Kidney tumor

Adult renal cell carcinoma - common

Clear cell eosinophilic variant

Last author update: 1 May 2015
Last staff update: 14 May 2024 (update in progress)

Copyright: 2003-2024,, Inc.

PubMed Search:: Eosinophilic [title] clear cell renal cell carcinoma

Nicole K. Andeen, M.D.
Maria Tretiakova, M.D., Ph.D.
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Cite this page: Andeen NK, Tretiakova M. Clear cell eosinophilic variant. website. Accessed June 16th, 2024.
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

Contributed by Nicole K. Andeen, M.D. and Maria Tretiakova, M.D., Ph.D.

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

Contributed by Nicole K. Andeen, M.D. and Maria Tretiakova, M.D., Ph.D.

Neoplastic cells have variable eosinophilic and conventional clear cell features

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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