron.
Negative: AMACR, CD10, CD68, RCC, vimentin.

References

↑ Delahunt, B.; Sika-Paotonu, D.; Bethwaite, PB.; McCredie, MR.; Martignoni, G.; Eble, JN.; Jordan, TW. (Jun 2007). "Fuhrman grading is not appropriate for chromophobe renal cell carcinoma.". Am J Surg Pathol 31 (6): 957-60. doi:10.1097/01.pas.0000249446.28713.53. PMID 17527087.
↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 290. ISBN 978-0781765275.
↑ ^3.0 ^3.1 ^3.2 ^3.3 Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 293. ISBN 978-0443066771.
↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1016-7. ISBN 0-7216-0187-1.
↑ URL: http://www.ultrapath.org/oldsite/cases99/sep99/cotm9-2.html. Accessed on: 9 October 2011.
↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 292. ISBN 978-0781765275.

[pmid17527087-1] Delahunt, B.; Sika-Paotonu, D.; Bethwaite, PB.; McCredie, MR.; Martignoni, G.; Eble, JN.; Jordan, TW. (Jun 2007). "Fuhrman grading is not appropriate for chromophobe renal cell carcinoma.". Am J Surg Pathol 31 (6): 957-60. doi:10.1097/01.pas.0000249446.28713.53. PMID 17527087.

[Ref_WMSP290-2] Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 290. ISBN 978-0781765275.

[Ref_GUP293-3] 3.0 ^3.1 ^3.2 ^3.3 Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 293. ISBN 978-0443066771.

[4] Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1016-7. ISBN 0-7216-0187-1.

[5] URL: http://www.ultrapath.org/oldsite/cases99/sep99/cotm9-2.html. Accessed on: 9 October 2011.

[Ref_WMSP292-6] Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 292. ISBN 978-0781765275.

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