Figure 1. (a) Bone marrow: normal hematopoietic elements (H&E stain, × 100 magnification). (b) Bone marrow: normal hematopoietic elements (H&E stain, × 40 magnification). (c) Bone marrow: replacement of the normal hematopoietic elements by nests of cohesive epithelial cells with prominent clear cytoplasm surrounded by a capillary network, consistent with metastatic clear cell renal cell carcinoma (H&E stain, × 400 magnification). (d) Bone marrow: diffuse replacement of the normal hematopoietic elements by metastatic clear cell renal cell carcinoma (nests of cohesive epithelial cells with prominent clear cytoplasm containing a rich capillary network, H&E stain, × 40 magnification).