Surgical Pathology Criteria

Oncocytic Papillary Renal Cell Carcinoma

Differential Diagnosis

Renal Oncocytoma Oncocytic Papillary Renal Cell Carcinoma
Solid, with minimal, poorly developed papillary change Usually predominantly papillary
At most, rare, focal foamy macrophages May have clusters of foamy macrophages
Necrosis is rare and only microscopic foci May have tumor cell necrosis
AMACR/racemase/P504S usually negative AMACR/racemase/P504S positive
Occasional oncocytic papillary renal cell carcinomas may be largely solid; the bottom three criteria are more important in such cases

Type 2 Papillary Renal Cell Carcinoma Oncocytic Papillary Renal Cell Carcinoma
Nuclei usually pseudostratified Nuclei usually linear, frequently apical
Cytoplasm eosinophilic but not abundant and granular Abundant granular eosinophilic cytoplasm
The distinction might be significant since oncocytic papillary carcinomas may have a better prognosis, but more data is needed.

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