Renal cell carcinoma staging: pitfalls, challenges, and updates

Abstract

Renal cell carcinoma (RCC) is unusual among cancers in that it often grows as a spherical, well‐circumscribed mass. Increasing tumour size influences the pathological pT stage category within pT1 and pT2, with cutoffs of 40, 70 and 100 mm; however, with increasing size also comes a sharp increase in the likelihood of renal sinus or renal vein tributary invasion, such that clear cell RCC rarely reaches 70 mm without invading one of these. To clarify some previous challenges in assigning tumour stage, the American Joint Committee on Cancer 2016 tumor–node–metastasis classification has removed the requirements than vein invasion be recognised grossly and that vein walls contain muscle for the diagnosis of vein invasion. Renal pelvis invasion has also been added as an additional route to pT3a. Multinodularity or finger‐like extensions from a renal mass should be viewed with great suspicion for the possibility of vein or renal sinus invasion, and, as tumour size increases to over 40–50 mm, thorough sampling of the renal sinus interface should always be undertaken. With increasing interest in adjuvant therapy in renal cancer, the pathologist's role in RCC staging will continue to be an important prognostic parameter and a tool for selection of patients for enrolment in clinical trials.

Updates in Staging and Reporting of Genitourinary Malignancies

“…Studies have identified that the amount of muscle within the vessel walls varied and gross suspicion for vascular invasion was often identified without a histologic correlate. [73][74][75] Fingerlike projections or multinodularity of tumor architecture should also raise suspicion for renal vein or sinus invasion. 75 Renal sinus invasion has also been identified as the most common pathway for extrarenal extension and may be associated with a more aggressive disease than tumors with perinephric fat involvement alone.…”

“…[73][74][75] Fingerlike projections or multinodularity of tumor architecture should also raise suspicion for renal vein or sinus invasion. 75 Renal sinus invasion has also been identified as the most common pathway for extrarenal extension and may be associated with a more aggressive disease than tumors with perinephric fat involvement alone. 76 The World Health Organization/International Society of Urologic Pathology nucleolar grade is now used in place of the Fuhrman nuclear grade.…”

“…[78][79][80][81][82][83] Microscopic LVI, which is defined as a focus of tumor within small vascular spaces that cannot be identified macroscopically on the slide, has also been shown to correlate with survival and is considered a prognostic factor. 1,75,77…”

Preoperative Neutrophil-to-Lymphocyte Ratio Was a Predictor of Overall Survival in Small Renal Cell Carcinoma: An Analysis of 384 Consecutive Patients

“…e patient's characteristics were extracted from the medical records and pathological reports, and all the data were entered into a database. Pathological stage was assigned according to the American Joint Committee on Cancer (8th edition) [12]. In particular, only patients with complete absolute lymphocyte count and absolute neutrophil count data within 2 weeks before surgery were included in the study [13].…”

The morphological characteristics and immunophenotype of renal cell carcinomas with eosinophilic cytoplasm

“…[6] . Стадии опухоли (рТ1-Т4) определяли согласно протоколу 8-го издания TNM-классификации опухолей мочевыделительной системы [7,8] .…”