PART TWO
Diagnostic Cytology
Fig. 27.14 (A) Chromophobe cell renal carcinoma demonstrates
polymorphous cellular infiltrate with granular to vacuolated cytoplasm
and "raisinoid” nuclei (arrows). (Inset, B) Air-dried preparation shows dense
granular cytoplasm and binucleated cells (Diff-Quik x MP).
Cytology
The FN A appearance shows polyg onal cells b o th sm all and large
set in a clean background. Cells have w ell-d efined borders, w ith
accentuation o f the cytoplasm at the cell borders and p red o m i-
n a n tly eccentrically placed nuclei w ith inconspicuous nucleoli.
There is m arked v a ria b ility in the size o f the nuclei, w h ic h
have sm o oth, fin e ly granular c hrom a tin and ra is in o id nuclei
(Fig. 27.14A,B). Cells m ay be binucleated o r m ultinucleated
and m ay have m ore th a n a dozen fused nuclei arranged p erip h-
e ra lly o r scattered sin g ly w ith in the cytoplasm (Fig. 27.15A,B).
The cytoplasm m ay be granular, and the density o f the granules
ranged fro m hyperdense, s im ila r to an oncocytom a, to areas o f
clearing and translucency m ore s im ila r to th a t seen in clear cell
RCC. In areas, the cytoplasm m ay appear fin e ly reticulated (Fig.
27.15A,C).
The h isto lo g y is characterized m ore b y a clear cell than the
typical e osin o p hilic variant, w ith large cells w ith sm all nuclei
fo rm in g nests separated b y fibrovascular tissue. T he cells display
p ro m in e n t cell m em branes, centrally cleared, o r fin e ly reticu-
lated cytoplasm th a t stain p o sitively fo r Hale's c o llo id a l iro n
Fig. 27.15 (A) and (B) Chromophobe cell renal carcinoma, fine-needle aspirate, eosinophilic variant, showing dispersed polygonal cells, well-defined cell
borders, and dense granular cytoplasm, resembling an oncocytoma (Papanicolaou stain x MP). Rare cells with finely reticulated clear cytoplasm and defined cell
borders. (Inset B)High magnification showing cells with juxtanuclear clearing of cytoplasm, binucleation, and smooth pale chromatin (Papanicolaou x MP).
(C) Trabecular pattern of cells with well-defined cell borders and granular cytoplasm. (Inset) Multinucleated giant cells with fused nuclei (Papanicolaou x MP).
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