College of American Pathologists
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  Anatomic Abstracts





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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;

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