Figure 6:

Biphasic Hyalinizing Psammomatous RCC case #5. Much of this neoplasm had the appearance of an unclassifiable RCC. At low power, the neoplasm demonstrates hyalinization with prominent psammomatous calcifications to the right, and a clear cell appearance to the left (A). Higher power view of the clear cell area reveals a nondescript solid clear cell proliferation that would be difficult to distinguish from high-grade conventional clear cell RCC (B). Other areas of the neoplasm demonstrates anastomosing tubular pattern in myxoid stroma that is reminiscent of mucinous tubular and spindle cell carcinoma (note the psammomatous calcification to the right of both Figures) (C, D). In other areas, one can appreciate tubular architecture and biphasic cytology (E). Higher power view of these areas reveals larger epithelioid cells with open chromatin and eosinophilic cytoplasm and smaller cells with condensed chromatin and minimal basophilic cytoplasm (F).