Kidney tumor

Adult renal cell carcinoma - common

Papillary type 2

Last author update: 1 December 2017
Last staff update: 20 December 2023 (update in progress)

Copyright: 2002-2024,, Inc.

PubMed Search: "Type 2" papillary renal cell carcinoma (eosinophilic)

See Also: Papillary type, renal cell carcinoma, type 1, solid growth pattern

Nicole K. Andeen, M.D.
Maria Tretiakova, M.D., Ph.D.
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Cite this page: Andeen NK, Tretiakova M. Papillary type 2. website. Accessed February 26th, 2024.
Definition / general
  • Papillary architecture with pseudostratified layers of cells with abundant eosinophilic cytoplasm and atypical nuclei with prominent nucleoli
  • Poorer prognosis than type 1; typically presents at higher stage
  • Type 1 vs. type 2 described in 1997 by Delahunt and Elbe (Mod Pathol 1997;10:537)
Essential features
  • Papillary architecture with pseudostratified cells, abundant eosinophilic to occasionally clear cytoplasm, atypical nuclei, prominent nucleoli (usually ISUP grade 3 or higher)
  • As currently defined, likely encompasses more than one entity (Am J Surg Pathol 2014;38:e35)
  • Kidney
Clinical features
  • In one series of papillary RCCs, roughly 25% had classical type 1 features, 25% were type 2 and 50% had some degree of overlapping features (Am J Surg Pathol 2014;38:887)
Radiology description
Prognostic factors
Case reports
Gross images

Images hosted on other servers:

Irregular friable yellow tumor of the upper pole

Large cystic tumor

Microscopic (histologic) description
  • Papillary architecture (Am J Surg Pathol 2014;38:887) with:
    • Pseudostratified layers of large cells (most important feature)
    • Abundant eosinophilic cytoplasm
    • Atypical nuclei with prominent nucleoli (usually ISUP grade 3 or higher)
  • May have areas of clear cytoplasm
  • Variable necrosis
  • Less frequent foam cells and psammoma bodies than type 1
  • Higher nuclear grade than type 1
  • Grading based on ISUP nucleolar grade
Microscopic (histologic) images

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

Type 2 PRCC with focal CK7 expression and diffuse AMACR expression (red)

Images hosted on other servers:

Fig. B

Cytology description
  • Papillary structures, foamy histiocytes, intracytoplasmic hemosiderin and nuclear grooves
Electron microscopy description
  • Similar to classic type but with more mitochondria
Molecular / cytogenetics description
Differential diagnosis
  • Acquired cystic disease associated RCC (ACD-RCC): occurs in setting of end stage renal disease, often has sieve-like architecture and abundant calcium oxalate crystals
  • Clear cell RCC with cytoplasmic eosinophilia: clear cell RCC may have papillary component but is CAIX positive and AMACR negative
  • Clear cell tubulopapillary RCC: is lower nuclear grade and diffusely CK7 positive with cup-like CAIX staining
  • HLRCC: may have many similar features but some cells have distinct, prominent eosinophilic nucleolus with clear halo (CMV-like) and has biallelic inactivation of fumarate hydratase
  • MiTF associated RCC: may also be papillary with eosinophilic and clear cells; express cathepsin K and some express HMB45 or MelanA; FISH for TFE3 tends to be technically superior to IHC
  • Type 1 PRCC: type 2 PRCC has more cytologic pleomorphism, pseudostratification and cells are more eosinophilic; foamy macrophages and psammoma bodies are less common; type 2 PRCC has patchy weak or negative CK7 and EMA and higher expression of Ki67 and p53 than type 1 PRCC (Am J Surg Pathol 2014;38:887)
Board review style question #1
Type 2 papillary renal cell carcinoma:

  1. Has a consistently better clinical outcome than clear cell RCC
  2. Has a diagnostic recurrent genetic abnormality
  3. Is heterogeneous and as currently defined likely encompasses more than one entity
  4. Usually forms a single layer of cells on papillae and is low nuclear grade
Board review style answer #1
C. Is heterogeneous and as currently defined likely encompasses more than one entity

Comment Here

Reference: Type 2 (eosinophilic) papillary renal cell carcinoma
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