Kidney tumor
Adult renal cell carcinoma - common
Clear cell eosinophilic variant
Last author update: 1 May 2015
Last staff update: 17 March 2023 (update in progress)
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PubMed Search:: Eosinophilic [title] clear cell renal cell carcinoma
Table of Contents
Definition / general | Terminology | Clinical features | Radiology images | Prognostic factors | Case reports | Treatment | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Positive stains | Negative stains | Electron microscopy description | Molecular / cytogenetics description | Differential diagnosis | Additional referencesCite this page: Andeen NK, Tretiakova M. Clear cell eosinophilic variant. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/kidneytumormalignantclearcelleosinophilic.html. Accessed June 9th, 2023.
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)
Terminology
- 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
- Same as clear cell RCC
Radiology images
Images hosted on other servers:
Contrast CT scan
Prognostic factors
- > 50% granular eosinophilic features may predict poor response to IL-2 therapy (J Immunother 2005;28:488)
- Clear cell RCCs with > 40% eosinophilic component may have worse clinical outcome (Mod Path 2015;28:S217)
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)
Treatment
- Resection
- Targeted therapy (tyrosine kinase inhibitors, VEGF inhibitors, mTOR inhibitors), cytokine therapy
Gross description
- Often extensive hemorrhage and necrosis (Arch Pathol Lab Med 2014;138:1531)
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)
Negative stains
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
- Not molecularly distinct; characteristics are similar to clear cell RCC (Histopathology 2007;50:678 )
Differential diagnosis
- Chromophobe RCC, including eosinophilic variant: characteristic cytomorphology with raisinoid nuclei, perinuclear halo, prominent cell membranes
- Negative for vimentin, CD10, RCC and CAIX; positive for CK7; membranous CD117 positivity (Pathol Int 2013;63:381, Am J Surg Pathol 2014;38:e35, Am J Surg Pathol 2005;29:640)
- Epithelioid angiomyolipoma: intermixed adipocytes, positive for HMB45 and MelanA, PAX8 negative
- Oncocytoma: CD10, RCC and CAIX negative; CD117 and S100A1 positive
- Papillary RCC, type 2: AMACR, CK7 positive
- Translocation associated RCC, particularly t(6;11)(p21;q12): positive for TFEB, Cathepsin K, HMB45, MelanA
