Papillary Adenoma of the Kidney
Grading / Staging
Grading
- Does not apply as these are benign neoplasms
- However, by definition they have grade 1 or 2 nuclei (see below)
Staging
- Most commonly cited grading scheme is that of Fuhrman
- Requires simultaneous assessement of three features: nulear size, shape and nucleoli
- Nuclear size may be subject to fixation variables and difficult to measure
- No provision for cases with discrepant grade features
- Poor interobserver agreement
- We and others find a simplified version based primarily on nucleolar prominence to be more practical
- Simplified Fuhrman Grading
| Grade 1 |
Small, round, dark lymphocyte-like nuclei with without visible nucleoli |
| Grade 2 |
Inconspicuous nucleoli, visible only at 200-400X (nuclei usually small and uniform with open, finely granular chromatin) |
| Grade 3 |
Prominent nucleoli, easily visible at 100X (nuclei usually mildly to moderately pleomorphic) |
| Grade 4 |
Markedly pleomorphic, bizarre nuclei, giant cells, multiple nucleoli or sarcomatoid/spindled features |
