Presentation
Flank pain.
Patient Data
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 the mid pole of the kidney. 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 artifact 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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