Department of Surgical and Oncological Sciences, Urologic Unit, University of Padua, Italy.
Eur Urol. 2010 Nov;58(5):655-68. doi: 10.1016/j.eururo.2010.08.001. Epub 2010 Aug 10.
In the last few years, the treatment of renal cell carcinoma (RCC) has progressed significantly, and some histopathologic issues have become important for selection and follow-up after medical and surgical therapies.
The aim of this collaborative article is to review the most recent literature on the role of traditional histopathologic features obtained from renal core biopsy or nephrectomy specimens in the management of confined, locally advanced, and metastatic RCC.
A nonsystematic review of the literature was performed in April 2010 using the Medline database. Multiple free-text searches were performed for the following items: renal cell carcinoma, clear cell, papillary, chromophobe, histologic* subtype*, histotype*, nuclear grade*, necrosis, sarcomatoid differentiation, biopsy, molecular marker*, and cytogenetic marker*. A total of 2369 records were retrieved from Medline, and 263 full-text studies were considered and partially included in the present review. A panel of experts reached consensus on the main subheadings of this paper.
Core needle biopsies can provide important information that is useful to avoid the overtreatment of benign tumors and to help plan watchful waiting or minimally invasive treatments in selected patients. Tumor histotype is fundamental in the pathologic report. In the context of integrated prognostic systems, the combination of the most important clinical and pathologic factors (TNM stage, Fuhrman nuclear grade, presence of necrosis, microvascular invasion, and sarcomatoid dedifferentiation) allows us to reach a high prognostic accuracy. These models can be used to select patients suitable for adjuvant protocols, to design an appropriate follow-up schedule, and to provide careful patient counseling. Molecular and cytogenetic markers should be further evaluated.
The histopathologic definition of parenchymal epithelial renal tumors is fundamental to plan the management and follow-up of patients with locally confined, locally advanced, and metastatic RCC.
在过去的几年中，肾细胞癌（RCC）的治疗取得了显著进展，一些组织病理学问题对于选择和随访医学和手术治疗后变得非常重要。
本文旨在回顾关于通过肾芯活检或肾切除术标本获得的传统组织病理学特征在局限性、局部进展性和转移性 RCC 管理中的作用的最新文献。
2010 年 4 月，使用 Medline 数据库进行了非系统性文献复习。针对以下项目进行了多次自由文本搜索：肾细胞癌、透明细胞、乳头状、嫌色细胞、组织学亚型、组织型*、核级*、坏死、肉瘤样分化、活检、分子标志物和细胞遗传学标志物。从 Medline 中检索到 2369 条记录，并考虑了 263 篇全文研究，并部分纳入了本综述。专家组就本文的主要副标题达成了共识。
芯针活检可提供重要信息，有助于避免对良性肿瘤的过度治疗，并有助于为选定的患者计划观察等待或微创治疗。肿瘤组织型在病理报告中至关重要。在综合预后系统的背景下，将最重要的临床和病理因素（TNM 分期、Fuhrman 核级、坏死、微血管侵犯和肉瘤样去分化的存在）结合起来，可以提高预后准确性。这些模型可用于选择适合辅助方案的患者、设计适当的随访计划，并为患者提供谨慎的咨询。分子和细胞遗传学标志物应进一步评估。
实质上皮性肾肿瘤的组织病理学定义对于计划局限性、局部进展性和转移性 RCC 患者的管理和随访非常重要。
