Nucleolar Grade But Not Fuhrman Grade is Applicable to Papillary Renal Cell Carcinoma

Sika-Paotonu, Dianne; Bethwaite, Peter; McCredie, Margaret; Jordan, T. William; Delahunt, Brett

doi:10.1097/01.pas.0000209833.69972.2b

Cited by 112 publications

(76 citation statements)

References 21 publications

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“…'s study, eighty-seven cases of chromophobe renal cell carcinoma were investigated. Authors emphasized that the fact that all the 8 dead chromophobe RCC patients had FNG-2, supports this opinion (13)(14)(15)(16)(17). According to our observations, tissue fixing is a misleading factor that complicates the evaluation.…”

Section: Discussionsupporting

confidence: 49%

The Relationship of Fuhrman Nuclear Grade, Tumor Stage and Sarcomatoid Differentiation with Survival in Renal Cell Carcinomas

Tastekin¹,

Puyan²,

Kaplan³

et al. 2012

Balkan Med J

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Objective: Renal cell carcinoma derived from tubular epithelium is one of the malignant tumors of the kidney. We have investigated the histological features, pathological stage, nuclear grade and sarcomatoid differentiation of these tumors. Results: In our study, cases with high nuclear grade, advanced stage and sarcomatoid differentiation revealed poor survival rates (p<0.05). In conclusion, the correlation between prognostic histopathological parameters and survival rates was consistent with literature findings.Conclusion: Fuhrman nuclear grading, stage and sarcomatoid differentiation are important parameters and are related factors in survival when investigating renal cell carcinomas. Fuhrman nuclear grading must be evaluated correctly and the highest grade should be reported. Although there aren't enough studies about sarcomatoid differentiation, its presence significantly decreases survival rates. It is very important to state histopathological parameters including sarcomatoid differentiation precisely on the pathology report.

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Section: Discussionsupporting

confidence: 49%

The Relationship of Fuhrman Nuclear Grade, Tumor Stage and Sarcomatoid Differentiation with Survival in Renal Cell Carcinomas

Tastekin¹,

Puyan²,

Kaplan³

et al. 2012

Balkan Med J

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“…47,48 For papillary RCC it was found that of the three parameters of the Fuhrman system, neither the morphometric measures of nuclear size nor pleomorphism correlated with outcome. Nucleolar prominence, based on the microscopic high-power field showing the greatest degree of nuclear pleomorphism was significantly associated with outcome on univariate analysis, although this was not independent of pT category or TNM stage.…”

Section: Fuhrman Gradingmentioning

confidence: 95%

“…Nucleolar prominence, based on the microscopic high-power field showing the greatest degree of nuclear pleomorphism was significantly associated with outcome on univariate analysis, although this was not independent of pT category or TNM stage. 47 For chromophobe RCC not one of the three grading components was correlated with outcome, when tested separately, which raises questions as to the validity of Fuhrman grading for these tumors. 48 Importantly, when tumors in both of these series were classified on the basis of nuclear size alone, utilizing the nuclear diameter cut points proposed by Fuhrman, then all tumors were classified as grade 1, whereas assessment of focal nucleolar prominence on its own showed 58% of papillary RCC and 24% of chromophobe RCC to exhibit grade 3 characteristics.…”

Section: Fuhrman Gradingmentioning

confidence: 99%

Advances and controversies in grading and staging of renal cell carcinoma

2009

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Despite the considerable progress made in our understanding of the pathogenesis, genetics, and pathology of renal cell carcinoma (RCC), difficulties remain relating to the prediction of clinical outcome for individual cases. Although there is evidence to show that high-grade tumors have a poorer prognosis when compared to those of low grade, debate remains regarding the predictive value of grading, especially for those tumors classified into the intermediate grades. Numerous composite morphologic and nuclear grading systems have been proposed for RCC and although that of the Fuhrman classification have achieved widespread usage, the validity of the grading criteria of this classification has been questioned. In addition, there are few studies that have attempted to validate the Fuhrman system for RCCs beyond that of the clear cell subtype. Recent studies have indicated that grading of papillary RCC should be based on nucleolar prominence alone and that the components of the Fuhrman grading classification do not provide prognostic information for chromophobe RCC. Independent of tumor grade, the prognostic importance of tumor stage for RCC is well recognized. The Union Internationale Contre le Cancer/American Joint Committee for Cancer Staging and End Results Reporting TNM staging system is now in its sixth edition (2002) and recent refinements have focused on defining size cut points that will identify apparently localized tumors that will develop recurrence and/or metastases despite attempted curative surgery. In parallel with these studies it has been shown that infiltration of the renal sinus is an important prognostic factor, being observed in almost all tumors 47 cm in diameter. Questions remain as to the appropriate stratification of regional extension of RCC, as defined in the T3 tumor-staging category. Recent modifications to this category have been suggested combining the level of infiltration of the venous outflow tract with the presence or absence of infiltration of the adrenal gland and/or perirenal fat. Similarly, the utility of classifying lymph node involvement by tumor is debated, although it is well recognized that lymph node infiltration is associated with a poor prognosis. Although the current TNM classification does provide useful prognostic information it would appear that further modifications are justified to enhance the predictive value of staging for RCC.

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“…Cases were subtyped into type 1 and 2 PRCC by a single expert genito-urinary pathologist (J.W.S) in accordance with Delahunt and Eble's original description (9). Because nucleolar grade but not Fuhrman grade is applicable for PRCC, all tumors were regraded according to the scheme described by Sika-Paotonu (16). Additional information included sarcomatoid features, collecting system invasion, necrosis, and multifocality.…”

mentioning

confidence: 99%

Cytogenetic and Molecular Tumor Profiling for Type 1 and Type 2 Papillary Renal Cell Carcinoma

Klatte¹,

Pantuck²,

Said³

et al. 2009

Clinical Cancer Research

169

121

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Purpose: The goal of this study was to evaluate immunohistochemical and cytogenetic features and their prognostic value in papillary renal cell carcinoma (PRCC) subtypes. Experimental Design: One hundred fifty-eight cases of PRCC were identified and reclassified by subtype. Tumoral expression of 29 molecular markers was determined by immunohistochemistry. Cytogenetic analyses were done on a prospective series of 65 patients. Associations with clinicopathologic information and disease-specific survival were assessed. Results: Fifty-one patients (32%) had type 1and 107 (68%) type 2 PRCC. Type 2 patients had worse Eastern Cooperative Oncology Group performance status, higherTstages, nodal and distant metastases, higher grades, and a higher frequency of necrosis, collecting system invasion and sarcomatoid features. Type 2 showed greater expression of vascular endothelial growth factor (VEGF)-R2 in the tumor epithelium, and of VEGF-R3 in both tumor epithelium and endothelium. Loss of chromosome 1p, loss of 3p, and gain of 5q were exclusively observed in type 2, whereas type 1more frequently had trisomy 17.Type 2 PRCC was associated with worse survival than type 1, but type was not retained as an independent prognostic factor. Lower PTEN, lower EpCAM, lower gelsolin, higher CAIX, and higher VEGF-R2 and VEGF-R3 expression, loss of 1p, 3p, or 9p, and absence trisomy 17 were all associated with poorer prognosis. Conclusions: Type 2 PRCC is associated with more aggressive clinicopathologic features and worse outcome. Molecular and chromosomal alterations can distinguish between PRCC subtypes and influence their prognosis. The effect of 3p loss on survival in PRCC is opposite to the relationship seen in clear cell RCC.

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Nucleolar Grade But Not Fuhrman Grade is Applicable to Papillary Renal Cell Carcinoma

Cited by 112 publications

References 21 publications

The Relationship of Fuhrman Nuclear Grade, Tumor Stage and Sarcomatoid Differentiation with Survival in Renal Cell Carcinomas

The Relationship of Fuhrman Nuclear Grade, Tumor Stage and Sarcomatoid Differentiation with Survival in Renal Cell Carcinomas

Advances and controversies in grading and staging of renal cell carcinoma

Cytogenetic and Molecular Tumor Profiling for Type 1 and Type 2 Papillary Renal Cell Carcinoma

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