67 years old man Asymptomatic left solid renal tumor of 6 cm. Radical nephrectomy Clear cell renal cell carcinoma Grade II Fuhrman grading Focal invasion fat tissue sinus Category pT3a

UROLOGIST COMMENTS

PATHOLOGIST COMMENTS

TUMOR-KIDNEY INTERFACE Tumoral psedocapsule

TUMOR-KIDNEY INTERFACE Tumoral psedocapsule

TUMOR-KIDNEY INTERFACE Tumoral psedocapsule * *

TUMOR-CAPSULE INTERFACE Kidney capsule

TUMOR-CAPSULE INTERFACE Kidney capsule

KIDNEY-RENAL SINUS INTERFACE No Kidney capsule

TUMOR-RENAL SINUS INTERFACE

RENAL SINUS

RENAL SINUS

RENAL SINUS

RENAL SINUS Vein wall Bonsib. Modern Pathol. 2007; 20: 44

RENAL SINUS

RENAL SINUS Extrarenal invasion 57% Only Sinus invasion.. 38.6% Sinus+Capsule inv. ... 61.4% Vascular invasion Sinus invasion..... 83% Capsule invasion.. 40% Main renal vein 55% Bonsib. Am. J. Surg. Pathol. 2004; 28: 1594

without stroma invasion Vein involvement without stroma invasion 19.5% Bonsib. Am. J. Surg. Pathol. 2004; 28: 1594

Sinus invasion and Fuhrman grading Sinus invasion and Tumoral size Grade 1 + 2.. 17% Grade 3 + 4... 71% Sinus invasion and Tumoral size Bonsib. Am. J. Surg. Pathol. 2004; 28: 1594

Sinus fat tissue invasion 21% of cases with extra-renal growth Sobrev.5a G+ M+ Peri-Renal 50.9% 7% 28% Sinusal. 25.9% 19% 30% J. Urol 2005; 174: 1218-1221 AJSP 2004; 28: 1594-1600

ONCOLOGIST COMMENTS

63 years old man Asymptomatic rigth solid renal tumor of 7.5 cm. Radical nephrectomy Chromophobe renal cell carcinoma Grade III Fuhrman grading Without invasion Category pT2a

UROLOGIST COMMENTS

PATHOLOGIST COMMENTS

Grados de Fuhrman Carcinomas células claras G1 G2 G3 G4

Disease-specific Survival Months from Nephrectomy GRADOS DE FUHRMAN Carcinomas células claras Rate (%) G1 5 yr 96 10 yr 93 15 yr 83 G2 68 54 44 G3 42 24 Median 41 G4 1 yr 43 2 yr 25 10 11 G1 100% 80% G2 60% Disease-specific Survival G3 40% T 20% G4 0% 60 120 180 Months from Nephrectomy

Grados de Fuhrman Carcinomas cromófobos G1 G2 G3 G4

Grados de Fuhrman Carcinomas cromófobos

Carcinomas cromófobos Nueva propuesta Carcinomas cromófobos Paner et al. Am. J. Surg. Pathol. 2010; 34: 1233 Grado 1 Con posible “atipia cromófoba” sin anaplasia ni apelotonamiento nuclear

Carcinomas cromófobos Nueva propuesta Carcinomas cromófobos Paner et al. Am. J. Surg. Pathol. 2010; 34: 1233 Grado 2 Variaciones nucleares Apelotonamiento nuclear focal

Carcinomas cromófobos Nueva propuesta Carcinomas cromófobos Paner et al. Am. J. Surg. Pathol. 2010; 34: 1233 Grado 3 Clara anaplasia Sarcomatoide

Carcinomas cromófobos Nueva propuesta Carcinomas cromófobos Paner et al. Am. J. Surg. Pathol. 2010; 34: 1233

Carcinomas cromófobos Nueva propuesta Carcinomas cromófobos Paner et al. Am. J. Surg. Pathol. 2010; 34: 1233

Carcinomas cromófobos Nueva propuesta Carcinomas cromófobos Paner et al. Am. J. Surg. Pathol. 2010; 34: 1233

ONCOLOGIST COMMENTS