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Charlie Herndon

@DrCycloPath

My education site https://nitter.cf/t.co/9SV87NkfSc PGY1 @UCSFPath All views are my own #CytoPath #Molecular #PathTwitter #Pathology

 San Francisco, CA
kikoxp.com/posts/31406
Joined April 2023
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Photo by Charlie Herndon (@DrCycloPath)Photo by Charlie Herndon (@DrCycloPath)Photo by Charlie Herndon (@DrCycloPath)Photo by Charlie Herndon (@DrCycloPath)Photo by Charlie Herndon (@DrCycloPath)Photo by Charlie Herndon (@DrCycloPath)Photo by Charlie Herndon (@DrCycloPath)Photo by Charlie Herndon (@DrCycloPath)Photo by Charlie Herndon (@DrCycloPath)Photo by Charlie Herndon (@DrCycloPath)
#MedStudents curious what pathologists actually do? Join @Pathologists @KMirza and @RoseannIWu for this webinar following a real case from biopsy to diagnosis—you will see how pathology shapes clinical decisions and patient care. 🗓️ Sept 22, 2026 ⏰ 5 PM PT 🔗 cap-org.zoom.us/webinar/regi… #Pathology #MedEd #MedTwitter #PathMatch27 #PathTwitter
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#PathQuiz 🔬🧬 A) Multilocular Cystic Renal Neoplasm of Low Malignant Potential B) Acquired Cystic Disease-Associated RCC C) Clear Cell Papillary Renal Cell Tumor D) Tubulocystic Renal Cell Carcinoma #Pathology #GUPath
Small and intermediate-sized tubules and cysts @IARCWHO

ALT Small and intermediate-sized tubules and cysts @IARCWHO

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❌ Clear Cell Papillary Renal Cell Tumor: • Tubulopapillary or cystic growth of cuboidal clear cells with linearly aligned, luminal-oriented nuclei • Stains strongly and diffusely for CK7 and exhibits a unique basolateral, "cup-like" CAIX expression pattern • Lacks the prominent eosinophilic hobnail cells and the characteristic genetic gains/losses of tubulocystic RCC
Cuboidal tumor cells with uniform nuclei and inconspicuous nucleoli @IARCWHO

ALT Cuboidal tumor cells with uniform nuclei and inconspicuous nucleoli @IARCWHO

CAIX-positive immunohistochemistry showing characteristic cup-like staining @IARCWHO

ALT CAIX-positive immunohistochemistry showing characteristic cup-like staining @IARCWHO

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✅ Tubulocystic Renal Cell Carcinoma 🎯🧬 • Exclusive tubulocystic growth of small to intermediate-sized tubules and cysts lined by a single layer of hobnail cells • Eosinophilic cells display enlarged, irregular nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm • Characterized genetically by a consistent gain of chromosome 17 and losses of chromosomes 9 and Y • Usually follows an indolent clinical course with an excellent prognosis, though rare metastases are documented
Tumor showing many cystic spaces at low magnification @IARCWHO

ALT Tumor showing many cystic spaces at low magnification @IARCWHO

Small and intermediate-sized tubules and cysts @IARCWHO

ALT Small and intermediate-sized tubules and cysts @IARCWHO

Cysts lined by a single layer of hobnail epithelium @IARCWHO

ALT Cysts lined by a single layer of hobnail epithelium @IARCWHO

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#PathQuiz 🔬 Mass in right abdomen. A) Adrenocortical adenoma B) Hepatocellular carcinoma C) Urothelial carcinoma D) Clear cell renal cell carcinoma #Pathology #Cytopathology
Large cohesive three-dimensional cluster of atypical cells displays hyperchromatic nuclei and finely vacuolated cytoplasm. (Courtesy of A. Hinsch & A. Luebke / iPath-Network / https://forumep.wordpress.com/)

ALT Large cohesive three-dimensional cluster of atypical cells displays hyperchromatic nuclei and finely vacuolated cytoplasm. (Courtesy of A. Hinsch & A. Luebke / iPath-Network / https://forumep.wordpress.com/)

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Which ancillary test result is characteristic? A) PAX8 (+) and CD10 (+) B) Melan A (+) and Inhibin (+) C) Glypican-3 (+) and HepPar-1 (+) D) GATA3 (+) and p63 (+)
57%A
29%B
7%C
7%D
14 votes • Final results
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✅ Clear cell renal cell carcinoma 🎯💎 • Characteristic clusters of cells with broad, foamy, or clear vacuolated cytoplasm • Nuclei show coarsely structured chromatin and prominent, distinct macronucleoli • Immunoprofile shows nuclear positivity for PAX8 and membranous positivity for CD10 and RCCma • History of renal masses and hemorrhagic background are important clinical and morphologic clues
Atypical cells with vacuolated cytoplasm and enlarged nuclei containing prominent nucleoli. (Courtesy of A. Hinsch & A. Luebke / iPath-Network / https://forumep.wordpress.com/)

ALT Atypical cells with vacuolated cytoplasm and enlarged nuclei containing prominent nucleoli. (Courtesy of A. Hinsch & A. Luebke / iPath-Network / https://forumep.wordpress.com/)

Three-dimensional budding cluster of atypical cells displays hyperchromatic nuclei and finely vacuolated cytoplasm. (Courtesy of A. Hinsch & A. Luebke / iPath-Network / https://forumep.wordpress.com/)

ALT Three-dimensional budding cluster of atypical cells displays hyperchromatic nuclei and finely vacuolated cytoplasm. (Courtesy of A. Hinsch & A. Luebke / iPath-Network / https://forumep.wordpress.com/)

Small clusters and single atypical cells highlight the finely vacuolated, foamy cytoplasm. (Courtesy of A. Hinsch & A. Luebke / iPath-Network / https://forumep.wordpress.com/)

ALT Small clusters and single atypical cells highlight the finely vacuolated, foamy cytoplasm. (Courtesy of A. Hinsch & A. Luebke / iPath-Network / https://forumep.wordpress.com/)

Coarsely structured chromatin within round nuclei and distinct cytoplasmic vacuolization. (Courtesy of A. Hinsch & A. Luebke / iPath-Network / https://forumep.wordpress.com/)

ALT Coarsely structured chromatin within round nuclei and distinct cytoplasmic vacuolization. (Courtesy of A. Hinsch & A. Luebke / iPath-Network / https://forumep.wordpress.com/)

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#PathQuiz 🔬🧬 A) Renal Oncocytoma B) Chromophobe Renal Cell Carcinoma C) SDH-Deficient Renal Cell Carcinoma D) Low-grade Oncocytic Tumor #Pathology #GUPath
Solid growth of eosinophilic cells with bland, low-grade nuclei @IARCWHO

ALT Solid growth of eosinophilic cells with bland, low-grade nuclei @IARCWHO

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❌ SDH-Deficient Renal Cell Carcinoma: • Bland cells with pale, bubbly eosinophilic cytoplasm and flocculent cytoplasmic inclusions • Characteristically shows complete loss of SDHB immunohistochemical expression • Associated with germline SDH mutations and lacks diffuse CK7 staining
Cuboidal neoplastic cells with eosinophilic to bubbly pale cytoplasm @IARCWHO

ALT Cuboidal neoplastic cells with eosinophilic to bubbly pale cytoplasm @IARCWHO

Loss of immunohistochemical expression of SDHB @IARCWHO

ALT Loss of immunohistochemical expression of SDHB @IARCWHO

Cytoplasmic inclusions containing pale flocculent material @IARCWHO

ALT Cytoplasmic inclusions containing pale flocculent material @IARCWHO

High-grade transformation area in direct continuity with typical areas @IARCWHO

ALT High-grade transformation area in direct continuity with typical areas @IARCWHO

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✅ Low-grade Oncocytic Tumor 🎯🧬 • Solid growth of oncocytic cells with uniform, bland nuclei lacking prominent nucleoli or nuclear wrinkles • Distinctive IHC profile: strong and diffuse CK7 positivity, while KIT is often negative or only focal • Driven by mutations in genes of the mTOR pathway, particularly TSC1, TSC2, or MTOR • Recognizing this newly defined entity is crucial, as it behaves in an indolent manner and overlaps with oncocytoma/ChRCC
Solid growth of eosinophilic cells with bland, low-grade nuclei @IARCWHO

ALT Solid growth of eosinophilic cells with bland, low-grade nuclei @IARCWHO

Strong and diffuse CK7 positivity in tumor cells @IARCWHO

ALT Strong and diffuse CK7 positivity in tumor cells @IARCWHO

Oncocytic tumor with a solid architecture and composed of eosinophilic cells @IARCWHO

ALT Oncocytic tumor with a solid architecture and composed of eosinophilic cells @IARCWHO

Overlapping morphology of low-grade oncocytic tumor and chromophobe RCC @IARCWHO

ALT Overlapping morphology of low-grade oncocytic tumor and chromophobe RCC @IARCWHO

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