Grade heterogeneity in clear cell renal cell carcinoma

López, José I.; Guarch, Rosa; Camarasa, Natalia; Caceres, Manuel; Moreno, V; Muñiz, Gorka; Garcia‐Prats,; Orozco, R

doi:10.1002/bjuiw-2012-091-web

Cited by 8 publications

(11 citation statements)

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“…However, as we have very recently demonstrated (13) grade distribution along the whole tumour is quite heterogeneous, and the same may happen with the rest of parameters. So, total tumour sampling shows to be much more precise to assign the real grade of a tumour with significant differences compared with classic sampling (13) This fact supports the need to reconsider current protocols for sampling renal tumours.…”

Section: Discussionmentioning

confidence: 74%

“…83). Average tumour diameter was 6 cm (range,[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] and the average number of paraffin blocks per case was 30 (range,. Fuhrman grade distribution assigned to the highest area in every case was quite balanced between low grade, with 24 cases (G1 = 9, G2 = 15), and high grade, with 27 cases (G3 = 10, G4 = 17).…”

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confidence: 99%

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Cell heterogeneity in clear cell renal cell carcinoma

López

Guarch

Larrinaga

et al. 2013

APMIS

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The aim of this study was to define the histological spectrum, frequency and significance of nonconventional tumour cells in clear cell renal cell carcinomas (CCRCC). Fifty-one totally sampled CCRCC were studied histologically to evaluate the spectrum of cell morphology variability, its frequency and significance, and their correlation with tumour grade and stage, and other histological parameters of aggressive behaviour like necrosis. Aside from conventional clear/eosinophilic granular cells, three additional cellular types were identified and considered in this study: small clear cells, syncytial cells and rhabdoid cells. Small clear cells were detected in 11 cases (21.5%), syncytial cells in 8 (15.6%) and rhabdoid cells in 5 (9.8%). The presence of syncytial and rhabdoid cells statistically correlated with grade (p = 0.003 and p = 0.006) and stage (p = 0.049 and p = 0.05) in CCRCC. Necrosis correlated with stage (p = 0.018) and grade (p = 0.004), but not with syncytial, rhabdoid or small clear cells. The presence of syncytial and rhabdoid cells in CCRCC is a relatively frequent event that significantly correlates with high-grade tumours and high stage status.

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Section: Discussionmentioning

confidence: 74%

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confidence: 99%

Cell heterogeneity in clear cell renal cell carcinoma

López

Guarch

Larrinaga

et al. 2013

APMIS

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“…The most worrying finding was that while conventional sampling detected seven cases of high grade carcinoma (Fuhrman grades 3 and 4), total sampling detected 17. This difference in a classical histological parameter with proven prognostic validity was statistically significant (9). There are no similar studies in the literature.…”

Section: Morphological Heterogeneitymentioning

confidence: 66%

Intratumor heterogeneity in clear cell renal cell carcinoma: a review for the practicing pathologist

López

2016

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Intertumor heterogeneity, defined as the spectrum of morphological differences found in similar tumors in different patients, is a well-known event for pathologists. However, recent molecular studies have pointed to intratumor heterogeneity as one of the most important issues in human neoplasia in the next years. Clear cell renal cell carcinoma is an example of an intrinsically heterogeneous neoplasm, and some of the most salient advances in the knowledge of intratumor heterogeneity have been developed on it. This review intends to analyze this phenomenon in this tumor from the practicing pathologist's point of view. A careful study of the surgical specimen and an exhaustive tumor sampling are mandatory to keep relevant information. Currently accepted protocols designed for renal tumor sampling may be insufficient. As a result, a different approach to tumor sampling is advisable to ascertain that intratumor heterogeneity, if present, will be well represented in the selected material.

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“…Recent studies, however, have demonstrated that more extensive tumour sampling of CCRCC yields data significantly different in terms of tumour grade and tumour cellularity in comparison to conventional sampling [13,14]. For instance, in a recent study, 28 CCRCCs were fully sampled and 17 tumour heterogeneities were found in terms of the presence of high grade areas while conventional sampling of the same tumours did show heterogeneity in 17 cases but high grade areas only in seven [13]. A recent study of 51 consecutively fully sampled CCRCCs reported foci of syncytial cells in eight cases and rhabdoid cells in five.…”

Section: Discussionmentioning

confidence: 99%

“…Pathologists have known for a long time that CCRCC is frequently microscopically heterogeneous, but studies trying to quantify this issue are rare [12][13][14]. Clinical and molecular data [12][13][14][15] suggest that conventional sampling of kidney tumours [16] probably allows only a partial and insufficient perception of tumour histology. In this context, minor foci of high grade as well as tumour areas with different genetic/epigenetic alterations [17] with impact on tumour behaviour could eventually be missed in some cases.…”

Section: Introductionmentioning

confidence: 99%

Large (>3.8 cm) clear cell renal cell carcinomas are morphologically and immunohistochemically heterogeneous

et al. 2014

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Heterogeneity is an inherent event to tumour development that is lately receiving much attention in oncologic research. The topic is being addressed primarily at the molecular level, and results are promising. However, translation to practical medicine is still pending. Our intention in this study is to approach the problem in a series of clear cell renal cell carcinomas with the tools that pathologists use in routine practice. Three randomly selected areas of 48 clear cell renal cell carcinomas prospectively collected in two different institutions were analysed for intratumour heterogeneity. The evaluated parameters were tumour size, cell type (clear vs. eosinophilic), Fuhrman's grade and immunohistochemical expression of carbonic anhydrase IX, BRCA1-associated protein-1 (BAP-1), cyclooxygenase-2 (COX-2) and Ki67. Intratumour heterogeneity was detected in 26 cases (54 %). Cell type, grade and Ki67 index were the parameters more frequently heterogeneous amounting, respectively, 44, 42 and 38 %. Tumour size was a significantly discriminative factor to predict tumour heterogeneity, with a cut-off of 3.8 cm (p < 0.001). Aside from tumour size, the most relevant parameters related with intratumour heterogeneity were cell type (clear vs. eosinophilic), Fuhrman's grade and Ki67 and COX-2 expression patterns. Carbonic anhydrase 9 and BAP-1 did not show statistical relevance. We conclude that heterogeneity is a common event in clear cell renal cell carcinomas that may be overlooked in cases insufficiently sampled. Tumour size appears as a reliable tool in identifying this situation since clear cell renal cell carcinomas under 3.8 cm in diameter are always homogeneous. This point may help the pathologist to make decisions in tumour sampling.

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Grade heterogeneity in clear cell renal cell carcinoma

Cited by 8 publications

References 0 publications

Cell heterogeneity in clear cell renal cell carcinoma

Cell heterogeneity in clear cell renal cell carcinoma

Intratumor heterogeneity in clear cell renal cell carcinoma: a review for the practicing pathologist

Large (>3.8 cm) clear cell renal cell carcinomas are morphologically and immunohistochemically heterogeneous

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