Surgical Pathology Criteria

Papillary Renal Cell Carcinoma

Differential Diagnosis

Papillary Renal Cell Carcinoma Renal Adenoma
>0.5 cm diameter Papillary lesion ≤0.5 cm REQUIRED
May have any nuclear grade Nuclear grade 1 or 2 REQUIRED

Papillary Renal Cell Carcinoma Conventional Clear Cell Renal Cell Carcinoma with Papillary Foci
Papillary pattern usually predominates Usually has conventional areas with sheets and clusters of cells with extensive vascular network
Fibrovascular cores in papillae Lacks fibrovascular cores in papillae
Frequent foamy macrophages and psammoma bodies Lacks foamy macrophages and psammoma bodies
May show intracystic growth pattern Does not show intracystic growth
CK7 and Racemase/AMACR/P504S usually strong positive CK7 and Racemase/AMACR/P504S usually negative to weak/focal

Papillary Renal Cell Carcinoma Clear Cell Tubulopapillary Renal Cell Carcinoma
Clear cell cytoplasm, if present, is focal Widespread clear cell cytoplasm, frequently subnuclear/basal
Frequently has foamy macrophages, psammoma bodies, stromal hemosiderin Lacks foamy macrophages, psammoma bodies, stromal hemosiderin
May have high grade nuclear features and necrosis Low grade nuclear features, no necrosis
CD10 pos, Racemase/AMACR pos CD10 neg, Racemase/AMACR neg

Papillary Renal Cell Carcinoma Collecting Duct Carcinoma
Lacks desmoplasia Prominent desmoplasia
Circumscribed Infiltrative
Frequently low grade nuclear features High grade nuclear features
CD10, AMACR/Racemase, PN15/gp200 positive CD10, AMACR/Racemase, PN15/gp200 negative

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.

Mucinous Tubular and Spindle Cell Carcinoma of the Kidney Papillary Renal Cell Carcinoma with Low Grade Spindle Cell Foci
Lacks areas of classic papillary carcinoma Areas of classic papillary carcinoma usually present
Mucinous stroma present Mucinous stroma generally absent
Lacks trisomy 7 and 17 Trisomy 7 and/or 17 present

Xp11 Translocation Renal Cell Carcinoma Papillary Renal Cell Carcinoma
Frequently occurs under age 20 Mean age 60
Mixed papillary and clear cell areas Clear cell areas focal to absent
Voluminous cytoplasm Moderately abundant cytoplasm at most
Typically high grade nuclear features May have any grade nuclear features
TPE3 immunostain or FISH positive in >80% Lacks Xp11 translocations
CK7 & EMA negative to weak CK7 & EMA frequently strong positive (but may be negative)

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