Histologic prognostic markers for renal cell neoplasia

Although numerous histologic prognostic parameters have been investigated for RCC, those with clinical utility are very limited in number. Tumour morphotype is of prognostic significance. Chromophobe RCC has a more favourable outcome than clear cell and papillary RCC, which in turn is associated with a more favourable outcome than collecting duct RCC. Both clear cell tubulopapillary and tubulocystic RCC appear to have an excellent prognosis. The presence of sarcomatoid or rhabdoid differentiation is a marker of poor prognosis, with sarcomatoid change being associated with median survivals of <18 months. The recently described ISUP/WHO grading system, based upon nucleolar prominence (grade 1–3) and the presence of extreme pleomorphism, sarcomatoid and/or rhabdoid differentiation (grade 4) has been correlated with outcome for clear cell and papillary RCC. It is recommended that chromophobe RCC not be graded. Microscopic coagulative necrosis is a marker of decreased survival, while microvascular invasion is an emerging prognostic parameter.