By Gregor Mikuz
With expanding emphasis at the early analysis and administration of urologic tumours, it really is relevant that the practicing urologist understand the relevance of the morphology for the scientific diagnostic and treatment. furthermore, the clinician could be absolutely knowledgeable of the significance of recent morphological tools for the analysis and administration of urological tumours. not just is that this hugely illustrated textual content an important adjunct within the attending urologist's armamentarium, it's going to additionally fulfill the desires of citizens in pathology or maybe of pathologists, who're now not day-by-day confronted with urological tumours. The constitution of the chapters follows a uniform schema: brief creation with the definition of the tumour/ tumours, scientific historical past epidemiology, aetiology, gross morphology, microscopy, tumour genetics, significance of ancillary equipment for the prognosis, differential analysis, rules of grading and staging, morphological prognostic elements, and medical path. The tables show off the most recent WHO histological class of the tumours of the one organs, the crucial (or whole) type of the most recent TNM staging model, and the foundations of the foreign permitted grading platforms (kidney, bladder, prostate, penis ). a quick bankruptcy is dedicated to dealing with tactics for surgical specimens and biopsies by means of clinicians.
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Additional info for Clinical Pathology of Urological Tumors
01). 83 Clear cell renal cell carcinoma with sarcomatoid transformation: macroscopic appearance of a whitish-gray bulging tumor. 84 Sarcomatoid chromophobe renal cell carcinoma: admixture of sarcoma-like neoplastic areas with epithelial chromophobic neoplastic cells. 85), characterized by homogeneous clusters and sheets of dead and degraded tumor cells that coalesce into an amorphous coagulum. 160,179 However, the impact of histologic tumor necrosis on patient outcome varies by histologic subtype.
Moreover, cranial extension of the tumor thrombus into the vena cava is reported to be associated with a higher probability of metastatic spread. Complete removal of the tumor thrombus in patients without other prognostic factors is associated with 5-year cause-specific survival rates of 47–68%. Survival rates dramatically decrease in the patients with positive lymph nodes or distant metastases to figures lower than 20%. An additional negative prognostic factor in this stage of the disease is the infiltration of the venous wall by the neoplastic thrombus.
The wide variability of the reported data could be explained in several ways. First of all, many authors pointed out the moderate interobserver reproducibility of the Fuhrman nuclear grading system. Lanigan et al were the first to analyze the level of agreement among four pathologists assigning renal cell carcinoma grades according to four different systems (Arner, Skinner, Syrjanen-Hjelt, and Fuhrman systems). 181 In the larger study in the field, Lohse et al compared original nuclear grades assigned at the moment of the initial pathologic diagnosis to the standardized grades reassigned after slide review of more than 2000 cases at the Mayo Clinic.