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October 2003
Renal cell carcinoma subtypes: outcome and prognostic feature
A limitation in comparing histologic subtypes of renal cell carcinoma
has been the relatively small number of cases of subtypes, other
than clear cell RCC, in a single study. The authors, however, undertook
a large study to compare cancer-specific survival and examine associations
with outcome among the histologic subtypes of RCC. They studied
2,385 cases between 1970 and 2000, including 1,985 patients with
clear cell, 270 with papillary, and 102 with chromophobe RCC, among
other types. The authors found that the cancer-specific survival
rates at five years for patients with clear cell, papillary, and
chromophobe RCC were 68.9 percent, 87.4 percent, and 86.7 percent,
respectively. This differential in outcome was also true after stratifying
by tumor stage (pT1 and pT2) and nuclear grade. Tumor stage (1997
TNM), size, presence of a sarcomatoid component, and nuclear grade
were significantly associated with death from clear cell, papillary,
and chromophobe RCC. Histologic tumor necrosis, however, was significantly
associated with death from clear cell and chromophobe RCC but not
with death from papillary RCC.
Cheville JC, Lohse CM, Zincke H, et al. Comparison of outcome and prognostic
features among histologic subtypes of renal cell carcinoma.Am
J Surg Pathol. 2003;27: 612–624.
Reprints: Dr. John C. Cheville, Dept. of Laboratory Medicine and Pathology,
Mayo Clinic, 200 First St. SW, Rochester, MN 55905; cheville.john@mayo.edu
Relevance of vertical growth pattern in thin level II cutaneous SSM
Thin (=0.76 mm) level II cutaneous superficial spreading melanomas
have an excellent prognosis, with very few recurring or metastasizing.
Although many prognostic features at this stage have been studied,
none appears to be statistically significant. The concept of tumor
growth phase is correlated with Clark’s level, except for
level II. Superficial spreading melanoma (SSM) level II shows an
invasive vertical growth phase or an invasive radial growth phase.
The authors conducted a retrospective, multicenter, case-control
study to investigate the prognostic impact of vertical growth phase
in thin level II cutaneous SSM. They identified 12 patients with
poor outcome with complete initial excision. Each case was matched
with three controls for gender, age, location, tumor thickness,
and followup period since diagnosis. Independent pathologists studied
all cases and controls. Univariate analyses were performed using
a conditional logistic regression method. A kappa test was used
to assess reproducibility between pathologists. The study found
that vertical growth phase is the only statistically significant
prognostic factor for thin level II cutaneous SSM. The authors proposed
that growth phase evaluation (a minimum of eight serial sections
being mandatory not to underdiagnose vertical growth phase) should
be added to the recommendations for a melanoma histologic report,
at least for level II SSM.
Lefevre M, Vergier B, Balme B, et al. Relevance of vertical growth pattern
in thin level II cutaneous superficial spreading melanomas. Am
J Surg Pathol. 2003;27(6):717–724.
Reprints: B. Vergier, CHU Bordeaux, Dept. of Pathology, Haut-Lévêque
Hospital, Avenue de Magellan, 33607 Pessac, France; beatrice.vergier@chu-bordeaux.frn
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