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RCC, Fuhrman Nuclear Grade 4

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Fuhrman grade 4 nuclei are larger than grade 3 nuclei and often have greater nuclear membrane irregularity and very clumpy chromatin, as demonstrated in this image. Higher Fuhrman grade is associated with more aggressive behavior and sarcomatoid transformation. Also notice that the cytoplasm is eosinophilic, with fewer clear cell forms, which is typically seen in higher nuclear grade tumors.

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