Oncocytic renal neoplasms are a major source of diagnostic challenge in genitourinary pathology; however, they are typically nonaggressive in general, raising the question of whether distinguishing different subtypes, including emerging entities, is necessary. Emerging entities recently described include eosinophilic solid and cystic renal cell carcinoma (ESC RCC), low-grade oncocytic tumor (LOT), eosinophilic vacuolated tumor (EVT), and papillary renal neoplasm with reverse polarity (PRNRP). A survey was shared among 65 urologic pathologists using SurveyMonkey.com (Survey Monkey, Santa Clara, CA, USA). De-identified and anonymized respondent data were analyzed. Sixty-three participants completed the survey and contributed to the study. Participants were from Asia (n = 21; 35%), North America (n = 31; 52%), Europe (n = 6; 10%), and Australia (n = 2; 3%). Half encounter oncocytic renal neoplasms that are difficult to classify monthly or more frequently. Most (70%) indicated that there is enough evidence to consider ESC RCC as a distinct entity now, whereas there was less certainty for LOT (27%), EVT (29%), and PRNRP (37%). However, when combining the responses for sufficient evidence currently and likely in the future, LOT and EVT yielded > 70% and > 60% for PRNRP. Most (60%) would not render an outright diagnosis of oncocytoma on needle core biopsy. There was a dichotomy in the routine use of immunohistochemistry (IHC) in the evaluation of oncocytoma (yes = 52%; no = 48%). The most utilized IHC markers included keratin 7 and 20, KIT, AMACR, PAX8, CA9, melan A, succinate dehydrogenase (SDH)B, and fumarate hydratase (FH). Genetic techniques used included TSC1/TSC2/MTOR (67%) or TFE3 (74%) genes and pathways; however, the majority reported using these very rarely. Only 40% have encountered low-grade oncocytic renal neoplasms that are deficient for FH. Increasing experience with the spectrum of oncocytic renal neoplasms will likely yield further insights into the most appropriate work-up, classification, and clinical management for these entities.

Department of Pathology Advanced Medical Research Institute Hospital Kolkata India

Department of Pathology Albany Medical Centre Albany USA

Department of Pathology All India Institute of Medical Sciences Bhubaneswar India

Department of Pathology All India Institute of Medical Sciences New Delhi India

Department of Pathology Apollo Hospitals Bhubaneshwar Bhubaneswar India

Department of Pathology Basavatakaram Indo American Cancer Hospital and Research Institute Hyderabad India

Department of Pathology Bioptika Laborator S R O Pilsen Czech Republic

Department of Pathology Brigham and Women's Hospital Boston USA

Department of Pathology Brown University Providence USA

Department of Pathology Cedars Sinai Medical Center Los Angeles USA

Department of Pathology Cleveland Clinic Cleveland USA

Department of Pathology Core Diagnostics Gurgaon India

Department of Pathology Cruces University Hospital Barakaldo Spain

Department of Pathology Douglass Hanly Moir Pathology Sydney Australia

Department of Pathology El Camino Hospital Mountain View USA

Department of Pathology Henry Ford Health System Detroit USA

Department of Pathology Homi Bhabha Cancer Center Visakhapatnam India

Department of Pathology Kapoor Center of Urology and Pathology Raipur India

Department of Pathology Keck School of Medicine of USC Los Angeles USA

Department of Pathology Kochi Red Cross Hospital Kochi City Kochi Japan

Department of Pathology Kokilaben Ambani Hospital Mumbai India

Department of Pathology Loyola University Medical Center Maywood USA

Department of Pathology Memorial Sloan Kettering Cancer Center New York USA

Department of Pathology Muljibhai Patel Urological Hospital Nadiad India

Department of Pathology Ohio State University Columbus USA

Department of Pathology Oxford University Hospital NHS Foundation Trust Oxford UK

Department of Pathology Postgraduate Institute of Medical Education and Research Chandigarh India

Department of Pathology Tata Medical Center Kolkata India

Department of Pathology Tata Memorial Hospital Mumbai India

Department of Pathology The University of North Carolina at Chapel Hill Chapel Hill USA

Department of Pathology The University of Tennessee Health Science Center Memphis USA

Department of Pathology The University of Texas MD Anderson Cancer Center Houston USA

Department of Pathology Trillium Health Partners Credit Valley Hospital Mississauga Canada

Department of Pathology Tufts University School of Medicine Boston USA

Department of Pathology University Hospital Zurich Switzerland

Department of Pathology University of Calgary Calgary Canada

Department of Pathology University of Chicago Chicago USA

Department of Pathology University of Michigan Ann Arbor USA

Department of Pathology University of Turin Turin Italy

Department of Pathology University of Utah ARUP Salt Lake City USA

Department of Pathology University of Verona Verona Italy

Department of Pathology University of Washington Seattle USA

Department of Pathology UT Southwestern Medical Center Dallas USA

Department of Pathology Vanderbilt University Medical Center Nashville USA

Department of Pathology Virginia Commonwealth University School of Medicine Richmond USA

Department of Pathology Wellington School Medicine Wellington New Zealand

IMP Pathology Garden City USA

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