Fuhrman Nuclear Grade for Clear Cell Renal Carcinoma

Fuhrman Nuclear Grade for RCC

Fuhrman Nuclear Grade

Fuhrman Grade: –

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Select a grade.

Provides prognostic grading system for tumor cells based on physical cellular appearance.

Why Use

There are no validated scoring systems for predicting survival in clear cell RCC. Using the Fuhrman grade or scoring systems that integrate it may help delineate categories of survival time better than clinical judgment alone.

When to Use

Patients with clear cell RCC and pathology assessment available.

Formula

Grade 1 The nuclei of the tumor cells are small (< 10 µm), hyperchromatic, and round (resembling mature lymphocytes), with no visible nucleoli and little detail in the chromatin, as shown in the image below. Grade 2 Using the 10× objective, the nuclei of the tumor cells are slightly larger (15 µm) with finely granular “open” chromatin but small, inconspicuous nucleoli (see the following image). The nucleoli are often present, and many appear as small chromocenters at 10× objective, with confirmation of their nature at higher power, but this does not count. Grade 3 Using the 10× objective, the nuclei of the tumor cells are larger (20 µm in size) and may be oval in shape, with coarsely granular chromatin (see the image below). The nucleoli are easily unequivocally recognizable. Grade 4 The nuclei are pleomorphic with open chromatin or hyperchromatic and single or multiple macronucleoli, as depicted in the following image:

Pearls / Pitfalls

The Fuhrman Nuclear Grade is a pathology component of renal cell cancers and an independent predictor of cancer-specific survival. Virtually all data are from chart or database reviews and predate modern targeted therapies, but typically worsening nuclear grade correlates with worsening prognosis.

Management

We are unaware of validated management algorithms using the score.

Critical Actions

The Fuhrman grade is not known to be accurate for individual survival prediction and should be considered a general guide rather than a reliable predictor. Consistency in pathological grading is critical.

Advice

The Fuhrman grade, like most other predictors for clear cell RCC prognosis, has not been prospectively tested and validated. However retrospective findings across studies are fairly consistent and Fuhrman grade is now a necessary component of some other scoring systems. The numerical survival estimates, it should be noted, are likely to be different in patients receiving targeted modern therapy.

More Information

More recent studies have shown 2- and 3-tier grading systems for the Fuhrman Scale are equally as effective.