Der Pathologe

, Volume 37, Issue 4, pp 355–360 | Cite as

WHO-ISUP-Graduierungssystem für Nierenkarzinome

Schwerpunkt: Grading-Systeme
First Online:

Zusammenfassung

Der histologische Differenzierungsgrad gehört zu den wenigen akzeptierten Prognoseparametern des Nierenzellkarzinoms. Die International Society of Uropathology (ISUP) hat 2012 ein neues Graduierungssystem für Nierenzellkarzinome vorgeschlagen. Dieses System beruht v. a. auf der Beurteilung der Nukleolen: Grad 1 – Nukleolen bei 400-facher Vergrößerung nicht oder kaum sichtbar und basophil; Grad 2 – Nukleolen bei 400-facher Vergrößerung eindeutig sichtbar und eosinophil; Grad 3 – Nukleolen bei 100-facher Vergrößerung eindeutig erkennbar; Grad 4 – Tumoren zeigen ausgeprägte Zellpolymorphien oder eine rhabdoide und/oder sarkomatoide Differenzierung. Dieses Graduierungssystem wurde für klarzellige und für papillare Nierenzellkarzinome validiert. Gleichzeitig hat die ISUP vorgeschlagen, chromophobe Nierenzellkarzinome nicht nach diesem System zu graduieren. Die Weltgesundheitsorganisation (WHO) hat 2015 bei einer Konsensuskonferenz in Zürich das ISUP-Graduierungssystem empfohlen, sodass nun international das WHO-ISUP-Graduierungssystem eingeführt werden sollte. Für andere histologische Subtypen kann dieses Graduierungssystem beschreibend verwendet werden, es wurde jedoch noch nicht als Prognoseparameter validiert.

Schlüsselwörter

Fuhrman Graduierung WHO International Society of Urological Pathology Nierenzellkarzinom 

The WHO/ISUP grading system for renal carcinoma

Abstract

Histological tumor grading is an accepted prognostic parameter of renal cell carcinoma (RCC). In 2012, the International Society of Urologic Pathologists (ISUP) proposed a novel grading system for RCC, mainly based on the evaluation of nucleoli: grade 1 tumors have nucleoli that are inconspicuous and basophilic at ×400 magnification; grade 2 tumors have nucleoli that are clearly visible at ×400 magnification and eosinophilic; grade 3 tumors have clearly visible nucleoli at ×100 magnification; and grade 4 tumors have extreme pleomorphism or rhabdoid and/or sarcomatoid morphology. This grading system was validated for clear cell renal cell carcinoma and papillary renal cell carcinoma. At the same time, the ISUP proposed not grading chromophobe renal cell carcinomas according to this system. At a consensus conference in Zurich the World Health Organization (WHO) recommended the ISUP grading system; thus, the WHO/ISUP grading system is now going to be implemented internationally. The ISUP/WHO grading system has not been validated as a prognostic parameter for other tumor subtypes, but can be used for descriptive purposes.

Keywords

Fuhrman Grading WHO International Society of Urological Pathology Renal cancer 
This is a preview of subscription content, log in to check access.

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

H. Moch gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Amin MB, Paner GP, Alvarado-Cabrero I, Young AN, Stricker HJ, Lyles RH, Moch H (2008) Chromophobe renal cell carcinoma: histomorphologic characteristics and evaluation of conventional pathologic prognostic parameters in 145 cases. Am J Surg Pathol 32:1822–1834. doi:10.1097/PAS.0b013e3181831e68CrossRefPubMedGoogle Scholar
  2. 2.
    Arner O, Blanck C, Schreeb T von (1965) Renal adenocarcinoma; morphology – grading of malignancy-prognosis. A study of 197 cases. Acta Chir Scand Suppl 346:1–51PubMedGoogle Scholar
  3. 3.
    Boxer RJ, Waisman J, Lieber MM, Mampaso FM, Skinner DG (1979) Renal carcinoma: computer analysis of 96 patients treated by nephrectomy. J Urol 122:598–601PubMedGoogle Scholar
  4. 4.
    Broders AC (1920) Squamous cell epithelioma of the lip. JAMA 74:656–664CrossRefGoogle Scholar
  5. 5.
    Cheville JC, Lohse CM, Sukov WR, Thompson RH, Leibovich BC (2012) Chromophobe renal cell carcinoma: the impact of tumor grade on outcome. Am J Surg Pathol 36:851–856. doi:10.1097/PAS.0b013e3182496895CrossRefPubMedGoogle Scholar
  6. 6.
    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 27:612–624CrossRefPubMedGoogle Scholar
  7. 7.
    Dahinden C, Ingold B, Wild P, Boysen G, Luu VD, Montani M, Kristiansen G, Sulser T, Buhlmann P, Moch H, Schraml P (2010) Mining tissue microarray data to uncover combinations of biomarker expression patterns that improve intermediate staging and grading of clear cell renal cell cancer. Clin Cancer Res 16:88–98. doi:10.1158/1078-0432.CCR-09-0260CrossRefPubMedGoogle Scholar
  8. 8.
    Peralta-Venturina M de, Moch H, Amin M, Tamboli P, Hailemariam S, Mihatsch M, Javidan J, Stricker H, Ro JY, Amin MB (2001) Sarcomatoid differentiation in renal cell carcinoma: a study of 101 cases. Am J Surg Pathol 25:275–284CrossRefPubMedGoogle Scholar
  9. 9.
    Delahunt B (2009) Advances and controversies in grading and staging of renal cell carcinoma Modern pathology. Mod Pathol 22(Suppl 2):24–36. doi:10.1038/modpathol.2008.183CrossRefGoogle Scholar
  10. 10.
    Delahunt B, Cheville JC, Martignoni G, Humphrey PA, Magi-Galluzzi C, McKenney J, Egevad L, Algaba F, Moch H, Grignon DJ, Montironi R, Srigley JR (2013) The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters. Am J Surg Pathol 37:1490–1504. doi:10.1097/PAS.0b013e318299f0CrossRefPubMedGoogle Scholar
  11. 11.
    Delahunt B, Eble JN, McCredie MR, Bethwaite PB, Stewart JH, Bilous AM (2001) Morphologic typing of papillary renal cell carcinoma: comparison of growth kinetics and patient survival in 66 cases. Hum Pathol 32:590–595. doi:10.1053/hupa.2001.24984CrossRefPubMedGoogle Scholar
  12. 12.
    Delahunt B, Egevad L, Samaratunga H, Martignoni G, Nacey JN, Srigley JR (2015) Gleason and Fuhrman no longer make the grade. Histopathology. doi:10.1111/his.12803Google Scholar
  13. 13.
    Delahunt B, Nacey JN (1987) Renal cell carcinoma: histological indicators of prognosis. Pathology 19:258–263CrossRefPubMedGoogle Scholar
  14. 14.
    Delahunt B, Sika-Paotonu D, Bethwaite PB, McCredie MR, Martignoni G, Eble JN, Jordan TW (2007) Fuhrman grading is not appropriate for chromophobe renal cell carcinoma. Am J Surg Pathol 31:957–960. doi:10.1097/01.pas.0000249446.28713.53CrossRefPubMedGoogle Scholar
  15. 15.
    Delahunt B, Sika-Paotonu D, Bethwaite PB, Jordan WT, Magi-Galluzzi C, Zhou M, Samaratunga H, Srigley JR (2011) Grading of clear cell renal cell carcinoma should be based on nucleolar prominence. Am J Surg Pathol 35:1134–1139. doi:10.1097/PAS.0b013e318220697fCrossRefPubMedGoogle Scholar
  16. 16.
    Eichelberg C, Junker K, Ljungberg B, Moch H (2009) Diagnostic and prognostic molecular markers for renal cell carcinoma: a critical appraisal of the current state of research and clinical applicability. Eur Urol 55:851–863CrossRefPubMedGoogle Scholar
  17. 17.
    Finley DS, Shuch B, Said JW, Galliano G, Jeffries RA, Afifi AA, Castor B, Magyar C, Sadaat A, Kabbinavar FF, Belldegrun AS, Pantuck AJ (2011) The chromophobe tumor grading system is the preferred grading scheme for chromophobe renal cell carcinoma. J Urol 186:2168–2174. doi:10.1016/j.juro.2011.07.068CrossRefPubMedGoogle Scholar
  18. 18.
    Fuhrman SA, Lasky LC, Limas C (1982) Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 6:655–663CrossRefPubMedGoogle Scholar
  19. 19.
    Gelb A, Shibuya R, Weiss L, Medeiros L (1993) Stage I renal cell carcinoma. Am J Surg Pathol 17:275–286CrossRefPubMedGoogle Scholar
  20. 20.
    Gokden N, Nappi O, Swanson PE, Pfeifer JD, Vollmer RT, Wick MR, Humphrey PA (2000) Renal cell carcinoma with rhabdoid features. Am J Surg Pathol 24:1329–1338CrossRefPubMedGoogle Scholar
  21. 21.
    Griffiths IH, Thackray AC (1949) Parenchymal carcinoma of the kidneys. Br J Urol 21:128–151CrossRefPubMedGoogle Scholar
  22. 22.
    Hand JR, Broders AC (1932) Carcinoma of the kidney: the degree of malignancy in relation to factors bearing on prognosis. J Urol 28:199–216Google Scholar
  23. 23.
    Hermanek P, Sigel A, Chlepas S (1976) Histological grading of renal cell carcinoma. Eur Urol 2:189–191PubMedGoogle Scholar
  24. 24.
    Hop WC, Werf-Messing BH van der (1980) Prognostic indexes for renal cell carcinoma. Eur J Cancer 16:833–840CrossRefPubMedGoogle Scholar
  25. 25.
    Jiang F, Moch H, Richter J, Gasser T, Gschwind R, Egenter C, Bubendorf L, Sauter G, Mihatsch M (1998) Comparative genomic hybridization reveals frequent chromosome 13q and 4q losses in renal cell carcinomas with sarcomatoid transformation. J Pathol 185:382–388CrossRefPubMedGoogle Scholar
  26. 26.
    Kloppel G, Knofel WT, Baisch H, Otto U (1986) Prognosis of renal cell carcinoma related to nuclear grade, DNA content and Robson stage. Eur Urol 12:426–431PubMedGoogle Scholar
  27. 27.
    Lieber M, Tomera F, Taylor W, Farrow G (1981) Renal adenocarcinomas in young adults: survival and variables affecting prognosis. J Urol 125:164–168PubMedGoogle Scholar
  28. 28.
    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. doi:10.1309/VLV6-BRTR-HY5B-H485CrossRefPubMedGoogle Scholar
  29. 29.
    Mathiesen W, Muri O, Myhre E (1965) Pathology and prognosis in renal tumors. Acta Clin Scand 130:303–313Google Scholar
  30. 30.
    McNichols D, Segura J, DeWeerd J (1981) Renal cell carcinoma: long-term survival and late recurrence. J Urol 126:17–23PubMedGoogle Scholar
  31. 31.
    Medeiros L, Gelb A, Weiss L (1988) Renal cell carcinoma: prognostic significance of morphologic parameters in 121 cases. Cancer 61:1639–1651CrossRefPubMedGoogle Scholar
  32. 32.
    Moch H, Artibani W, Delahunt B, Ficarra V, Knuechel R, Montorsi F, Patard JJ, Stief CG, Sulser T, Wild PJ (2009) Reassessing the current UICC/AJCC TNM staging for renal cell carcinoma. Eur Urol 56:636–643CrossRefPubMedGoogle Scholar
  33. 33.
    Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM (2016) The 2016 WHO classification of tumours of the urinary system and male genital organs. Part A: Renal, penile and testicular tumours. Eur Urol 70(1):93–105 doi:10.1016/j.eururo.2016.02.029Google Scholar
  34. 34.
    Moch H, Gasser T, Amin MB, Torhorst J, Sauter G, Mihatsch MJ (2000) Prognostic utility of the recently recommended histologic classification and revised TNM staging system of renal cell carcinoma: a Swiss experience with 588 tumors. Cancer 89:604–614CrossRefPubMedGoogle Scholar
  35. 35.
    Moch H, Humphrey PA, Ulbright TM, Reuter V (2016) WHO Classification of Tumours of the Urinary System and Male Genital Organs. IARC, LyonGoogle Scholar
  36. 36.
    Moch H, Srigley J, Delahunt B, Montironi R, Egevad L, Tan PH (2014) Biomarkers in renal cancer. Virchows Arch 464:359–365. doi:10.1007/s00428-014-1546-1CrossRefPubMedGoogle Scholar
  37. 37.
    Myers G, Fehrenbaker L, Kelalis P (1968) Prognostic significance of renal vein invasion by hypernephroma. J Urol 100:420–423PubMedGoogle Scholar
  38. 38.
    Onodera Y, Matsuda N, Ohta M, Goto R, Fujii N, Yamada Y, Ikeuchi T, Kai Y (2000) Prognostic significance of tumor grade for renal cell carcinoma. Int J Urol 7:4–9CrossRefPubMedGoogle Scholar
  39. 39.
    Paner GP, Amin MB, Alvarado-Cabrero I, Young AN, Stricker HJ, Moch H, Lyles RH (2010) A novel tumor grading scheme for chromophobe renal cell carcinoma: prognostic utility and comparison with Fuhrman nuclear grade. Am J Surg Pathol 34:1233–1240. doi:10.1097/PAS.0b013e3181e96f2aCrossRefPubMedGoogle Scholar
  40. 40.
    Riches EW (1958) Factors in the prognosis of carcinoma of the kidney. J Urol 79:190–195PubMedGoogle Scholar
  41. 41.
    Selli C, Hinshaw W, Woodard B, Paulson D (1983) Stratification of risk factors in renal cell carcinoma. Cancer 52:899–903CrossRefPubMedGoogle Scholar
  42. 42.
    Sika-Paotonu D, Bethwaite PB, McCredie MR, Jordan WT, Delahunt B (2006) Nucleolar grade but not Fuhrman grade is applicable to papillary renal cell carcinoma. Am J Surg Pathol 30:1091–1096. doi:10.1097/01.pas.0000209833.69972.2bCrossRefPubMedGoogle Scholar
  43. 43.
    Skinner D, Colvin R, Vermillion C, Pfister R, Leadbetter W (1971) Diagnosis and management of renal cell carcinoma- a clinical and pathological study of 309 cases. Cancer 28:1165–1177CrossRefPubMedGoogle Scholar
  44. 44.
    Srigley JR, Delahunt B, Eble JN, Egevad L, Epstein JI, Grignon D, Hes O, Moch H, Montironi R, Tickoo SK, Zhou M, Argani P (2013) The International Society of Urological Pathology (ISUP) Vancouver Classification of Renal Neoplasia. Am J Surg Pathol 37:1469–1489. doi:10.1097/PAS.0b013e318299f2d1CrossRefPubMedGoogle Scholar
  45. 45.
    Storkel S, Thoenes W, Jacobi GH, Lippold R (1989) Prognostic parameters in renal cell carcinoma--a new approach. Eur Urol 16:416–422PubMedGoogle Scholar
  46. 46.
    Syrjanen K, Hjelt L (1978) Grading of human renal adenocarcinoma. Scand J Urol Nephrol 12:49–55PubMedGoogle Scholar
  47. 47.
    Tan PH, Cheng L, Rioux-Leclercq N, Merino MJ, Netto G, Reuter VE, Shen SS, Grignon DJ, Montironi R, Egevad L, Srigley JR, Delahunt B, Moch H (2013) Renal tumors: diagnostic and prognostic biomarkers. Am J Surg Pathol 37:1518–1531. doi:10.1097/PAS.0b013e318299f12eCrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Thoenes W, Storkel S, Rumpelt HJ (1986) Histopathology and classification of renal cell tumors (adenomas, oncocytomas and carcinomas). The basic cytological and histopathological elements and their use for diagnostics. Pathol Res Pract 181:125–143CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Institut für Pathologie und MolekularpathologieUniversitätsSpital ZürichZürichSchweiz

Personalised recommendations