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Review
. 2019 Dec;111(4):369-374.
doi: 10.32074/1591-951X-28-19.

Eosinophilic cytoplasmic inclusions in type 2 papillary renal cell carcinoma

M Ungari  1 , M Trombatore  1 , G Ferrero  1 , M D Gusolfino  1 , L Manotti  1 , G Tanzi  1 , E Varotti  1 , R Bertoni  1
Affiliations
Review

Eosinophilic cytoplasmic inclusions in type 2 papillary renal cell carcinoma

M Ungari et al. Pathologica. 2019 Dec.

Abstract

A case of a patient with type 2 papillary renal cell carcinoma with eosinophilic cytoplasmatic inclusions is presented. About 50% of tumor cells were characterized by a well-circumscribed intra-cytoplasmatic round-to-oval or irregular inclusion/globule. Inclusions were 7-30 micron in diameter. They were glassy and pale to slightly eosinophilic in color in hematoxylin and eosin, were stained red by trichrome and were negative for periodic acid-Schiff reaction. Immunohistochemically, globules were negative for PAX8, epithelial membrane antigen, Carbonic Anhydrase IX, pan-cytokeratin (AE1/AE3), CD10, S100 protein, α-smooth-muscle actin, cytokeratin 7 and cytokeratin 34βE12. Glassy hyaline globules were not detected in any adjacent normal kidney cells. The presence of eosinophilic cytoplasmic inclusions in renal cell carcinoma, especially in papillary renal cell carcinoma, has been rarely emphasized in the literature. In this article, we review similar cases in the literature and discuss the nature of eosinophilic globules.

Keywords: Aggressive behavior; Eosinophilic cytoplasmatic inclusions; Pppillary renal cell carcinoma; Sarcomatoid differentiation.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

None declared.

Figures

Fig. 1.
Fig. 1.
Hematoxylin and eosin. (A) The tumor was well circumscribed with a fibrous pseudo-capsule. (B) Tubule-papillary architecture; papillae showed delicate or hyalinized fibrovascular cores, with inflammatory cells and occasional foamy macrophages. (C) Papillae were covered by atypical epithelial cells characterized by a well-circumscribed intra-cytoplasmatic round-to-oval or irregular inclusion with a halo. (D) Approximately 5% of tumor showed sarcomatoid changes.
Fig. 2.
Fig. 2.
Immunohistochemistry reactions. (A) Focal expression of pan-cytokeratin AE1/AE3. (B) Diffuse expression of PAX 8. (C) Negative staining for cytokeratin 7 (two normal tubules positive). (D) Focal expression of carbonic anhydrase IX. (E) Diffuse expression of alpha-methylacyl-CoA racemase, with negative eosinophilic cytoplasmic inclusions. (F) Diffuse expression of epithelial membrane antigen, with negative eosinophilic cytoplasmic inclusions.
Fig. 3.
Fig. 3.
(A) Bone localization of epithelial atypical cells organized in cellular cords (hematoxylin and eosin). (B) Large atypical cells with irregular nucleus and clear, abundant cytoplasm (hematoxylin and eosin). (C) Diffuse expression of PAX 8. (D) Focal expression of Carbonic Anhydrase IX.
See this image and copyright information in PMC

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