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Kidney
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Fuhrman Nuclear Grading Scheme For Renal Cell Carcinoma
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Grade* |
Freq |
Nuclear Features |
Survival Rates |
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I |
10% |
Small (10 um), uniform round, no nucleoli seen at 400X. |
67% (5-year) & 51% (10-year) |
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II |
35% |
Larger nuclei (15 um) with variable size, nucleoli seen at 400X. |
56% (5-year) & 42% (10-year) |
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III |
35% |
Nuclei = 20 um, obviously pleomorphic and irregular shape. Large nucleoli seen at 100X. |
33% (5-year) & 15% (10-year) |
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IV |
20% |
Nuclei > 20 um, multilobed giant tumor cells; occasionally may demonstrate spindling and severe nuclear anaplasia. |
8% (5-year) & 0% (10-year) |
* When tumor heterogeneity is present, the highest grade is always assigned.
* This grading system was largely based on studies of the conventional (clear cell) renal cell carcinomas. It is controversial whether this grading scheme should be applied to non-conventional renal cell carcinomas.
Renal Allograft Acute Cellular Rejection
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Category |
Histologic Features (Renal Allograft Acute Cellular Rejection) |
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Borderline |
Foci of mild tubulitis (1 to 4 mononuclear cells/tubular cross section). No intimal arteritis. |
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IA |
Significant interstitial infiltration (>25% of parenchyma affected) and foci of moderate tubulitis (> 4 mononuclear cells/tubular cross section or group of 10 tubular cells). |
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IB |
significant interstitial infiltration (> 25% of parenchyma affected) and foci of severe tubulitis (> 10 mononuclear cells/tubular cross section or group of 10 tubular cells). |
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IIA |
Significant interstitial infiltration and Mild-to-moderate intimal arteritis in at least one arterial cross section. |
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IIB |
Severe intimal arteritis with at least 25% luminal area lost in at least one arterial cross section |
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III |
Arterial fibrinoid change and/or transmural arteritis with medial smooth muscle necrosis with lymphocytic inflammation |
Specimen Adequacy (Banff '97)
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Adequacy |
Histologic Features |
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Unsatisfactory |
Less than 7 glomeruli & no arteries |
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Marginal |
7 glomeruli with one artery |
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Adequate |
10 or more glomeruli with at least two arteries |
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Note: |
Adequate specimen is a necessary prerequisite for numeric coding. Minimal sampling: 3 H&E, 3 PAS or silver stains, and 1 trichrome, section thickness 3-4 microns. |
Chronic/Sclerosing Allograft Nephropathy
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