Kidney tumor
Adult renal cell carcinoma
Eosinophilic variant of clear cell renal cell carcinoma

Topic Completed: 1 May 2015

Revised: 4 March 2019

Copyright: 2003-2019,, Inc.

PubMed Search: Eosinophilic [title] clear cell renal cell carcinoma
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Cite this page: Andeen NK, Tretiakova M. Eosinophilic variant of clear cell renal cell carcinoma. website. Accessed May 24th, 2019.
Definition / general
  • Clear cell renal cell carcinoma (RCC) with prominent areas of eosinophilic cytoplasm
    • May mimic another subtype of RCC, particularly on small biopsies
  • Often associated with areas of higher grade and stage, extensive (> 50%) necrosis and higher risk of progression (Arch Pathol Lab Med 2014;138:1531, Am J Surg Pathol 2000;24:1247)
  • Not a distinct subtype of clear cell (conventional) RCC (Am J Surg Pathol 2013;37:1469)
  • Former "granular cell variant" terminology is discouraged, as multiple distinct tumor subtypes may be falsely categorized together
Clinical features
Radiology images

Images hosted on other servers:

Contrast CT scan

Prognostic factors
Case reports
  • 22 year old woman with renal epithelioid angiomyolipoma presenting clinically as renal cell carcinoma (Af J Urol 2014;20:197)
  • 54 year old woman with renal cell carcinoma metastasis to the ovary (Cases J 2009;2:7472)
  • Resection
  • Targeted therapy (tyrosine kinase inhibitors, VEGF inhibitors, mTOR inhibitors), cytokine therapy
Gross description
Gross images

Images hosted on other servers:

Kidney RCC eosinophilic

Microscopic (histologic) description
  • Cytoplasmic features:
    • Variable fine to coarse eosinophilic granularity, distributed irregularly
    • Occasional numerous eosinophilic inclusions and hyaline globules
  • Nuclear features: predominantly higher grade areas
  • Classic clear cell areas present elsewhere
Microscopic (histologic) images

Images hosted on other servers:

Neoplastic cells have variable eosinophilic and conventional clear cell features

Figure 3

With eosinophilic hyaline globules

Cytology description
  • May have bland cytomorphology, difficult to distinguish from other renal oncocytic neoplasms on FNA (Cancer 2001;93:390)
Electron microscopy description
  • Similar to classic type (with abundant lipid and glycogen) but with more mitochondria that are swollen and pleomorphic, rarefied matrix and attenuated cristae (Am J Surg Pathol 2000;24:1247)
  • May have scant microvesicles
Molecular / cytogenetics description
Differential diagnosis
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