Which gross pathologic findings are characteristic of clear cell renal cell carcinoma (CCRCC)?

Updated: Mar 11, 2019
  • Author: Ronald J Cohen, MB, BCh, PhD, FRCPA, FFPATH; Chief Editor: Liang Cheng, MD  more...
  • Print
Answer

Answer

Clear cell renal cell carcinoma (CCRCC) is typically a solitary tumor, with multifocality and bilaterality only occurring in 2-7% and 1-2% of sporadic cases, respectively. [8, 39, 40] Tumor sizes in contemporary series range from 0.3-30 cm in maximal diameter, with a mean of 6-7 cm, [5, 8] although current trends are toward smaller tumors.

The tumor commonly presents as a bosselated, well-circumscribed mass with a capsule or pseudocapsule and a pushing margin. Occasionally, an infiltrative margin is seen. On cut section, CCRCC is typically a golden color because of the accumulation of lipid in the malignant cells, while areas of hemorrhage (brown), fibrosis (gray), necrosis, and cystic degeneration often give a variegated appearance. [41] See the images below.

Typical gross presentation of clear cell renal cel Typical gross presentation of clear cell renal cell carcinoma (lower left) with golden color due to intracellular lipid accumulation. White areas are foci of sarcomatoid differentiation. Note tumor extension along the renal vein.
Clear cell renal cell carcinoma (upper right) on g Clear cell renal cell carcinoma (upper right) on gross examination, with extensive dark areas indicating hemorrhage. Note extension through the capsule into the perinephric fat along a pushing, expansile margin (top).

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!