Clear-cell renal-cell carcinoma

Clear-cell renal-cell carcinoma (CCRCC) is a type of renal-cell carcinoma.

Genetics

Cytogenetics

• Alterations of chromosome 3p segments occurs in 70–90% of CCRCCs
• Inactivation of von Hippel–Lindau disease (VHL) gene by gene mutation and promoter hypermethylation
• Gain of chromosome 5q
• Loss of chromosomes 8p, 9p, and 14q

Molecular genetics

Several frequently mutated genes were discovered in CCRCC: VHL, KDM6A/UTX, SETD2, KDM5C/JARID1C and MLL2. PBRM1 is also commonly mutated in CCRCC.

Histogenesis

CCRCC is derived from the proximal convoluted tubule.

Microscopy

Generally, the cells have a clear cytoplasm, are surrounded by a distinct cell membrane and contain round and uniform nuclei.

Microscopically, CCRCCs are graded by the ISUP/WHO as follows:

• Grade 1: Inconspicuous and basophilic nucleoli at magnification of 400 times
• Grade 2: Clearly visible and eosinophilic nucleoli at magnification of 400 times
• Grade 3: Clearly visible nucleoli at magnification of 100 times
• Grade 4: Extreme pleomorphism or rhabdoid and/or sarcomatoid morphology

Epidemiology

• CCRCC most commonly affects male patients in their sixties and seventies.
• Majority of cases arise sporadically.
• Only 2–4% of the cases presenting as part of an inherited cancer syndrome, such as von Hippel–Lindau disease.

Images

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  Clear-cell renal-cell carcinoma. Macroscopy
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  Clear-cell renal-cell carcinoma. HE, × 100
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  Clear-cell renal-cell carcinoma. Fuhrman grade = 1. HE, × 400
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  Grade 3: Arrows point at a clearly visible nucleolus.