ASPSCR1 and metastatic malignant neoplasm in the lymph nodes: Of note, compared with other TFE3-tRCC subtypes, tumors with ASPSCR1-TFE3 fusion were highly aggressive, characterized by higher ISUP nuclear grade (ISUP ≥ 3, 11/13 vs. 19/44, P = 0.017) and more frequent lymph node metastasis (6/13 vs. 7/44, P = 0.057, Supplementary Table 1).