Which microscopic 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...
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Answer

Answer

Typically, clear cell renal cell carcinoma (CCRCC) is characterized by epithelial cells with clear cytoplasm and a well-defined cell membrane, interspersed within a highly vascularized stroma. The transparency of the cytoplasm results from accumulated droplets of glycogen, phospholipids, and neutral lipids-in particular, cholesterol ester. [42, 43] Glycogen can be demonstrated by periodic-acid Schiff (PAS) stain, whereas neutral lipids can be identified using the Oil red O stain on unfixed tissue but are dissolved by histological processing.

CCRCC may also contain a variable proportion of cells with granular eosinophilic cytoplasm. Rarely, these granular cells are the predominant or even the only cell type. [41] See the images below.

Typical histologic appearance of clear cell renal Typical histologic appearance of clear cell renal cell carcinoma on hematoxylin and eosin stain, showing nests of epithelial cells with clear cytoplasm and a distinct cell membrane, separated by a delicate branching network of vascular tissue.
Granular cell variant of clear cell renal cell car Granular cell variant of clear cell renal cell carcinoma on hematoxylin and eosin stain.

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