Vancouver Classification of Renal Neoplasia New entities recognized and “some important informations”

Prof. Valdi Pešutić-Pisac, MD PhD

Institute of Pathology, Clinical Hospital Split, Split, Croatia

Summary: The International Society of Urological Pathology (ISUP) 2012 Consensus Conference made recommendations regarding the classification, prognostic factors, staging, and immunohistochemical and molecular assessment of adult renal tumors – the classification known as the ISUP Vancouver.
There is consensus that 5 new entities should be recognized: tubulocystic renal cell carcinoma (RCC), acquired cystic disease-associated RCC, clear cell (tubulo) papillary RCC, the MiT family translocation RCCs, and hereditary leiomyomatosis RCC syndrome-associated RCC.
In addition, there are 3 carcinomas considered as emerging entities: thyroid-like follicular RCC; succinate dehydrogenase B deficiency-associated RCC; and ALK translocation RCC.
It was agreed upon that multicystic clear cell RCC is best considered as a neoplasm of low malignant potential. There was agreement that subtyping of papillary RCC is of value and that the oncocytic variant of papillary RCC should not be considered as a distinct entity. The hybrid oncocytic chromophobe tumor was placed within the chromophobe RCC category. Advances in understanding of angiomyolipoma, including the epithelioid and epithelial cystic variants, were considered.
Tumor morphotype, sarcomatoid/rhabdoid differentiation, and tumor necrosis were identified as significant prognostic parameters for RCC. The ISUP Grading System was accepted with grades 1-3 of clear cell and papillary RCC, whereas extreme nuclear pleomorphism or sarcomatoid and/or rhabdoid differentiation defined grade 4 tumors. It was agreed that chromophobe RCC should not be graded. The role of biomarkers in the diagnosis and assessment of prognosis of renal tumors was considered, and panels of immunohistochemical markers were identified for use in specific differential diagnostic scenarios.