The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters

Brett Delahunt (Lead / Corresponding author), John C. Cheville, Guido Martignoni, Peter A. Humphrey, Cristina Magi-Galluzzi, Jesse McKenney, Lars Egevad, Ferran Algaba, Holger Moch, David J. Grignon, Rodolfo Montrioni, John R. Srigley, ISUP Renal Tumor Panel

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    606 Citations (Scopus)


    The International Society of Urological Pathology 2012
    Consensus Conference made recommendations regarding classification,
    prognostic factors, staging, and immunohistochemical
    and molecular assessment of adult renal tumors. Issues relating to
    prognostic factors were coordinated by a workgroup who identified
    tumor morphotype, sarcomatoid/rhabdoid differentiation, tumor
    necrosis, grading, and microvascular invasion as potential prognostic
    parameters. There was consensus that the main morphotypes
    of renal cell carcinoma (RCC) were of prognostic significance, that
    subtyping of papillary RCC (types 1 and 2) provided additional
    prognostic information, and that clear cell tubulopapillary RCC
    was associated with a more favorable outcome. For tumors
    showing sarcomatoid or rhabdoid differentiation, there was consensus
    that a minimum proportion of tumor was not required for
    diagnostic purposes. It was also agreed upon that the underlying
    subtype of carcinoma should be reported. For sarcomatoid carcinoma,
    it was further agreed upon that if the underlying carcinoma
    subtype was absent the tumor should be classified as a grade
    4 unclassified carcinoma with a sarcomatoid component. Tumor
    necrosis was considered to have prognostic significance, with assessment
    based on macroscopic and microscopic examination of
    the tumor. It was recommended that for clear cell RCC the
    amount of necrosis should be quantified. There was consensus
    that nucleolar prominence defined grades 1 to 3 of clear cell and
    papillary RCCs, whereas extreme nuclear pleomorphism or sarcomatoid
    and/or rhabdoid differentiation defined grade 4 tumors.
    It was agreed upon that chromophobe RCC should not be graded.
    There was consensus that microvascular invasion should not be
    included as a staging criterion for RCC
    Original languageEnglish
    Pages (from-to)1490–1504
    Number of pages15
    JournalAmerican Journal of Surgical Pathology
    Issue number10
    Publication statusPublished - Oct 2013


    • pathology
    • kidney
    • renal cell carcinoma
    • tumor


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