PATHOLOGY

Recommendations for the reporting of surgically resected specimens of renal cell carcinoma: the Association of Directors of Anatomic and Surgical Pathology
Higgins JP, McKenney JK, Brooks JD, Argani P, Epstein JI; Association of Directors of Anatomic and Surgical Pathology
Department of Pathology, Stanford University, Stanford, CA, USA
Hum Pathol. 2009; 40: 456-63

• A checklist based approach to reporting the relevant pathologic details of renal cell carcinoma resection specimens improves the completeness of the report. Karyotypic evaluation of renal neoplasms has refined but also complicated their classification. The number of diagnostic possibilities has increased and the importance of distinguishing different tumor types has been underscored by dramatic variation in prognosis and the development of targeted therapies for specific subtypes. The increasing number of recognized renal neoplasms has implications for handling renal resection specimens. Furthermore, the prognostic significance of other features of renal neoplasms related to grade and stage has been demonstrated. This guideline for the handling of renal resection specimens will focus on problem areas in the evolving practice of diagnosis, grading, and staging of renal neoplasms. The accompanying checklist will serve to ensure that all necessary details of the renal resection specimen are included in the surgical pathology report.
  
  
• Editorial Comment
  The reporting of renal cell carcinoma is facilitated by the provision of a checklist to insure that pathologists provide all of the essential information to enable clinicians to optimize patient care.
  The checklist includes the gross description and the diagnostic information:
  1. Gross description. Includes how the specimen is received, how the specimen is identified, the type of nephrectomy (total or partial), the length of ureters and the description of other structures. The tumor description includes the site within the kidney, the size in 3 dimensions, the gross characteristics (color, consistency and degree of heterogeneity, the relationship to the perinephric soft tissue with emphasis to the renal sinus fat, renal vein invasion, adrenal invasion, lymph nodes, and other findings (hydronephrosis, pyelonephritis, etc.)
  2. Diagnostic information. Includes the histologic type according to the World Health Organization 2004 classification (1): clear cell carcinoma, multilocular cystic carcinoma, papillary carcinoma, mucinous tubular and spindle carcinoma, collecting duct carcinoma, medullary carcinoma, translocation carcinomas (includes Xp11 and 6:11), tubulocystic carcinoma, acquired cystic disease-associated carcinoma, and renal cell carcinoma, unclassified. For the histological grade may be used the Fuhrman scheme (2). Sarcomatoid dedifferentiation is a growth pattern that may occur in any of the major types of renal cell carcinoma. Presence of necrosis has been found to be of prognostic significance (3). The number of nodes sampled and the number positive should be reported. The prognosis appears to be significantly adversely affected by extranodal extension of the metastatic focus, and therefore, it is recommended that this be assessed and reported as well (4).

References
1. Hamilton SR, Aaltonen LA. World Health Organization classification of tumours. pathology and genetics. IARC Press, Lyon. 2000.
2. Fuhrman SA, Lasky LC, Limas C: Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol. 1982; 6: 655-63.
3. Amin MB, Amin MB, Tamboli P, Javidan J, Stricker H, de-Peralta Venturina M, et al.: Prognostic impact of histologic subtyping of adult renal epithelial neoplasms: an experience of 405 cases. Am J Surg Pathol. 2002; 26: 281-91.
4. Dimashkieh HH, Lohse CM, Blute ML, Kwon ED, Leibovich BC, Cheville JC: Extranodal extension in regional lymph nodes is associated with outcome in patients with renal cell carcinoma. J Urol. 2006; 176: 1978-82; discussion 1982-3.

Dr. Athanase Billis
Full-Professor of Pathology
State University of Campinas, Unicamp
Campinas, São Paulo, Brazil
E-mail: athanase@fcm.unicamp.br