Recommendations for the Reporting of Surgically Resected Specimens of Renal Cell Carcinoma Association of Directors of Anatomic and Surgical Pathology* Key Words: Surgical pathology; Staging; Histology; Histopathology

The reporting of renal cell carcinoma is facilitated by the provision of a checklist to ensure that pathologists provide all of the essential information to enable clinicians to optimize patient care. Classification of renal tumors is complicated by the wide range of morphologic types of renal cell carcinoma, some of which have recognized subtypes. Cytogenetic data have clarified the morphologic features of some of these tumors, but such data are not routinely available to assist most practicing pathologists attempting to classify individual tumors. Nevertheless, consideration should be given to cytogenetic evaluation for renal cortical tumors in young patients or tumors of unusual morphologic appearance regardless of the age of the patient. It is also important to note that although the biologic aggressiveness differs for the different types of renal cell carcinoma, staging and grading of renal cell carcinoma are driven by the behavior of clear cell carcinoma, the overwhelmingly most common subtype. Several aspects of renal cell carcinoma classification remain problematic. Despite the large and growing number of renal cell carcinoma subtypes, classification of well-differentiated, low-grade tumors is relatively routine. However, with increasing tumor grade, the features by which renal cell carcinomas are classified may be lost or are at least obscured. Subclassifications of papillary renal cell carcinoma have been proposed but do not clearly have prognostic relevance independent of nuclear grade.1 The grading scheme proposed by Fuhrman et al2 and modifications thereof are used to grade clear cell renal carcinomas, but this scheme was developed before many renal cell carcinoma subtypes were recognized and may not be applicable to other subtypes. Difficulties also arise with respect to the stage of a renal carcinoma. In particular, it is difficult to assess the point at which a carcinoma has extended beyond the kidney. Based on the most current data, this guideline attempts to address these problematic points and suggest reasonable means of providing the information called for in the accompanying checklist.