Pathology and Molecular Pathogenesis of Renal Cell Carcinoma

Prognosis of patients with RCCs is most accurately predicted by TNM stage. Within stages, Fuhrman grade has a strong predictive value. Although not considered in nuclear grading, sarcomatoid dedifferentiation is a severely negative event for all RCC subtypes. Histologic subtypes of RCCs are not independent prognostic factors comparable with TNM stage and Fuhrman grade. Histologic coagulative tumour necrosis was an independent prognostic factor of outcome for clear cell and chromophobe RCC. Immunohistochemical panels including RCC marker, CD10, and KIT are now available for differential diagnosis of the distinct RCC subtypes. Genetic studies have improved understanding of subtypes, offering a promising approach for clinical diagnosis, prognosis, and possibly therapy. Urologists should be aware that currently many molecular analyses can be performed on RCCs, and when feasible, fresh samples sent to the pathologist.