Abstract
Abstract The International Society of Urological Pathology (ISUP) 2012 Consensus Conference has made recommendations regarding the classification, prognostic factors, staging, and immunohistochemical and molecular assessment of adult renal tumors. There was consensus that five entities should be recognized as new tumor entities: tubulocystic renal cell carcinoma (RCC), acquired cystic disease-associated RCC, clear cell papillary RCC, MiT family translocation RCC (in particular t(6;11) RCC) and hereditary leiomyomatosis-associated RCC. In addition, three rare epithelial carcinomas were considered emerging or provisional entities: thyroid-like follicular RCC; succinate dehydrogenase B deficiency-associated RCC; and ALK-translocation RCC. There were also a number of suggested modifications to existing WHO 2004 categories with the new classification to be known as the ISUP Vancouver Classification. Tumor morphotype, sarcomatoid/rhabdoid differentiation and tumor necrosis were identified as significant prognostic parameters for RCC. The ISUP Grading System was accepted with grades 1–3 of clear cell and papillary RCC being based upon nucleolar prominence, while extreme nuclear pleomorphism, or sarcomatoid and/or rhabdoid differentiation defined grade 4 tumors. It was agreed that chromophobe RCC should not be graded. Consensus guidelines were formulated for specimen handling and it was agreed that renal sinus invasion is present when the tumor is in direct contact with fat or the loose connective tissue of the sinus, or if there is involvement of endothelial lined spaces within the renal sinus, regardless of size. The role of biomarkers in the diagnosis and assessment of prognosis of renal tumors was considered and panels of immunohistochemical markers were identified for use in specific differential diagnostic scenarios.
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