Clear cell renal cell carcinoma

Clear cell renal cell carcinoma, abbreviated CRCC or CCRCC, is the most common type of renal cell carcinoma.

Clear cell renal cell carcinoma
Diagnosis in short
Clear cell renal cell carcinoma. H&E stain.
LM	Solid or trabecular pattern, polygonal cells usually with clear cytoplasm, central nucleus, delicate branching vasculature (chicken wire-like), +/-hyaline bodies
Subtypes	eosinophilic variant
LM DDx	chromophobe renal cell carcinoma, clear cell papillary renal cell carcinoma, Xp11.2 translocation carcinoma, Adrenocortical carcinoma, alveolar soft part sarcoma
Stains	Hale's colloidal iron stain -ve
IHC	CK7 -ve, CK20 -ve, TFE3 -ve
Site	kidney - see kidney tumours
Syndromes	von Hippel-Lindau syndrome, familial clear cell renal cell carcinoma
Signs	+/-hematuria, +/-abdominal mass
Prevalence	common
Radiology	renal mass
Prognosis	good-to-poor - dependent on stage and grade
Clin. DDx	other renal tumours

General

• Most common subtype of RCC.
• May be associated with Von Hippel-Lindau syndrome.
• Familial clear cell renal cell carcinoma.
  • VHL gene mutation not in all cases.

Gross

• Gold/yellow.
• +/-Haemorrhage (common).
• +/-Necrosis (common in large tumours).
• +/-Calcification.
• +/-Cysts.

Image

• 

  CCRCC. (WC/euthman)

Microscopic

Features:

• Solid or trabecular pattern.
• Polygonal cells.
• Clear cytoplasm.
• Central nucleus.
• Delicate branching vasculature.
  • Often called "chicken wire-like" vasculature.
• +/-Rhabdoid cells:
  • Eccentric nucleus.
  • Abundant eosinophilic cytoplasma.

Notes:

• Cytoplasm may be eosinophilic.
  • This change is typically focal - other areas have a classic appearance.
  • Chicken wire-like vasculature present - helps distinguish from other tumours.
• Hyaline bodies common.
  • Not common in papillary RCC.
• Clear cytoplasm - due to lipid content.

DDx:

• Chromophobe renal cell carcinoma.
• Clear cell papillary renal cell carcinoma.
• Xp11.2 translocation carcinoma.
• Adrenocortical carcinoma (ACC)
  • EMA -ve, CKs mostly -ve, inhibin +ve (neg. in RCC).
• Alveolar soft part sarcoma.
• Adrenal gland, normal.

Images

• 

  CRCC - intermed. mag. (WC/Nephron)

• 

  CRCC - high mag. (WC/Nephron)

Stains

• Hale's colloidal iron -ve.
  • +ve in chromophobe RCC.

Note: Hale's colloidal iron does not stain iron... it stains hemosiderin.

Clear cell vs. chromophobe:

• Chromophobe: "translucent" (NOT quite clear), reticulated, Hale's colloidal iron stain+, CK7+ (cell membrane).

IHC

• CK7 -ve.
• CK20 -ve.

CCRCC versus chromophobe RCC:

• Vimentin +ve.
  • -ve in ChRCC.
• CD117 -ve.
  • +ve ~80% of ChRCC.

Sign out

Note:

• The surgeon wants the diagnosis and margin status; thus, these are included in the diagnosis line with the tumour stage.

KIDNEY, LEFT, NEPHRECTOMY:
- CLEAR CELL RENAL CELL CARCINOMA, FUHRMAN GRADE 2, pT1a, pNx.
-- MARGINS NEGATIVE FOR MALIGNANCY.
-- PLEASE SEE TUMOUR SUMMARY.

Adrenal gland present

KIDNEY, RIGHT, RADICAL NEPHRECTOMY:
- CLEAR CELL RENAL CELL CARCINOMA, FUHRMAN GRADE 2, pT1a, pNx.
-- MARGINS NEGATIVE FOR MALIGNANCY.
-- PLEASE SEE TUMOUR SUMMARY.
- ADRENAL GLAND WITHIN NORMAL LIMITS.

KIDNEY, RIGHT, RADICAL NEPHRECTOMY:
- CLEAR CELL RENAL CELL CARCINOMA, FUHRMAN GRADE 3, pT1b, pNx.
-- MARGINS NEGATIVE FOR MALIGNANCY.
-- PLEASE SEE TUMOUR SUMMARY.
- ADRENAL GLAND WITHIN NORMAL LIMITS.

Micro

The sections show a tumour with a chicken wire-like vasculature composed of clear cells with basally stratified nuclei. Hemosiderin-laden macrophages are present. Necrosis is present. Abundant hyaline globules are present.

There is no perinuclear clearing. The cytoplasm is not whispy. Collections of macrophages are not identified within the stroma of the tumour. Papillae are not evident.

Rare, small nucleoli are visible with the 10x objective. The tumour nuclei are approximately 15 micrometers.

See also

• Kidney tumours.