Renal oncocytoma revisited: a clinicopathological study of 109 cases with emphasis on problematic diagnostic features

Histopathology. 2010 Dec;57(6):893-906. doi: 10.1111/j.1365-2559.2010.03726.x.


Aim: To evaluate problematic diagnostic features in renal oncocytoma.

Methods and results: One hundred and nine cases of oncocytoma were reviewed and the problematic gross and microscopic features recorded. Multifocal and bilateral neoplasms were found in 12 (11%) and five (4.6%) cases, respectively. Haemorrhage was seen grossly in 30 (27.5%) neoplasms and a central scar was identified in 35 (32.1%). On microscopy, perinephric fat extension was present in 17 (15.6%) neoplasms and vascular extension was identified in four (3.7%) oncocytomas. Rare mitoses and focal coagulative necrosis were identified in two (1.8%) cases each. Focal clear cell changes were found in 16 (14.7%) oncocytomas, typically within hyalinized areas. Limited foci with chromophobe-like histology (not exceeding 5% of the neoplasm) were found in 13 (11.9%) oncocytomas. In 12 (11%) oncocytomas, rare papillary formations were noted in the lumina of microcysts. Significant nuclear atypia, oncoblasts and entrapped tubules were identified in 27 (24.8%), 41 (37.6%) and 40 (36.7%) neoplasms, respectively. After a median follow-up of 52 months (range 1-113 months), there was no disease recurrence, progression or death attributed to oncocytoma.

Conclusions: The recognition of the spectrum of morphological changes observed in renal oncocytoma should help pathologists establish a diagnosis of oncocytoma in problematic cases.

MeSH terms

  • Adenoma, Oxyphilic / metabolism
  • Adenoma, Oxyphilic / pathology*
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Renal Cell / metabolism
  • Carcinoma, Renal Cell / pathology
  • Diagnosis, Differential
  • Female
  • Humans
  • Kidney / metabolism
  • Kidney / pathology*
  • Kidney Neoplasms / metabolism
  • Kidney Neoplasms / pathology*
  • Male
  • Middle Aged
  • Necrosis
  • Retrospective Studies