*Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand †Department of Pathology, Mayo Clinic, Rochester, MN §Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO ∥Department of Anatomic Pathology, Cancer Biology and Glickman Urological Institute, Cleveland, OH ††Department of Pathology, Indiana University School of Medicine, Indianapolis, IN ‡Dipartimento di Patologia e Diagnostica, Universitá di Verona, Verona ‡‡The Institute of Pathological Anatomy and Histopathology, University of Ancona School of Medicine, Ancona, Italy ¶Department of Oncology and Pathology, Karolinska University Hospital, Solna, Stockholm, Sweden #Department of Pathology, Fundacion Puigvert-University Antonomous, Barcelona, Spain **University of Zurich, Switzerland §§Department of Laboratory Medicine, Credit Valley Hospital, Mississauga ∥∥Department of Pathology and Molecular Medicine, McMaster University, Toronto, ON, Canada.
Am J Surg Pathol. 2013 Oct;37(10):1490-504. doi: 10.1097/PAS.0b013e318299f0fb.
The International Society of Urological Pathology 2012 Consensus Conference made recommendations regarding classification, prognostic factors, staging, and immunohistochemical and molecular assessment of adult renal tumors. Issues relating to prognostic factors were coordinated by a workgroup who identified tumor morphotype, sarcomatoid/rhabdoid differentiation, tumor necrosis, grading, and microvascular invasion as potential prognostic parameters. There was consensus that the main morphotypes of renal cell carcinoma (RCC) were of prognostic significance, that subtyping of papillary RCC (types 1 and 2) provided additional prognostic information, and that clear cell tubulopapillary RCC was associated with a more favorable outcome. For tumors showing sarcomatoid or rhabdoid differentiation, there was consensus that a minimum proportion of tumor was not required for diagnostic purposes. It was also agreed upon that the underlying subtype of carcinoma should be reported. For sarcomatoid carcinoma, it was further agreed upon that if the underlying carcinoma subtype was absent the tumor should be classified as a grade 4 unclassified carcinoma with a sarcomatoid component. Tumor necrosis was considered to have prognostic significance, with assessment based on macroscopic and microscopic examination of the tumor. It was recommended that for clear cell RCC the amount of necrosis should be quantified. There was consensus that nucleolar prominence defined grades 1 to 3 of clear cell and papillary RCCs, whereas extreme nuclear pleomorphism or sarcomatoid and/or rhabdoid differentiation defined grade 4 tumors. It was agreed upon that chromophobe RCC should not be graded. There was consensus that microvascular invasion should not be included as a staging criterion for RCC.
国际泌尿病理学会 2012 年共识会议就成人肾肿瘤的分类、预后因素、分期、免疫组织化学和分子评估提出了建议。与预后因素相关的问题由一个工作组协调，该工作组确定肿瘤形态类型、肉瘤样/横纹肌样分化、肿瘤坏死、分级和微血管侵犯作为潜在的预后参数。共识认为肾细胞癌 (RCC) 的主要形态类型具有预后意义，乳头状 RCC (1 型和 2 型) 的亚型分类提供了额外的预后信息，透明细胞管状乳头状 RCC 与更有利的结果相关。对于表现出肉瘤样或横纹肌样分化的肿瘤，共识认为诊断目的不需要肿瘤的最小比例。还同意报告癌的基础亚型。对于肉瘤样癌，进一步达成共识，如果基础癌亚型不存在，则应将肿瘤分类为具有肉瘤样成分的 4 级未分类癌。肿瘤坏死被认为具有预后意义，评估基于肿瘤的宏观和微观检查。建议对透明细胞 RCC 进行坏死量的定量评估。共识认为核仁突出定义了透明细胞和乳头状 RCC 的 1 级至 3 级，而极端核多形性或肉瘤样和/或横纹肌样分化定义了 4 级肿瘤。共识认为嫌色细胞 RCC 不应分级。共识认为微血管侵犯不应作为 RCC 的分期标准。
