The current status of renal cell carcinoma and prostate carcinoma grading

Developments in Prostate Cancer Therapy: From the Androgen Receptor to Antiandrogens and Beyond

“…Prostate cancer is an eloquent example of the evolution of the criteria applied in morphological classification systems. The system designed by Donald Gleason, used worldwide since the 1960s [23], has been systematically revised, in direct relation to the clinical and prognostic significance [12,13,47]. Unlike other systems, the classification of prostate cancer was based on an essential elementthe histoarchitectural pattern, which led to the definition of 5 histological grades, marked from 1 to 5 [23].…”

“…Changes of the grading criteria were proposed by Gleason in 1974 and1977 [12, 24, 25], resulting in grouping the scores into the following categories: 2 -3, 4 -5, 6, 7 and 8 -10, concerning the prognosis. The conference organized by the International Society of Urological Pathology (ISUP) in 2005 [12,47] also brought amendments to the grading system. Thus, it was established that grade 1 corresponds to adenosis, grade 2 is rarely assigned, grade 3 includes the cribriform pattern with small, uniform glands with a well-defined lumen, grade 4 consists of poorly formed acini and irregular cribriform glands, and grade 5 is characterized by comedonecrosis, and presence of single tumoural cells, solid cords and masses.…”

“…Another novelty was the decision to consider the presence of the higher grade pattern, even if it represents a minor component (tertiary grade), and to add it to the most representative grade (primary grade) in calculating the Gleason score [13]. Subsequently, as a result of the changes made in 2005, the Gleason score values comprised between 6 and 10 were distributed into 3 clinical risk classes: low, intermediate and high [12]. In 2014, ISUP Consensus Conference assigned the cribriform and glomeruloid pattern a Gleason grade 4 and decided that the mucinous histopathological variant of adenocarcinoma should be graded exclusively on histoarchitectural features.…”

“…For radical prostatectomy, no consensus has yet been established for quantifying a tertiary pattern. All these clarifications increased the quality of the assessment of prostate biopsies, due to a much more objective perspective of the prognosis [12].…”

Updates in Histologic Grading of Urologic Neoplasms

“…36 These slight alterations have resulted in the downgrading of tumors, particularly from grade 2 to 1 and grade 3 to 2, in large part due to the requirement of eosinophilia. 31,34,37 Chromophobe Renal Cell Carcinoma Chromophobe RCC is associated with a more favorable prognosis than that of other subtypes, but owing to the inherent nuclear pleomorphism (ie, irregular nuclei and prominent nucleoli) they are paradoxically given a higher Fuhrman grade. In 2010, Paner and colleagues 38 proposed a 3-tiered novel chromophobe tumor grading system that discounts the nuclear atypia and is instead based upon nuclear anaplasia and crowding assessed within 2 distinct areas.…”