Table 2 Papillary tumors with predominant clear cells
Typical histology | Expected immunoprofile | Recommendation | |
|---|---|---|---|
Clear cell papillary | Papillary or tubular growth, nuclei arranged away from basement membrane (reverse polarity), low grade nuclei, no necrosis | CK7+ CAIX+ GATA3+ | - No IHC needed if typical morphology - Perform IHC panel when other entities are in the differential |
Xp11 translocation | Large epitheloid clear and eosinophilic cells, psammoma bodies | TFE3+, Cathepsin K + | - refer to TFE3 break-apart FISH testing (if TFE3 immunostain not available) if suggestive morphology or presentation < 50 year or with lymph node metastasis |
Papillary (with clear cells) | extensive papillary growth, high nuclear grade (ISUP 3 or 4) or necrosis | Pan-cytokeratin + CK7 + AMARC + TFE3/TFEB - | - rule out MiT family traslocation |