Grading and Prognostication Flashcards
Breast carcinoma - MBR
- Tubule formation:
- -1 = > 75% tubules
- -2 = 10-75% tubules
- -3 = < 10% tubules
- Mitoses: -counted per 10 HPF -dependent upon focal field
- Nuclear pleomorphism
- -1 = nuclei with mimimal variation in size and shape
- -2 = nuclei with moderate variation in size and shape
- -3 = nuclei with marked variation in size and shape
- Final total: I = 3-5 II = 6-7 III = >7
Endometrioid endometrial carcinoma
% nonsquamous areas show solid growth and no glandular features Grade I = 50% solid
What are determinants of prognosis in seminoma?
- pathologic stage - tumor size - rete testis invasion - intertubular growth > 3 high-power fields Note: LVI important prognostic factor in univariate analysis but not independent prognostic factor; Concept of “anaplastic” seminoma (> 3 mitoses per high-power field) is not accepted as separate entity and not adverse prognostic factor
Features of Leydig cell suggeseting malignancy
- large tumour size (>5 cm) - infiltrative margins - vascular invastion - nuclear atypia - necrosis - high mitotic rate (> 3/10 hpf)
Urothelial carcinoma special subtypes
nested micropapillary microcystic with small tubules plasmacytoid carcinoma lymphoepithelioma-like carcinoma small cell sarcomatoid with rhabdoid features with osteoclast-like giant cells with clear cytoplasm with lipoid features large cell undifferentiated
What are the four histological types of neuroblastoma?
Neuroblastoma (Schwannian stroma-poor) Ganglioneuroblastoma, nodular (composite, Schwannian stroma-rich/stroma-dominant and stromapoor) Ganglioneuroblastoma, intermixed (Schwannian stroma-rich) Ganglioneuroma (Schwannian stroma-dominant)
Histological subtypes of melanoma
Superficial spreading melanoma Nodular melanoma Lentigo maligna melanoma Acral lentiginous melanoma Mucosal-lentiginous melanoma Desmoplastic/neurotropic melanoma Melanoma arising from blue nevus Melanoma arising from a giant congenital nevus Melanoma in childhood Nevoid melanoma Persistent melanoma Melanoma, not otherwise classified
Prognostic features for urothelial carcinoma
depth of invasion - stage histological variants LVI LN and distand mets associated CIS or multifocality
Poor prognostic histological types of urothelial carcinoma
Small cell micropapillary sarcomatoid undifferentiated carcinoma with rhabdoid features plasmacytoid carcinoma
Colorectal carcinoma
- Low grade (grade 1): >95% glands (15-20% of all carcinomas)
- Moderately differentiated (grade 2): 50-95% glands (60-70% of all carcinomas)
- High grade (grade 3): < 50% gland formation (15-20% all of carcinomas
Nuclear grading of DCIS
- nuclear size: 1 = <1.5 rbc, 2=1-2 rbc, 3 =>2.5 rbc
- mitoses/10hpf: 1 = < 1, 2 = 1-2, 3 = >2
- nuclear plemorphsm: mild = 1, moderate = 2, severe = 3
- necrosis: 1 = none, 2 = central necrosis, 3 = comedonecrosis
Phyllodes grading
- Benign:
- mild stromal cellularity
- minimal stromal pleomorphism
- no infiltrative border
- 0-1 mits/10HPF
- Borderline
- moderate stromal cellularity
- mild stromal pelomorphism
- may have infiltratrive border
- 2-5 mits/10HPF
- Malignant
- marked stromal cellularity
- marked stromal pelomorphism
- stromal overgrowth (4X field full of stroma)
- infiltratrive border
- >5 mits/10HPF
Gleason Grading
- non-infiltrative nodule, round to oval nuclei with back to back glands
- well circumscribed nodule with minimal infiltration; more loosely arranged
- clearly infiltrative pattern with variable gland size and shape; all glands are distinct (circle around all glands)
- fused glands, poorly defined, cirbiform or glomeruloid
- solid sheets, rosettes, cords or single cells; comedonecrosis
Ruhrman nuclear grading of RCC
- grading guidelines: worst area, applies to clear cell
- nuclei
- 1 - small, round and uniform
- 2 - larger, crinkly nuclear membrane
- 3 - large and very crinkly
- 4 - pleomorphic, clumped chromatin
- nucleoli
- 1 - absent
- 2 - absent to inconspicuous
- 3 - conspicuous (visibla at 10X)
- 4 - prominent
- other
- 4 - sarcomatoid features
- sarcomatoid carcinoma = Grade 4
- collecting duct = Grade 3-4
Criteria for anaplasia in Wilms Tumour
- nucleomegaly (at least 3X)
- nuclear hyeprchromasia
- atypical mitoses
predicts resistance to chemomotherapy
Flat dysplasia vs flat CIS
- dysplasia:
- some features of CIS but fall short of threshold
- CIS:
- nucleomegaly (5X stromal lymphocyte or 2-3X normal urothelium)
- pleomorphism
- crowding
- loss of polarity
Classification of non-invasive papillary urothelial neoplasm
- papilloma
- < 7 layers
- orderly, polarised, without crowding or disorganisation
- no pleomorphism
- no mits
- no fusion or branching
- PUNLMP
- increased thickness
- orderly, polarised, without crowding or disorganisation
- no pleomorphism
- rare basal mits
- rare fusion or branching
- LGTCC
- increased thickness
- minimal crowding or disorganisation
- mild pleomorphism
- occ mits at any level
- occ fusion or branching
- HGTCC
- increased thickness
- prominent crowding or disorganisation
- moderate to severe pleomorphism
- requent mits at any level
- frequent fusion or branching
Thyroid carcinoma grading by histolgoical type or features
- well differentiated
- papillary (caveat for high risk histology: tall cell, columnar or diffuse sclerosing)
- follicular - widely invasive or encapsulated
- moderatly differentiated
- some place high risk PTC histo here but is controversial
- poorly differentiated
- insular, solid or trabecular + no PTC features + one of (convoluted nuclei, elevated mits > 2/ 10HPF or necrosis)
- some groups use necrosis or mites > 3/10HPF
- undifferentiated
- minimal or no thyroid differentiation
- squamoid, pelomrphicc/giant cell and spindled variants
Mucoepidermoid AFIP grading
- Point scale:
- Low-grade 0-4
- Intermediate-grade 5-6
- High-grade >7
- Features
- 2 points - cystic componenet < 20%
- 2 points - neural invasion
- 3 points - necrosis
- 3 points > 4 mits/10HPF
- 4 points - anaplasia
Autoimmune sialoadenitis in labial biopsy
- focus = 50 lymphs, plasma cells or macrophages
- Grade based on amount of inflammation
- 0 - absent - ND
- 1 - slight infiltrate - ND
- 2 - moderate infiltrate ( <1 focus/ 4mm2) - ND
- 3 - 1 focus/ 4mm2 - suggestive
- 4 - > 1 focus/ 4mm2 - diagnostic
Salivary gland neoplasm grading by histological type
- Low-grade
- acinic cell carcinoma
- polymorphous low-grade adenocarcinoma
- basla cell adenocarcinoma
- epithelial-myoepitheilal carcinoma
- Intermediate-grade
- adenoid cystic carcinoma
- myoepithelial carcinoma
- High-grade
- salivary duct carcinoma
- large cell carcinoma
Barrett’s esphagus grading
- Negative for dysplasia
- no architectural atypia
- no cytological atypia
- surface maturation present
- inflammation variable
- Indefinite for dysplasia
- minimal architectural atypia
- mild cytological atypia
- surface maturation present
- inflammation frequent
- low-grade dysplasia
- mild architectural atypia
- moderate cytological atypia
- surface maturation absent
- inflammation minimal
- high-grade dysplasia
- prominent architectural atypia
- severe cytological atypia with loss of polarity
- surface maturation absent
- inflammation minimal
French system for soft tissue sarcoma grading
- Final score:
- Grade 1 = 2-3
- Grade 2 = 4-5
- Grade 3 = 6-8
- Tissue differentiation
- closely resemble normal
- definite histologic type
- embryonal, poorly differentiated or uncertain histo
- Mitoses (/10HPF)
- 0-9
- 10-19
- >19
- Tumour necrosis
- no necrosis
- <50%
- >50%
Pulmonary NET grading
- neuroendocrine cell hyperplasia - <2 mm
- carcinoid tumourlet - <5 mm
- typical carcinoid
- < 2 mits/10HPF
- no necrosis
- < 2% Ki-67 *
- atypical carcinoid
- 2-10 mits/10HPF
- focal necrosis
- < 20% Ki-67 *
- NEC
- >10 mits/10HPF
- extensive necrosis
- > 20% Ki-67 *
GI/pancreatic NET grading
- NET, Grade 1
- < 2 mit/10HPF
- < 3% Ki-67
- NET, Grade 2
- 2 - 20 mit/10HPF
- 3 - 20% Ki-67
- NEC, Grade 3
- > 20 mit/10HPF
- > 20% Ki-67
Must count 50 HPF for mitoses
Must count 500-2000 cells in hot spots for Ki-67
Prognostic features for GI/pancreatic NET
- Site:
- poor: colon, esophagus
- good: appendix, rectum
- intermediate: small bowel, stomach
- Clinical setting:
- gastric NETs excellent if ZES, MEN1 or pernicious anemia vs sporadic which is worse
- Size and depth of invasion
- Type of hypersecretory syndrome in pancreas
- insulinom - better
- glucagonaom - worse
Revised Shimada for Neuroblastoma
- Stroma rich (> 50% schwannian stroma)
- no microscopic nodules of NB cells; FH = ganglineuroma, maturing
- microscopic nodules of NB cells; FH = ganglineurblastoma, intermixed
- macroscopic nodules of NB cells; UH/FH = ganglioneuroblastoma, nodular
- Stroma poor (< 50% schwannian stroma)
- no ganglion cells; no neuropil; always FH (any age) - undifferentiated neuroblastoma
- < 5% ganglion cells; neuropil present; UH if >1.5 y or MKI >4% otherwise FH = poorly differentiated neuroblastoma
- >5% ganglion cells; neuropil present; UH if > 5 y or 1.5-5 y + MKI > 2%, or < 1.5 y + MKI > 4% = differentiating neuroblastoma
Trophoblastic disease prognostic factors?
- Overall score <7 low risk and 7 or greater is high risk
- Factors:
- age - <40 (0), > 40 (1)
- antecedent pregnancy - mole (0), abortion (1), term preg (2)
- months from antecedent - <4 (0), 4-<7 (1), 7-12 (2), >12 (4)
- pretx bHCG - <1 000 (0), 1000 - 10 000 (1), 10^4-10^5 (2), >10^5 (4)
- tumour size - < 3 cm (0), 3-5 cm (1), >5 cm (2)
- met site - lung, (0), spleen/kidney (1), GI (2), liver/brain (4)
- number of mets - 1-4 (1), 5-8 (2), >8 (4)
- failed chemotx - single drug (2), multidrug (4)
