PMC7534079_01
(A) Scar dividing lobules of clear cell RCC with peripheral involvement by granulomata and varying intensity of mixed inflammation (hematoxylin and eosin stain, 2x magnification). (B) Well-developed scar (hematoxylin and eosin stain, 4x magnification).
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Histologic evaluation showed a clear cell neoplasm with acinar growth and delicate, chicken wire-type vasculature in a background of lobulated fibrosis and tumoral-associated inflammation containing granulomata (Figure 1A and B).
Tumor showing classic morphology of clear cell RCC, namely acinar growth with delicate chicken wire-like vasculature, and tumro cells with abundant clear cytoplasm. Nucleoli are prominent and eosinophilic at this magnification (40x), ISUP Grade 2 (hematoxylin and eosin stain, 40x magnification).
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Tumor foci of greatest nuclear pleomorphism contained nuclei with vesicular chromatin and conspicuous eosinophilic nucleoli visible at 40x magnification (Figure 2).
(A, B) Interface of tumor with sarcoidal-like granulomata. (A) Jagged tumor interface with exuberant well-developed pauci-inflammatory sarcoidal-like granulomata, as well as (B) granulomata with exuberant inflammation containing neutrophils, eosinophils, lymphocytes, and plasma cells (hematoxylin and eosin stain; 10x magnification).
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Non-necrotizing sarcoidal-like granulomata (SLG) were present in both a peri-tumoral and intra-tumoral distribution and were accompanied by mixed inflammation of varying intensity, including pauci-inflammatory (Figure 3A) as well as heavily inflamed (Figure 3B). The latter contained actively forming SLG in association with neutrophils, eosinophils, lymphoctyes, and plasma cells (Figure 3B).