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

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