What are the essential features of renal neoplasms based on the current (2004) WHO classification system? What is the clinical implication of the new classification? How does the Fuhrman grading system work? What are the factors affecting survival of renal cell carcinoma patients?
Renal cell neoplasms are classified histologically into several types (Table 2-1-1). The four most common types of renal cell neoplasms are clear cell (51%–83%), papillary (11%–20%), and chromophobe (4%–6%) renal cell carcinomas (RCCs) and (benign) oncocytoma (4%–8%). Uncommon tumors, which account for 5%–10% of renal neoplasms, include collecting duct carcinoma, renal medullary carcinoma, mucinous tubular and spindle cell carcinoma, and unclassifiable carcinoma, which does not fit any defined category. Unclassifiable RCCs and collecting duct carcinoma are the most aggressive followed by, in descending order of aggressiveness, clear cell carcinoma, papillary carcinoma, and chromophobe carcinomas. Factors significantly affecting the cancer-specific survival are pathologic stage, nuclear grade, the presence of tumor necrosis, the histologic tumor type, and the presence of sarcomatoid differentiation.
KeywordsRenal Cell Carcinoma Nuclear Grade Clear Cell Carcinoma Clear Cell Renal Cell Carcinoma Renal Cell Carcinoma Patient
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
WHO classification of tumours of the kidney (2004). In: Eble JN, Sauter G, Epstein JI, Sesterhenn IA (eds) Tumours of the urinary system and male genital organs. IARC Press, Lyon, p 10.Google Scholar
Storkel S, Eble JN, Adlakha K, Amin M, Blute ML, Bostwick DG, Darson M, Delahunt B, Iczkowski K (1997) Classification of renal cell carcinoma; Work-group No. 1 (1997) Union Internationale Centre Cancer (UICC) and the American Joint Committee on Cancer (AJCC). Cancer 80:987–989.PubMedCrossRefGoogle Scholar
Fuhrman SA, Lasky LC, Limas C (1982) Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 6:655–663.PubMedCrossRefGoogle Scholar
Amin MaB, Amin MiB, Tamboli P, Javidan J, Stricker H, De-Peralta Ventrina M, Deshpande A, Menon M (2002) Prognostic impact of histologic subtyping of adult renal epithelial neoplasms. An experience of 405 cases. Am J Surg Pathol 26:281–291.PubMedCrossRefGoogle Scholar
Lohse CM, Blute ML, Zincke H, Weaver AL, Cheville JC (2002) Comparison of standardized and nonstandardized nuclear grade of renal cell carcinoma to predict outcome among 2,042 patients. Am J Clin Pathol 118:877–886.PubMedCrossRefGoogle Scholar
Moch H, Gasser T, Amin MB, Torhorst J, Sauter G, Mihatsch MJ (2000) Prognostic utility of the recently recommended histologic classificaion and revised TNM staging system of renal cell carcinoma. A Swiss experience with 588 tumors. Cancer 89:604–614.PubMedCrossRefGoogle Scholar
Cheville JC, Lohse CM, Zincke H, Weaver AL, Blute ML (2003) Comparisons of outcome and prognostic features among histologic subtypes of renal cell carcinoma. Am J Surg Pathol 27:612–624.PubMedCrossRefGoogle Scholar
Cheville JC, Lohse CM, Zincke H, Weaver AL, Leibovich BC, Frank I, Blute ML (2004) Sarcomatoid renal cell carcinoma. An examination of underlying histologic subtype and an analysis of association with patient outcome. Am J Surg Pathol 28:435–441.PubMedCrossRefGoogle Scholar
Thoenes W, Storkel S, Rumpelt HJ (1986) Histopathology and classification of renal cell tumors (adenomas, oncocytomas and carcinomas). The basic cytological and histological elements and their use for diagnostics. Pathol Res Pract 181:125–143.PubMedGoogle Scholar
Storkel S, Thoenes W, Jacobi GH, Lippold R (1989) Prognostic parameters in renal cell carcinoma: A new approach. Eur Urol 16:416–422.PubMedGoogle Scholar
Delahunt B, Nacey JN (1987) Renal cell carcinoma, II: histological indicators of prognosis. Pathology 19: 258–263.PubMedCrossRefGoogle Scholar
Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Leibovich BC, Zincke H (2003) A multifactorial postoperative surveillance model for patients with surgically treated clear cell renal cell carcinoma. J Urol 170:2225–2232.PubMedCrossRefGoogle Scholar