Confusing cases: clear cell but not renal cell lesions in kidney

Diagnosis of low-grade clear cell lesions in kidney can be challenging to the pathologist in practice. There is limited information in the literature addressing the practical issues that may be encountered in this regard. Herein is presented two cases: one was an adrenal cortical nodule; the second, an intrarenal adrenal heterotopia that was assumed to be renal cell carcinoma initially. Certain red flags should prompt pathologists to investigate further; close morphological examination including immunohistochemistry may be warranted in these lesions.