Abstract
There have been significant changes in the staging, classification and grading of renal cell neoplasia in recent times. Major changes have occurred in our understanding of extra-renal extension by renal cell cancer and how gross specimens must be handled to optimally display extra-renal spread. Since the 1981 World Health Organization (WHO) classification of renal tumors, in which only a handful of different entities were reported, many new morphological types have been described in the literature, resulting in 50 different entities reported in the 2004 WHO classification. Since 2004, further new entities have been recognized and reported necessitating an update of the renal tumor classification. There have also been numerous grading systems for renal cell carcinoma with Fuhrman grading, the most widely used system. In recent times, the prognostic value and the applicability of the Fuhrman grading system in practice has been shown to be, at best, suboptimal. To address these issues and to recommend reporting guidelines, the International Society of Urological Pathology (ISUP) undertook a review of adult renal neoplasia through an international consensus conference in Vancouver in 2012. The conduct of the conference was based upon evidence from the literature and the current practice amongst recognized experts in the field. Working groups selected to deal with key topics evaluated current data and identified points of controversy. A pre-meeting survey of the ISUP membership was followed by the consensus conference at which a formal ballot was taken on each key issue. A 65% majority vote was taken as consensus. This review summarizes the outcome and recommendations of this conference with regards to staging, classification and grading of renal cell neoplasia.
Highlights
Renal cancer is one of the most common visceral malignancies with a significant rate of cancer related deaths in both males and females [1, 2]
Advances in renal neoplasia classification among staging criteria it has recently been recognized that renal sinus invasion is the most common route of extra-renal spread
Renal sinus invasion was found in 14 (42%) of these cases and they compared these findings with a matched set of 33 patients who had not died of renal cell carcinoma (RCC)
Summary
Renal cancer is one of the most common visceral malignancies with a significant rate of cancer related deaths in both males and females [1, 2]. Renal sinus invasion was found in 14 (42%) of these cases and they compared these findings with a matched set of 33 patients who had not died of RCC. Cancer/American Joint Commission on Cancer/ (UICC/AJCC) introduced several changes to the staging system of RCC [11, 12]. In parallel with this renal tumor classification has undergone major changes in the last three decades, with novel morphotypes being added to successive classification systems [13,14,15].
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