Fig. 1Histologic variations of clear cell renal cell carcinomas. Typical clear cell morphology (A), eosinophilic cytoplasm (B), rhabdoid features (C), and sarcomatoid differentiation (D).
Fig. 2(A) Primary clear cell renal cell carcinoma composed of typical clear cells with rhabdoid features. (B) Metastatic lesion of a lung mainly composed of tumor cells with unclassifiable morphology. Immunohistochemical staining of a metastatic lesion showing CD10 (C) and vimentin (D) positivity.
Table 1.Clinicopathologic characteristics of primary clear cell renal cell carcinomas
Parameter |
|
No. (%) (n = 81) |
Sex |
Male |
64 (79.0) |
|
Female |
17 (21.0) |
Fuhrman grade |
I |
0 (0) |
|
II |
19 (23.5) |
|
III |
48 (59.3) |
|
IV |
14 (17.3) |
Stage |
I |
25 (30.9) |
|
II |
12 (14.8) |
|
III |
16 (19.8) |
|
IV |
28 (34.6) |
Table 2.Sites of metastatic clear cell renal cell carcinomas
Metastatic site |
No. (%) (n = 119) |
Lung |
49 (41.2) |
Bone |
26 (21.8) |
Soft tissue |
14 (11.8) |
Skin |
6 (5.0) |
Pancreas |
5 (4.2) |
Liver |
4 (3.4) |
Adrenal gland |
4 (3.4) |
Brain |
2 (1.7) |
Palatine tonsil |
2 (1.7) |
Gallbladder |
1 (0.8) |
Nasal cavity |
1 (0.8) |
Thyroid |
1 (0.8) |
Parotid gland |
1 (0.8) |
Colon |
1 (0.8) |
Lymph node (mediastinum) |
1 (0.8) |
Stomach |
1 (0.8) |
Table 3.Overall histologic features of primary and metastatic clear cell renal cell carcinomas
Primary (n = 81) |
No. |
Metastatic (n = 119) |
No. |
CL |
37 |
CL |
42 |
|
|
CL+E |
4 |
|
|
CL+R |
3 |
|
|
R |
1 |
|
|
UN |
2 |
CL+E |
19 |
CL |
12 |
|
|
CL+E |
8 |
|
|
E |
8 |
|
|
R |
1 |
CL+R |
15 |
R |
10 |
|
|
CL+R |
11 |
|
|
CL+R+UN |
1 |
CL+SA |
2 |
CL |
1 |
|
|
CL+SA |
3 |
CL+E+R |
5 |
CL |
2 |
|
|
CL+E |
2 |
|
|
CL+R |
2 |
|
|
E+R |
1 |
CL+R+SA |
2 |
CL+R+SA |
2 |
|
|
R+SA |
2 |
CL+E+R+SA |
1 |
E+R+SA |
1 |
Table 4.Proportions of non-clear cell histologic component in primary and metastatic clear cell renal cell carcinomas
Histologic feature |
Primary (n = 81) |
Metastatic (n = 119) |
p-value |
Eosinophilic |
25 (30.9) |
24 (20.2) |
.094 |
Rhabdoid |
23 (28.4) |
35 (29.4) |
.877 |
Sarcomatoid |
5 (6.2) |
8 (6.7) |
.707 |
Unclassifiable |
0 (0) |
3 (2.5) |
.158 |
Table 5.Histologic features from cases with multiple metastatic clear cell renal cell carcinoma lesions
Case No. |
Primary |
1st mets |
2nd mets |
3rd mets |
4th mets |
5th mets |
3 |
CL+R |
R (bone) |
R (bone) |
|
|
|
14 |
CL+R |
R (skin) |
R (skin) |
|
|
|
21 |
CL+E |
CL+E (soft ts) |
CL+E (liver) |
|
|
|
28 |
CL+R |
CL+R (lung) |
CL+R (soft ts) |
|
|
|
32 |
CL+E |
E (lung) |
E (lung) |
E (lung) |
E (lung) |
E (tonsil) |
33 |
CL+SA |
CL+SA (lung) |
CL+SA (lung) |
|
|
|
38 |
CL+R |
R (bone) |
R (bone) |
|
|
|
39 |
CL+R |
CL+R (lung) |
CL+R (lung) |
|
|
|
41 |
CL+R+SA |
CL+R+SA (lung) |
CL+R+SA (soft ts) |
|
|
|
47 |
CL+R+SA |
R+SA (soft ts) |
R+SA (lung) |
|
|
|
48 |
CL |
CL+R (tonsil) |
CL+R (skin) |
|
|
|
49 |
CL+R |
CL+R (lung) |
CL+R (soft ts) |
|
|
|
79 |
CL |
CL+E (soft ts) |
CL+E (liver) |
CL+E (sto) |
|
|
12 |
CL+E+R |
CL+E (lung) |
CL (lung) |
CL (soft ts) |
|
|
16 |
CL+E |
CL (adrenal) |
R (bone) |
|
|
|
69 |
CL+R |
CL+R (soft ts) |
R (skin) |
|
|
|
73 |
CL |
CL+R (lung) |
CL (lung) |
|
|
|
Table 6.Immunohistochemical results of primary and metastatic clear cell renal cell carcinomas
Immunohistochemical marker |
Positive cases/Total cases (%)
|
p-value |
Primary |
Metastatic |
CD10 |
20/20 (100) |
45/46 (97.8) |
.514 |
RCC Ma |
3/5 (60) |
7/15 (46.7) |
.628 |
CK7 |
0/12 (0) |
1/18 (5.6) |
.424 |
CK20 |
0/7 (0) |
0/15 (0) |
- |
CK |
5/7 (71.4) |
9/20 (45.0) |
.245 |
EMA |
1/1 (100) |
11/13 (84.6) |
- |
VT |
7/12 (58.3) |
24/29 (82.8) |
.158 |
PAX2 |
4/4 (100) |
2/3 (66.7) |
.423 |