Handling and staging of renal cell carcinoma the international society of urological pathology consensus (ISUP) conference recommendations

Trpkov, Kiril, Grignon, David J., Bonsib, Stephen M., Amin, Mahul B., Billis, Athanase, Lopez-Beltran, Antonio, Samaratunga, Hemamali, Tamboli, Pheroze, Delahunt, Brett, Egevad, Lars, Montironi, Rodolfo, Srigley, John R. and the ISUP Renal Tumor Panel (2013) Handling and staging of renal cell carcinoma the international society of urological pathology consensus (ISUP) conference recommendations. American Journal of Surgical Pathology, 37 10: 1505-1517. doi:10.1097/PAS.0b013e31829a85d0

Author Trpkov, Kiril
Grignon, David J.
Bonsib, Stephen M.
Amin, Mahul B.
Billis, Athanase
Lopez-Beltran, Antonio
Samaratunga, Hemamali
Tamboli, Pheroze
Delahunt, Brett
Egevad, Lars
Montironi, Rodolfo
Srigley, John R.
the ISUP Renal Tumor Panel
Title Handling and staging of renal cell carcinoma the international society of urological pathology consensus (ISUP) conference recommendations
Journal name American Journal of Surgical Pathology   Check publisher's open access policy
ISSN 0147-5185
Publication date 2013-01-01
Year available 2013
Sub-type Article (original research)
DOI 10.1097/PAS.0b013e31829a85d0
Open Access Status DOI
Volume 37
Issue 10
Start page 1505
End page 1517
Total pages 13
Place of publication Philadelphia, PA United States
Publisher Lippincott Williams and Wilkins
Language eng
Subject 2702 Anatomy
2734 Pathology and Forensic Medicine
2746 Surgery
Abstract The International Society of Urologic Pathology 2012 Consensus Conference on renal cancer, through working group 3, focused on the issues of staging and specimen handling of renal tumors. The conference was preceded by an online survey of the International Society of Urologic Pathology members, and the results of this were used to inform the focus of conference discussion. On formal voting a Z65% majority was considered a consensus agreement. For specimen handling it was agreed that with radical nephrectomy specimens the initial cut should be made along the long axis and that both radical and partial nephrectomy specimens should be inked. It was recommended that sampling of renal tumors should follow a general guideline of sampling 1 block/cm with a minimum of 3 blocks (subject to modification as needed in individual cases). When measuring a renal tumor, the length of a renal vein/caval thrombus should not be part of the measurement of the main tumor mass. In cases with multiple tumors, sampling should include at a minimum the 5 largest tumors. There was a consensus that perinephric fat invasion should be determined by examining multiple perpendicular sections of the tumor/perinephric fat interface and by sampling areas suspicious for invasion. Perinephric fat invasion was defined as either the tumor touching the fat or extending as irregular tongues into the perinephric tissue, with or without desmoplasia. It was agreed upon that renal sinus invasion is present when the tumor is in direct contact with the sinus fat or the loose connective tissue of the sinus, clearly beyond the renal parenchyma, or if there is involvement of any endothelium-lined spaces within the renal sinus, regardless of the size. When invasion of the renal sinus is uncertain, it was recommended that at least 3 blocks of the tumor-renal sinus interface should be submitted. If invasion is grossly evident, or obviously not present (small peripheral tumor), it was agreed that only 1 block was needed to confirm the gross impression. Other recommendations were that the renal vein margin be considered positive only when there is adherent tumor visible microscopically at the actual margin. When a specimen is submitted separately as "caval thrombus, "the recommended sampling strategy is to take 2 or more sections to look for the adherent caval wall tissue. It was also recommended that uninvolved renal parenchyma be sampled by including normal parenchyma with tumor and normal parenchyma distant from the tumor. There was consensus that radical nephrectomy specimens should be examined for the purpose of identifying lymph nodes by dissection/palpation of the fat in the hilar area only; however, it was acknowledged that lymph nodes are found in <10% of radical nephrectomy specimens. Copyright
Keyword Fat invasion
International Society of Urological Pathology
Renal cell carcinoma
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
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Created: Fri, 29 Nov 2013, 05:53:08 EST by System User on behalf of Discipline of Molecular and Cellular Pathology