Is it “hybrid” or “intermediate”?—more than just a semantic issue in oncocytic renal cell tumors

Hybrid oncocytic/chromophobe tumor (HOCT) is a neoplasm of renal cells encompassing cellular and architectural features of both renal oncocytoma (RO) and chromophobe renal cell carcinoma (ChRCC) (1). The first cases were recognized in patients with Birt-Hogg-Dubé (BHD) syndrome and sporadic cases were also identified, subsequently. HOCT may show distinct typical RO and typical ChRCC areas admixed within the same tumor or composite/ambiguous morphologic and immunohistochemical features intermediate between RO and ChRCC (1). Although the latest [2016] World Health Organization classification of renal cell neoplasms considers HOCT a ChRCC subtype (2), the place of HOCT in the spectrum of renal cell neoplasms remains controversial.