Surgical Pathology Criteria

Clear Cell Renal Cell Carcinoma

Differential Diagnosis

Conventional Clear Cell Renal Cell Carcinoma Chromophobe Renal Cell Carcinoma
Sheets and nests of clear cells with prominent surrounding vascular network Rigid cell membranes, central nuclei with surrounding nuclear clearing
CD117/KIT neg CD117/KIT pos
Vimentin, Carbonic Anhydrase IX generally pos Vimentin, Carbonic Anhydrase IX negative
Hale colloidal iron negative Hale colloidal iron positive

Conventional Clear Cell Renal Cell Carcinoma, Granular Variant Renal Oncocytoma
Nearly always has clear cell areas Clear cells only in focal, hyalinized scar areas
Prominent surrounding capillary network Surrounding stroma hypocellular
Carbonic anhydrase IX, AMACR/racemase, vimentin usually pos Carbonic anhydrase IX, AMACR/racemase, vimentin usually neg
cKIT/CD117 usually neg cKIT/CD117 usually pos

Conventional Clear Cell Renal Cell Carcinoma Clear Cell Tubulopapillary Renal Cell Carcinoma
Sheets and clusters of cells with extensive vascular network Nearly all have branched tubules and anastomosing ribbons
Solid areas have clusters more than two cells wide Solid areas usually formed by compressed tubules, each only two cells wide
May have high grade nuclear features, vascular invasion and necrosis Low grade nuclear features, no invasion or necrosis
Cysts frequently due to degeneration, lined in areas by multiple layers of cells Uniformly lined by single layer of cells
Clear cytoplasm apical or diffuse, non-localized Frequent regular basal clearing, resembling interval endometrium
Usually CK7 neg, CD10 pos CK7 pos, CD10 neg to focal

Conventional Clear Cell Renal Cell Carcinoma Multilocular Cystic Renal Cell Carcinoma
Both cystic and solid areas No solid areas
Nodules of clear cells are expansile and/or invasive Nests of clear cells are not expansile or invasive
May be low or high grade Must be low grade (1 or 2)

Conventional Clear Cell Renal Cell Carcinoma Renal Adenoma
No size cutoff for clear cell tumors Papillary lesion ≤0.5 cm, clear cells not permitted
May be high or low grade Must be no higher than grade 2
CK7, AMACR/racemase/P504S neg to focal CK7, AMACR/racemase/P504S pos

Stanford Medicine Resources:

Footer Links: