{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:58:23Z","timestamp":1791910703509,"version":"4.3.4"},"reference-count":88,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,12,18]],"date-time":"2018-12-18T00:00:00Z","timestamp":1545091200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:p>Grading of renal cell carcinoma (<jats:styled-content style=\"fixed-case\">RCC<\/jats:styled-content>) has been recognised as a prognostic factor for almost 100\u00a0years. Numerous grading systems have been proposed, initially focusing upon a constellation of cytological features and more recently on nuclear morphology. It has been recommended that grading of <jats:styled-content style=\"fixed-case\">RCC<\/jats:styled-content> should be based upon nucleolar prominence\/eosinophilia for grades 1\u20133, while grade 4 requires nuclear anaplasia (including tumour giant cells, sarcomatoid differentiation and\/or rhabdoid morphology). The grading system was adopted formally by the International Society of Urological Pathology (<jats:styled-content style=\"fixed-case\">ISUP<\/jats:styled-content>) and subsequently by the World Health Organisation (<jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content>), being designated the <jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">ISUP<\/jats:styled-content> grading classification in the fourth edition of the <jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content> classification tumours of the urinary system and male genital organs (2016). This grading system has been validated for both clear cell and papillary <jats:styled-content style=\"fixed-case\">RCC<\/jats:styled-content>. Validation studies for chromophobe <jats:styled-content style=\"fixed-case\">RCC<\/jats:styled-content> failed to demonstrate a correlation between grade and outcome for both the superseded Fuhrman grading system and the <jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">ISUP<\/jats:styled-content> grading classification, and it has been recommended that these tumours not be graded. The <jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">ISUP<\/jats:styled-content> system has been incorporated into the structured reports of the International Cancer Collaboration on Cancer Reporting for both clear cell and papillary <jats:styled-content style=\"fixed-case\">RCC<\/jats:styled-content>. It is also noted that other types of <jats:styled-content style=\"fixed-case\">RCC<\/jats:styled-content> may be graded, but it must be emphasised in the report that this is for descriptive and diagnostic purposes, and not outcome prediction. More recent studies have shown the incorporation of the presence of tumour necrosis into <jats:styled-content style=\"fixed-case\">RCC<\/jats:styled-content> grading to improve outcome prediction, and this has been validated in several studies.<\/jats:p>","DOI":"10.1111\/his.13735","type":"journal-article","created":{"date-parts":[[2018,12,19]],"date-time":"2018-12-19T01:10:23Z","timestamp":1545181823000},"page":"4-17","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":210,"title":["Grading of renal cell carcinoma"],"prefix":"10.1111","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5398-0300","authenticated-orcid":false,"given":"Brett","family":"Delahunt","sequence":"first","affiliation":[{"name":"Department of Pathology and Molecular Medicine Wellington School of Medicine and Health Sciences Wellington New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John N","family":"Eble","sequence":"additional","affiliation":[{"name":"Department of Pathology Indiana University Indianapolis IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8531-222X","authenticated-orcid":false,"given":"Lars","family":"Egevad","sequence":"additional","affiliation":[{"name":"Department of Oncology\u2010Pathology Karolinska Institute Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemamali","family":"Samaratunga","sequence":"additional","affiliation":[{"name":"Aquesta Uropathology Brisbane Qld Australia"},{"name":"University of Queensland School of Medicine Brisbane Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,18]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1920.02620100016007"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-192205000-00002"},{"key":"e_1_2_9_4_1","first-page":"375","article-title":"Carcinoma. Grading and practical applications","volume":"2","author":"Broders AC","year":"1926","journal-title":"Arch. Pathol."},{"key":"e_1_2_9_5_1","first-page":"453","article-title":"Varying degrees of malignancy in cancer of the breast","volume":"9","author":"Greenough RB","year":"1925","journal-title":"J. Cancer Res."},{"key":"e_1_2_9_6_1","first-page":"375","article-title":"Discussion in Broders AC. Carcinoma. Grading and practical applications","volume":"2","author":"Heuper W","year":"1926","journal-title":"Arch. Pathol."},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)72654-7"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/S0022-5347(17)73007-8","article-title":"Hypernephroma","volume":"22","author":"Judd ES","year":"1929","journal-title":"J. Urol."},{"key":"e_1_2_9_9_1","first-page":"445","article-title":"Malignant tumors of the kidney and pelvis of the kidney. Five year cures following nephrectomy with partial or complete nephrectomy","volume":"56","author":"Walters W","year":"1933","journal-title":"Surg. Gynecol. Obstet."},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1939.02800350012004"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.1949.tb10761.x"},{"key":"e_1_2_9_12_1","volume-title":"Urological pathology","author":"Herbert PA","year":"1952"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)67846-7"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)66257-8"},{"key":"e_1_2_9_15_1","first-page":"303","article-title":"Pathology and prognosis in renal tumors","volume":"130","author":"Mathisen W","year":"1965","journal-title":"Acta Chir. Scand."},{"key":"e_1_2_9_16_1","first-page":"1","article-title":"Renal adenocarcinoma morphology, grading of malignancy, prognosis. A study of 197 cases","volume":"346","author":"Arner O","year":"1965","journal-title":"Acta Chir. Scand."},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1159\/000472001"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)56521-0"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/0014-2964(80)90136-X"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)54359-1"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19830901)52:5<899::AID-CNCR2820520526>3.0.CO;2-#"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000001025"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000000514"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)62543-6"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(1971)28:5<1165::AID-CNCR2820280513>3.0.CO;2-G"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-198210000-00007"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/his.13311"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/his.12803"},{"key":"e_1_2_9_29_1","first-page":"91A","article-title":"Interobserver variability of nuclear grading (NG) in renal cell carcinoma","volume":"11","author":"Nazeer T","year":"1998","journal-title":"Mod. Pathol."},{"key":"e_1_2_9_30_1","doi-asserted-by":"crossref","first-page":"593","DOI":"10.5858\/2003-127-0593-IAIVUT","article-title":"Interobserver and intraobserver variability using Fuhrman grading system for renal cell carcinoma","volume":"127","author":"Al\u2010Aynati M","year":"2003","journal-title":"Arch. Pathol. Lab. Med."},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20812"},{"key":"e_1_2_9_32_1","first-page":"49","article-title":"Grading of human renal adenocarcinoma","volume":"12","author":"Syrj\u00e4nen K","year":"1978","journal-title":"Scand. J. Urol. Nephrol."},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)54948-4"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1159\/000472673"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.3109\/00313028709066560"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1159\/000471633"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1442-2042.2000.00132.x"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1309\/VLV6-BRTR-HY5B-H485"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19970901)80:5<990::AID-CNCR25>3.0.CO;2-Q"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19970901)80:5<994::AID-CNCR27>3.0.CO;2-Q"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2011.10690.x"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2014.08.002"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e31821a455d"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e3181e96f2a"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e318220697f"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.pas.0000209833.69972.2b"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.pas.0000249446.28713.53"},{"key":"e_1_2_9_48_1","first-page":"1372","article-title":"Sarcomatoid renal carcinoma: the final common dedifferentiation pathway of renal epithelial malignancies","volume":"31","author":"Delahunt B","year":"1993","journal-title":"Pathology"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-200103000-00001"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-200404000-00002"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2011-0227"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(05)65384-0"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2011.10785.x"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2014.02.019"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.3800739"},{"key":"e_1_2_9_56_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9896(199808)185:4<382::AID-PATH124>3.0.CO;2-4"},{"key":"e_1_2_9_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2016.01.051"},{"key":"e_1_2_9_58_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2559.2002.01427.x"},{"key":"e_1_2_9_59_1","doi-asserted-by":"crossref","first-page":"102","DOI":"10.5858\/2007-131-102-RCCWRF","article-title":"Renal cell carcinoma with rhabdoid features: an aggressive neoplasm with overexpression of p53","volume":"31","author":"Leroy X","year":"2007","journal-title":"Arch. Pathol. Lab. Med."},{"key":"e_1_2_9_60_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-199111000-00003"},{"key":"e_1_2_9_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anndiagpath.2011.03.002"},{"key":"e_1_2_9_62_1","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.5858\/2004-128-1435-CCRCCW","article-title":"Clear cell renal cell carcinoma with syncytial giant cells: a case report and review of the literature","volume":"128","author":"Shen R","year":"2004","journal-title":"Arch. Pathol. Lab. Med."},{"key":"e_1_2_9_63_1","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1097\/PAS.0000000000000251","article-title":"Rhabdoid differentiation is associated with aggressive behaviour in renal cell carcinoma. A clinicopathologic analysis of 76 cases with clinical follow\u2010up","volume":"38","author":"Przybycin CG","year":"2014","journal-title":"Am. J. Surg. Pathol."},{"key":"e_1_2_9_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2015.01.002"},{"key":"e_1_2_9_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2014.09.001"},{"key":"e_1_2_9_66_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000000787"},{"key":"e_1_2_9_67_1","first-page":"5219","article-title":"The significance of florid giant cell component in renal cell carcinoma: a case report and review of the literature","volume":"17","author":"Faragalia H","year":"2010","journal-title":"Can. J. Urol."},{"key":"e_1_2_9_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2013.10.033"},{"key":"e_1_2_9_69_1","first-page":"113","article-title":"Syncytial giant cell component. Review of 55 renal cell carcinomas","volume":"19","author":"Berzal Cantalejo F","year":"2004","journal-title":"Histol. Histopathol."},{"key":"e_1_2_9_70_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e318299f0fb"},{"key":"e_1_2_9_71_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e318270f71c"},{"key":"e_1_2_9_72_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2011.09.053"},{"key":"e_1_2_9_73_1","volume-title":"World Health Organisation (WHO) Classification of tumours. Pathology and genetics of the urinary system and male genital organs","author":"Humphrey PA","year":"2016"},{"key":"e_1_2_9_74_1","volume-title":"Invasive carcinoma of renal tubular origin, histopathology reporting guide","author":"Delahunt B","year":"2017"},{"key":"e_1_2_9_75_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdw328"},{"key":"e_1_2_9_76_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humpath.2015.07.001"},{"key":"e_1_2_9_77_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000000690"},{"key":"e_1_2_9_78_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.3800589"},{"key":"e_1_2_9_79_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep23594"},{"key":"e_1_2_9_80_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajpath.2017.12.018"},{"key":"e_1_2_9_81_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2018.01.005"},{"key":"e_1_2_9_82_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.21206"},{"key":"e_1_2_9_83_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2009.11.010"},{"key":"e_1_2_9_84_1","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.2004.018846"},{"key":"e_1_2_9_85_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semdp.2015.02.008"},{"key":"e_1_2_9_86_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-200305000-00005"},{"key":"e_1_2_9_87_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.21127"},{"key":"e_1_2_9_88_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2006.06.021"},{"key":"e_1_2_9_89_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAT.0000000000000193"}],"container-title":["Histopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fhis.13735","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/his.13735","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T13:14:34Z","timestamp":1694610874000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/his.13735"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12,18]]},"references-count":88,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.1111\/his.13735"],"URL":"https:\/\/doi.org\/10.1111\/his.13735","archive":["Portico"],"relation":{},"ISSN":["0309-0167","1365-2559"],"issn-type":[{"value":"0309-0167","type":"print"},{"value":"1365-2559","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12,18]]},"assertion":[{"value":"2018-06-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-12-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}