Elsevier

Human Pathology

Volume 40, Issue 4, April 2009, Pages 456-463
Human Pathology

Current topics
Recommendations for the reporting of surgically resected specimens of renal cell carcinoma: The Association of Directors of Anatomic and Surgical Pathology

https://doi.org/10.1016/j.humpath.2008.12.004Get rights and content

Summary

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.

Section snippets

Scope of the guidelines

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. Classification of renal tumors is complicated by the wide range of morphological types of renal cell carcinoma, some of which have recognized subtypes. Cytogenetic data have clarified the morphologic features of some of these tumors, but such data are not routinely available to assist most

Gross description

  • A.

    How the specimen was received: fresh, in formalin, intact, fragmented, morcellated, etc.

  • B.

    How the specimen was identified: labeled (name, medical record number) and designated (eg, right radical nephrectomy).

  • C.

    If the specimen is a radical nephrectomy, inspect the external aspect of the specimen (Gerota fascia) for evidence of tumor. Locate the ureteral and vascular margins in the renal hilus. These may be sampled before inking the specimen when they are most easily identified. Hemostatic forceps

Diagnostic information

  • 1.

    Laterality of tumor and type of resection.

  • 2.

    Histologic type: the World Health Organization 2004 classification of renal cell carcinoma is recommended [26].

    • a.

      Clear cell carcinoma

    • b.

      Multilocular cystic carcinoma

    • c.

      Papillary carcinoma

    • d.

      Chromophobe carcinoma

    • e.

      Mucinous tubular and spindle carcinoma

    • f.

      Collecting duct carcinoma

    • g.

      Medullary carcinoma

    • h.

      Translocation carcinomas (includes Xp11 and 6:11)

    • i.

      Tubulocystic carcinoma

    • j.

      Acquired cystic disease-associated carcinoma

    • k.

      Renal cell carcinoma, unclassified

    • l.

      Others (specify)

  • Outcome

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