Abstract
Although numerous histologic prognostic parameters have been investigated for RCC, those with clinical utility are very limited in number. Tumour morphotype is of prognostic significance. Chromophobe RCC has a more favourable outcome than clear cell and papillary RCC, which in turn is associated with a more favourable outcome than collecting duct RCC. Both clear cell tubulopapillary and tubulocystic RCC appear to have an excellent prognosis. The presence of sarcomatoid or rhabdoid differentiation is a marker of poor prognosis, with sarcomatoid change being associated with median survivals of <18 months. The recently described ISUP/WHO grading system, based upon nucleolar prominence (grade 1–3) and the presence of extreme pleomorphism, sarcomatoid and/or rhabdoid differentiation (grade 4) has been correlated with outcome for clear cell and papillary RCC. It is recommended that chromophobe RCC not be graded. Microscopic coagulative necrosis is a marker of decreased survival, while microvascular invasion is an emerging prognostic parameter.