Kidney tumor - adult malignancies
Adult renal cell carcinoma
Papillary type, renal cell carcinoma

Author: Sean Williamson, M.D. (see Authors page)

Revised: 31 January 2017, last major update June 2012

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: "Papillary type" renal cell carcinoma kidney

See Also: Type 1, Type 2, Solid variant
Cite this page: Papillary type, renal cell carcinoma. PathologyOutlines.com website. http://pathologyoutlines.com/topic/kidneytumormalignantrccpap.html. Accessed September 20th, 2017.
Definition / general
  • Papillary or tubulopapillary tumor with foamy macrophages and intracellular hemosiderin
  • Size greater than 5 mm distinguishes tumor from papillary adenoma; frequently trisomy 7, 17
  • Also called chromophil; some cases were formerly called renal cell carcinoma granular type due to granular cytoplasm, but this term is obsolete and may also refer to oncocytoma or eosinophilic variant of clear cell carcinoma
  • 10 - 20% of adult renal carcinomas
  • Origin: proximal or distal convoluted tubule
  • Epidemiology: 75% male
Clinical features
  • Tends to present at early stage
  • 5 year survival is 82 - 90%, may be better than clear cell carcinoma (Am J Surg Pathol 2002;26:281)
  • Metastasizes to regional lymph nodes
Case reports
Gross description
  • Thick capsule with reactive changes and hemorrhage, red / brown (from hemorrhage); multifocal (80% of tumors), occasionally bilateral; mean 7 cm
  • Tissue "pours out" of kidney
  • Looks necrotic but microscopically less necrosis than expected
Gross images

Images hosted on PathOut server:

Golden yellow tumor

Predominant cysts with localized mural nodule


Images hosted on other servers:

Tan pink mass with satellite nodules

Renal vein extension

Large cystic tumor infiltrates perirenal fat

Hemorrhagic and partially necrotic tumor

Multiple tumor nodules, one is hemorrhagic cystic

Capsular invasion

Microscopic (histologic) description
  • Well circumscribed, often with distinct fibrous capsule
  • Papillary or tubulopapillary in every case
  • Have papillary fibrovascular cores that may be edematous and look cystic; papillae may be long and solidly packed
  • Foamy macrophages in papillary cores and intracellular hemosiderin are sensitive / specific features
  • often tubular dysplasia
  • May have glassy hyaline globules
  • Variable psammoma bodies, neutrophils and necrosis
  • Focally clear cell areas may be present (J Urol 2011;185:30, Am J Surg Pathol 2008;32:1780)
  • One study recommends assessing nucleolar prominence based upon high power field with greatest nuclear pleomorphism (Am J Surg Pathol 2006;30:1091)
Microscopic (histologic) images

Images hosted on PathOut server:


Papillary pattern:

Fibrovascular papillary stalk


Tumor cell features:

Nuclear anaplasia

Papillary structures have numerous stromal xanthoma cells

Cholesterol clefts

Abundant hemosiderin granules


Images hosted on other servers:


Papillary pattern:

Oncocytic variant of papillary renal cell carcinoma, contributed by: Dr. Semir Vranic, University of Sarajevo (Bosnia)


Papillary tumors with fibrovascular cores


Tumor cell features:

Finely granular cytoplasm

Prominent nucleoli

Nuclear grooves (fig 4A - D)

Papillary adenoma versus papillary carcinoma

Cytology description
Cytology images

Images hosted on other servers:

Various Images

Positive stains
Most common:
Suggested positive staining panel:
Electron microscopy description
  • Variably sized microvilli, small amounts of cytoplasmic lipid, no glycogen
Molecular / cytogenetics description
  • +7 (75%), +17 (80%), +12, +16, +20, +3q, -Y, -X (p or q for all chromosomes)
  • These changes occur early in tumor neoplasia (Mod Pathol 2003;16:1053), point mutation in c-kit intron 17
  • Mutations in MET proto-oncogene on 7 are common
  • Also associated with papillary RCC gene on 1
  • Not associated with p53 mutations or 3p-
Differential diagnosis
Additional references