Renal cell carcinoma (pathology)

Case contributed by Andrew Ryan


Flank pain.

Patient Data

Age: 55 years

Left kidney - coronal section


The photo shows a left kidney bisected in the coronal plane.

There is a multi-nodular, yellow/grey, variably congested tumor, 120 mm in maximum dimension, in the upper to mid pole of the kindey. The tumor shows predominantly expansile growth but also shows invasion into sinus fat and prominent renal vein involvement.


Histological sections confirmed clear cell renal cell carcinoma (RCC) with tumor cells containing abundant, predominantly cleared cytoplasm. Clear cell RCC is graded according to presence/size of nuceoli (nucleolar grading) +/- nuclear morphology (Fuhrman grading - this is grade 4), with a final grade based on the highest grade area. 

Case Discussion

This is a nice example of clear cell renal cell carcinoma that demonstrates several aspects of the tumor:

  • classical yellow/golden macroscopic appearance
  • propensity to grow into the renal vein, sometimes extending into the inferior vena cava and right ventricle
  • cells classically have clear cytoplasm; this is actually a processing artefact secondary to removal of the cytoplasmic lipid during processing
  • often has marked variation in tumor cell morphology and grade across the tumor; this is attributed to 'clones' of tumor cells arising from the initial tumor clone

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