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Vancouver-Klassifikation von Nierentumoren

Empfehlungen der Konsenskonferenz der Internationalen Gesellschaft für Uropathologie (ISUP) 2012

Vancouver classification of renal tumors

Recommendations of the 2012 consensus conference of the International Society of Urological Pathology (ISUP)

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Zusammenfassung

Die Konsenskonferenz der Internationalen Gesellschaft für Urologische Pathologie (ISUP) aus dem Jahr 2012 hat Empfehlungen zu Klassifikation, Prognosefaktoren, Stadieneinteilung und Immunhistochemie/Molekularpathologie adulter renaler Tumoren formuliert. Übereinstimmung herrschte darüber, 5 neue Tumorentitäten anzuerkennen: das tubulozystische Nierenzellkarzinom (NZK), das erworbene zystennierenassoziierte NZK, das klarzellige (tubulo-)papilläre NZK, die Mikrophthalmia-Transkriptionsfaktor-Familie Translokations-NZK (insbesondere t(6;11)-NZK) und das hereditäre leiomyomatoseassoziierte NZK. Zusätzlich wurden 3 seltene Karzinome als aufkommende bzw. provisorische Entitäten betrachtet: das schilddrüsenartige follikuläre NZK, das Sukzinatdehydrogenase-B-Defizienz-assoziierte NZK und das ALK-Translokations-NZK. In dieser neuen ISUP-Vancouver-Klassifikation wurden zudem Modifikationen zu bestehenden WHO-2004-Festlegungen vorgeschlagen. Die Tumormorphologie, eine sarkomatoide/rhabdoide Differenzierung und Tumornekrosen wurden als signifikante prognostische Parameter für das NZK hervorgehoben. Das hier abgestimmte ISUP-Gradierungssystem vergibt bei klarzelligen und papillären NZK die Grade 1–3 aufgrund nukleolärer Prominenz, Grad 4 ist für Fälle mit extremer nukleärer Pleomorphie oder sarkomatoider und/oder rhabdoider Differenzierung reserviert. Es wurden außerdem Konsensleitlinien für die Bearbeitung der Proben festgelegt. Man kam beispielsweise überein, eine Nierensinusinvasion zu diagnostizieren, wenn der Tumor in direktem Kontakt mit dem Fettgewebe oder lockerem Bindegewebe des Sinus (intrarenales peripelvines Fettgewebe) steht, oder wenn unabhängig von der Größe endothelialisierte Hohlräume innerhalb der renalen Sinus tumorbefallen sind. Auch die Bedeutung von Biomarkern zur Diagnostik bzw. Prognostik renaler Tumoren wurde erörtert und Markerprofile für die Anwendung zur spezifischen Differenzialdiagnostik formuliert.

Abstract

The 2012 consensus conference of the International Society of Urological Pathology (ISUP) has formulated recommendations on classification, prognostic factors and staging as well as immunohistochemistry and molecular pathology of renal tumors. Agreement was reached on the recognition of five new tumor entities: tubulocystic renal cell carcinoma (RCC), acquired cystic kidney disease-associated RCC, clear cell (tubulo) papillary RCC, microphthalmia transcription factor family RCC, in particular t(6;11) RCC and hereditary leiomyomatosis-associated RCC. In addition three rare forms of carcinoma were considered as emerging or provisional entities: thyroid-like follicular RCC, succinate dehydrogenase B deficiency-associated RCC and anaplastic lymphoma kinase (ALK) translocation RCC. In the new ISUP Vancouver classification, modifications to the existing 2004 World Health Organization (WHO) specifications are also suggested. Tumor morphology, a differentiation between sarcomatoid and rhabdoid and tumor necrosis were emphasized as being significant prognostic parameters for RCC. The consensus ISUP grading system assigns clear cell and papillary RCCs to grades 1-3 due to nucleolar prominence and grade 4 is reserved for cases with extreme nuclear pleomorphism, sarcomatoid and/or rhabdoid differentiation. Furthermore, consensus guidelines were established for the preparation of samples. For example, agreement was also reached that renal sinus invasion is diagnosed when the tumor is in direct contact with the fatty tissue or loose connective tissue of the sinus (intrarenal peripelvic fat) or when endothelialized cavities within the renal sinus are invaded by the tumor, independent of the size. The importance of biomarkers for the diagnostics or prognosis of renal tumors was also emphasized and marker profiles were formulated for use in specific differential diagnostics.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. G. Kristiansen, B. Delahunt, J.R Srigley, C. Lüders, J.-M. Lunkenheimer, H. Gevensleben, T. Thiesler, R. Montironi, L. Egevad geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Institut für Pathologie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland

    G. Kristiansen, C. Lüders, J.-M. Lunkenheimer, H. Gevensleben & T. Thiesler

  2. Abteilung für Pathologie und Molekulare Medizin, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, Neuseeland

    B. Delahunt

  3. Abteilung für Pathologie und Molekulare Medizin, McMaster University, Hamilton, ON, Kanada

    J.R. Srigley

  4. Institut für Pathologische Anatomie und Histologie, Polytechnische Universität für Medizin, Vereinigte Krankenhäuser, Ancona, Italien

    R. Montironi

  5. Abteilung für Onkologie und Pathologie, Karolinska Institut, Stockholm, Schweden

    L. Egevad

Authors
  1. G. Kristiansen
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  2. B. Delahunt
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  3. J.R. Srigley
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  4. C. Lüders
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  5. J.-M. Lunkenheimer
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  6. H. Gevensleben
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  7. T. Thiesler
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  8. R. Montironi
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  9. L. Egevad
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Correspondence to G. Kristiansen.

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Kristiansen, G., Delahunt, B., Srigley, J. et al. Vancouver-Klassifikation von Nierentumoren. Pathologe 36, 310–316 (2015). https://doi.org/10.1007/s00292-014-2030-z

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  • DOI: https://doi.org/10.1007/s00292-014-2030-z

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