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Clear cell renal cell carcinoma (view source)
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Clear_cell_renal_cell_carcinoma_high_mag.jpg | |||
| Width = | |||
| Caption = Clear cell renal cell carcinoma. [[H&E stain]]. | |||
| Micro = Solid or [[trabecular]] pattern, polygonal cells usually with clear cytoplasm, central nucleus, delicate branching vasculature (chicken wire-like) | |||
| Subtypes = eosinophilic variant | |||
| LMDDx = [[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 | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[kidney]] - see [[kidney tumours]] | |||
| Assdx = | |||
| Syndromes = [[von Hippel-Lindau syndrome]], familial clear cell renal cell carcinoma | |||
| Clinicalhx = | |||
| Signs = +/-hematuria, +/-abdominal mass | |||
| Symptoms = | |||
| Prevalence = common | |||
| Bloodwork = | |||
| Rads = renal mass | |||
| Endoscopy = | |||
| Prognosis = good-to-poor - dependent on stage and grade | |||
| Other = | |||
| ClinDDx = other [[renal tumours]] | |||
}} | |||
'''Clear cell renal cell carcinoma''', abbreviated '''CRCC''' or '''CCRCC''', is the most common type of [[renal cell carcinoma]]. | |||
==General== | |||
*Most common subtype of [[RCC]]. | |||
*May be associated with [[Von Hippel-Lindau syndrome]]. | |||
==Gross== | |||
*Gold/yellow. | |||
*+/-Haemorrhage (common). | |||
*+/-Necrosis (common in large tumours). | |||
*+/-Calcification. | |||
*+/-Cysts. | |||
==Microscopic== | |||
Features:<ref name=Ref_PBoD1017-8>{{Ref PBoD|1017-8}}</ref> | |||
*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.<ref name=Ref_WMSP291>{{Ref WMSP|291}}</ref> | |||
**This change is typically focal - other areas have a classic appearance. | |||
**Chicken wire-like vasculature present - helps distinguish from other tumours. | |||
*[[Hyaline bodies]] common.<ref>AFIP Renal Tumours Book.</ref> | |||
**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).<ref name=Ref_GUP285>{{Ref GUP|285}}</ref> | |||
*[[Alveolar soft part sarcoma]]. | |||
*[[Adrenal gland]], normal. | |||
===Images=== | |||
<gallery> | |||
Image:Clear_cell_renal_cell_carcinoma_intermed_mag.jpg | CRCC - intermed. mag. (WC/Nephron) | |||
Image:Clear_cell_renal_cell_carcinoma_high_mag.jpg | CRCC - high mag. (WC/Nephron) | |||
</gallery> | |||
==IHC== | |||
*CK7 -ve. | |||
*CK20 -ve. | |||
*Hale's colloidal iron -ve. | |||
**+ve in [[chromophobe RCC]]. | |||
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). | |||
==Sign out== | |||
<pre> | |||
KIDNEY, LEFT, NEPHRECTOMY: | |||
- CLEAR CELL RENAL CELL CARCINOMA, FUHRMAN GRADE 2, pT1a, pNx. | |||
-- MARGINS NEGATIVE FOR MALIGNANCY. | |||
-- PLEASE SEE TUMOUR SUMMARY. | |||
</pre> | |||
<pre> | |||
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. | |||
</pre> | |||
Note: | |||
*The surgeon wants the diagnosis and margin status; thus, these are included in the diagnosis line with the tumour stage. | |||
===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]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Kidney tumours]] | |||