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Histopathology. 2019 Jan;74(1):4-17. doi: 10.1111/his.13735.

Grading of renal cell carcinoma.

Author information

1
Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, Wellington, New Zealand.
2
Department of Pathology, Indiana University, Indianapolis, IN, USA.
3
Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
4
Aquesta Uropathology, Brisbane, Qld, Australia.
5
University of Queensland School of Medicine, Brisbane, Qld, Australia.

Abstract

Grading of renal cell carcinoma (RCC) has been recognised as a prognostic factor for almost 100 years. Numerous grading systems have been proposed, initially focusing upon a constellation of cytological features and more recently on nuclear morphology. It has been recommended that grading of RCC should be based upon nucleolar prominence/eosinophilia for grades 1-3, while grade 4 requires nuclear anaplasia (including tumour giant cells, sarcomatoid differentiation and/or rhabdoid morphology). The grading system was adopted formally by the International Society of Urological Pathology (ISUP) and subsequently by the World Health Organisation (WHO), being designated the WHO/ISUP grading classification in the fourth edition of the WHO classification tumours of the urinary system and male genital organs (2016). This grading system has been validated for both clear cell and papillary RCC. Validation studies for chromophobe RCC failed to demonstrate a correlation between grade and outcome for both the superseded Fuhrman grading system and the WHO/ISUP grading classification, and it has been recommended that these tumours not be graded. The WHO/ISUP system has been incorporated into the structured reports of the International Cancer Collaboration on Cancer Reporting for both clear cell and papillary RCC. It is also noted that other types of RCC may be graded, but it must be emphasised in the report that this is for descriptive and diagnostic purposes, and not outcome prediction. More recent studies have shown the incorporation of the presence of tumour necrosis into RCC grading to improve outcome prediction, and this has been validated in several studies.

KEYWORDS:

International Society of Urological Pathology; grading; prognosis; renal neoplasia

PMID:
30565310
DOI:
10.1111/his.13735
[Indexed for MEDLINE]

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