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WHO-ISUP-Graduierungssystem für Nierenkarzinome

The WHO/ISUP grading system for renal carcinoma

  • Schwerpunkt: Grading-Systeme
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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.

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.

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Literatur

  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.0b013e3181831e68

    Article  PubMed  Google Scholar 

  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 346:1–51

    CAS  PubMed  Google Scholar 

  3. Boxer RJ, Waisman J, Lieber MM, Mampaso FM, Skinner DG (1979) Renal carcinoma: computer analysis of 96 patients treated by nephrectomy. J Urol 122:598–601

    CAS  PubMed  Google Scholar 

  4. Broders AC (1920) Squamous cell epithelioma of the lip. JAMA 74:656–664

    Article  Google Scholar 

  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.0b013e3182496895

    Article  PubMed  Google Scholar 

  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 27:612–624

    Article  PubMed  Google Scholar 

  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-09-0260

    Article  CAS  PubMed  Google Scholar 

  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 25:275–284

    Article  PubMed  Google Scholar 

  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.2008.183

    Article  Google Scholar 

  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.0b013e318299f0

    Article  PubMed  Google Scholar 

  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.2001.24984

    Article  CAS  PubMed  Google Scholar 

  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.12803

    Google Scholar 

  13. Delahunt B, Nacey JN (1987) Renal cell carcinoma: histological indicators of prognosis. Pathology 19:258–263

    Article  CAS  PubMed  Google Scholar 

  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.0000249446.28713.53

    Article  PubMed  Google Scholar 

  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.0b013e318220697f

    Article  PubMed  Google Scholar 

  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 55:851–863

    Article  CAS  PubMed  Google Scholar 

  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.2011.07.068

    Article  PubMed  Google Scholar 

  18. Fuhrman SA, Lasky LC, Limas C (1982) Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 6:655–663

    Article  CAS  PubMed  Google Scholar 

  19. Gelb A, Shibuya R, Weiss L, Medeiros L (1993) Stage I renal cell carcinoma. Am J Surg Pathol 17:275–286

    Article  CAS  PubMed  Google Scholar 

  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 24:1329–1338

    Article  CAS  PubMed  Google Scholar 

  21. Griffiths IH, Thackray AC (1949) Parenchymal carcinoma of the kidneys. Br J Urol 21:128–151

    Article  CAS  PubMed  Google Scholar 

  22. Hand JR, Broders AC (1932) Carcinoma of the kidney: the degree of malignancy in relation to factors bearing on prognosis. J Urol 28:199–216

    Google Scholar 

  23. Hermanek P, Sigel A, Chlepas S (1976) Histological grading of renal cell carcinoma. Eur Urol 2:189–191

    CAS  PubMed  Google Scholar 

  24. Hop WC, Werf-Messing BH van der (1980) Prognostic indexes for renal cell carcinoma. Eur J Cancer 16:833–840

    Article  CAS  PubMed  Google Scholar 

  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 185:382–388

    Article  CAS  PubMed  Google Scholar 

  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 12:426–431

    CAS  PubMed  Google Scholar 

  27. Lieber M, Tomera F, Taylor W, Farrow G (1981) Renal adenocarcinomas in young adults: survival and variables affecting prognosis. J Urol 125:164–168

    CAS  PubMed  Google Scholar 

  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-H485

    Article  PubMed  Google Scholar 

  29. Mathiesen W, Muri O, Myhre E (1965) Pathology and prognosis in renal tumors. Acta Clin Scand 130:303–313

    Google Scholar 

  30. McNichols D, Segura J, DeWeerd J (1981) Renal cell carcinoma: long-term survival and late recurrence. J Urol 126:17–23

    CAS  PubMed  Google Scholar 

  31. Medeiros L, Gelb A, Weiss L (1988) Renal cell carcinoma: prognostic significance of morphologic parameters in 121 cases. Cancer 61:1639–1651

    Article  CAS  PubMed  Google Scholar 

  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 56:636–643

    Article  PubMed  Google Scholar 

  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.2016.02.029

    Google Scholar 

  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 89:604–614

    Article  CAS  PubMed  Google Scholar 

  35. Moch H, Humphrey PA, Ulbright TM, Reuter V (2016) WHO Classification of Tumours of the Urinary System and Male Genital Organs. IARC, Lyon

    Google Scholar 

  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/s00428-014-1546-1

    Article  CAS  PubMed  Google Scholar 

  37. Myers G, Fehrenbaker L, Kelalis P (1968) Prognostic significance of renal vein invasion by hypernephroma. J Urol 100:420–423

    PubMed  Google Scholar 

  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 7:4–9

    Article  CAS  PubMed  Google Scholar 

  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.0b013e3181e96f2a

    Article  PubMed  Google Scholar 

  40. Riches EW (1958) Factors in the prognosis of carcinoma of the kidney. J Urol 79:190–195

    CAS  PubMed  Google Scholar 

  41. Selli C, Hinshaw W, Woodard B, Paulson D (1983) Stratification of risk factors in renal cell carcinoma. Cancer 52:899–903

    Article  CAS  PubMed  Google Scholar 

  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.0000209833.69972.2b

    Article  PubMed  Google Scholar 

  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 28:1165–1177

    Article  CAS  PubMed  Google Scholar 

  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.0b013e318299f2d1

    Article  PubMed  Google Scholar 

  45. Storkel S, Thoenes W, Jacobi GH, Lippold R (1989) Prognostic parameters in renal cell carcinoma--a new approach. Eur Urol 16:416–422

    CAS  PubMed  Google Scholar 

  46. Syrjanen K, Hjelt L (1978) Grading of human renal adenocarcinoma. Scand J Urol Nephrol 12:49–55

    CAS  PubMed  Google Scholar 

  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.0b013e318299f12e

    Article  PubMed  PubMed Central  Google Scholar 

  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 181:125–143

    Article  CAS  PubMed  Google Scholar 

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  1. Institut für Pathologie und Molekularpathologie, UniversitätsSpital Zürich, Schmelzbergstrasse 12, 8091, Zürich, Schweiz

    H. Moch

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Moch, H. WHO-ISUP-Graduierungssystem für Nierenkarzinome. Pathologe 37, 355–360 (2016). https://doi.org/10.1007/s00292-016-0171-y

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