Place du pathologiste dans la prise en charge du carcinome rénal en situation néoadjuvante

The medical treatment of renal-cell carcinoma, and of its most frequent histologic subtype, the clear cell renal-cell carcinoma, has been changed by the emergence of targeted therapies. The development of these drugs has been made possible by more precise knowledge of molecular mechanisms involved in the carcinogenesis of these tumors. Three molecular pathways may be involved in clear cell renal-cell carcinoma: VHL/HIF/VEGF, PI3 K/AKT/mTOR and MAPKinases pathways. These antiangiogenic therapies are approved for the treatment of advanced and metastatic clear cell renal-cell carcinoma. In metastatic disease, pathologists have significant and different implications: 1) in tumor biopsy, only the diagnosis of clear cell renal-cell carcinoma implies the prescription of antiangiogenic drugs, and 2) after targeted therapies, pathologists must evaluate the therapeutic effects on tumor. Consensus on macroscopic and histologic reports are needed by pathologists.