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Histopathology. 2016 Mar;68(4):475-81. doi: 10.1111/his.12803. Epub 2015 Nov 16.

Gleason and Fuhrman no longer make the grade.

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Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, Wellington, New Zealand.
Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
Aquesta Uropathology, Brisbane, Queensland, Australia.
Department of Pathology and Diagnostics, University of Verona, Verona, Italy.
Department of Surgery, Wellington School of Medicine and Health Sciences, Wellington, New Zealand.
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.


Grading is an important prognostic parameter for prostate adenocarcinoma and renal cell carcinoma (RCC); however, the most frequently used classifications fail to account for advances in our understanding of the diagnostic features, classification and/or behaviour of these tumours. In 2005 and 2014, the International Society of Urological Pathology (ISUP) proposed changes to Gleason scoring with the adoption of the ISUP grading for prostate cancer in 2014 (grade 1, score 3 + 3; grade 2, score 3 + 4; grade 3, score 4 + 3; grade 4, score 8; grade 5, score 9-10). Internationally the Fuhrman grading system is widely employed despite criticisms related to its application, validity, and reproducibility. In 2012, the ISUP established a grading system for RCC (grade 1, the nucleolus is not seen or is inconspicuous and basophilic at ×400 magnification; grade 2, nucleoli are eosinophilic and clearly visible at ×400 magnification; grade 3, nucleoli are clearly visible at ×100 magnification; grade 4, tumours show extreme pleomorphism or rhabdoid and/or sarcomatoid morphology). This grading has been validated for clear cell RCC and papillary RCC. It was further recommended that chromophobe RCC not be graded. For other morphotypes of RCC, ISUP grading has not been validated as a prognostic parameter, but can be used for descriptive purposes.


Fuhrman; Gleason; International Society of Urological Pathology; prostatic adenocarcinoma; renal cell carcinoma

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