Clear cell renal cell carcinoma

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Author: Mikael Häggström [notes 1]
Clear cell renal cell carcinoma (CCRCC):

Gross processing

As per: Kidney with tumor

Microscopic examination

Clear cell renal cell carcinoma.

CCRCC typically shows cells in nests or solid pattern, and a delicate branching fibrovascular network.[1]

Differential diagnosis: Kidney with tumor
If unsure, useful immunohistochemistry markers that are positive in CCRCC are vimentin, EMA, keratin, CD10, Pax2, RCC, CAIX (circumferential membranous).[1]


CCRCCs are graded by the ISUP/WHO as follows:[2][3]

  • Grade 1: Inconspicuous and basophilic nucleoli at ×400 magnification
  • Grade 4: Extreme pleomorphism or rhabdoid and/or sarcomatoid morphology

Microscopy report

There should preferably be a free text report and a synoptic report, the free text report including:

  • Diagnosis of clear cell renal cell carcinoma
  • Greatest dimension (from grossing)
  • ISUP/WHO grade
  • Radicality


Kidney, left, partial nephrectomy:
  • Clear cell renal cell carcinoma, 3.2 cm in greatest dimension, ISUP/WHO grade 3.
  • Surgical margins are negative for carcinoma.

Synoptic report

The synoptic report should include:

  • Procedure: Total or partial nephrectomy
  • Laterality: Left or right


  • Histologic type: Such as papillary renal cell carcinoma, type 1
  • Histologic grade
  • Tumor size: From gross description
  • Tumor focality: Unifocal or multifocal
  • Tumor extension: Such as tumor limited to kidney
  • Sarcomatoid features: Identified or not identified
  • Rhabdoid features: Identified or not identified
  • Tumor necrosis: Identified or not identified


  • Margin involvement: Involved by invasive carcinoma (and in which direction), or negative for malignancy
  • Margins type(s): Generally renal parenchymal margin if partial nephrectomy


  • Regional lymph nodes: Involved by invasive carcinoma (and how many), or "no lymph nodes submitted or found"
  • Pathologic stage classification (by pTNM, AJCC 8th Edition):
  • Primary tumor (pT)
  • Regional lymph nodes (pN): Such as pNX if no lymph nodes submitted or found

Any pathologic findings in non-neoplastic kidney


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

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  1. 1.0 1.1 Sirohi, Deepika; Smith, Steven C.; Agarwal, Neeraj; Maughan, Benjamin L. (2018). "Unclassified renal cell carcinoma: diagnostic difficulties and treatment modalities ". Research and Reports in Urology Volume 10: 205–217. doi:10.2147/RRU.S154932. ISSN 2253-2447. 
  2. YiFen Zhang. What is the ISUP/WHO grading system for renal cell carcinoma (RCC)?. Medscape. Updated: Jul 02, 2019
  3. Moch, H. (2016). "WHO-ISUP-Graduierungssystem für Nierenkarzinome ". Der Pathologe 37 (4): 355–360. doi:10.1007/s00292-016-0171-y. ISSN 0172-8113.