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We report a middle-aged man, who was undergoing treatment with pembrolizumab for locally recurrent cutaneous basal cell carcinoma and was incidentally found to have a renal mass. Radical nephrectomy demonstrated a 5.0\u2005cm renal mass with extensive xanthogranulomatous features, mimicking xanthogranulomatous pyelonephritis. However, rare clusters of cells demonstrated gland-like lumina, clear cytoplasm, and slightly increased atypia, suggesting scant residual renal cell carcinoma cells. Immunohistochemistry demonstrated focal positivity for pan-keratin and keratin 8\/18, EMA, PAX8, CD10, and carbonic anhydrase 9 (CA9), supporting a diagnosis of renal cell carcinoma with extensive treatment response, to the point that it mimicked xanthogranulomatous pyelonephritis. This report demonstrates the histologic features of post-immunotherapy renal cell carcinoma, aiding pathologists in recognition of this phenomenon, which may be misdiagnosed as an inflammatory process, if immunotherapy was performed for other reasons.<\/jats:p>","DOI":"10.1177\/10668969221101873","type":"journal-article","created":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T19:09:41Z","timestamp":1652900981000},"page":"316-320","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Clear Cell Renal Cell Carcinoma with Immunotherapy Effect Mimicking Xanthogranulomatous Pyelonephritis"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1008-1871","authenticated-orcid":false,"given":"Yan","family":"Wang","sequence":"first","affiliation":[{"name":"MetroHealth Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santhi","family":"Ganesan","sequence":"additional","affiliation":[{"name":"MetroHealth Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3898-1460","authenticated-orcid":false,"given":"Sean R.","family":"Williamson","sequence":"additional","affiliation":[{"name":"Cleveland Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rania","family":"Rayes-Danan","sequence":"additional","affiliation":[{"name":"MetroHealth Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,5,16]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1080\/21645515.2016.1199310"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1816714"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30436-8"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1712126"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1816047"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/7102504"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2019.01033"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13691-020-00403-9"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.3892\/mco.2018.1779"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.urolonc.2019.08.012"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.609235"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijscr.2015.11.026"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1159\/000463873"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/0090-4295(92)90307-i"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2019-232097"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0344-0338(11)80364-X"},{"issue":"3","key":"e_1_3_2_18_2","first-page":"299","article-title":"Xanthomatous pseudotumor of the small intestine following treatment for burkitt's lymphoma","volume":"116","author":"Ashfaq R","year":"1992","unstructured":"Ashfaq R, Timmons CF. 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