Kidney tumor
Renal pelvis
TNM staging of renal pelvic carcinoma (AJCC 8th edition)


Topic Completed: 3 January 2019

Revised: 16 September 2019

Copyright: 2003-2019, PathologyOutlines.com, Inc.

PubMed Search: Staging [title] renal pelvic tumors kidney

Debra Zynger, M.D.
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Cite this page: Zynger D. TNM staging of renal pelvic carcinoma (AJCC 8th edition). PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/kidneytumormalignantstagingrenalpelvis.html. Accessed November 12th, 2019.

Pathologic TNM staging of renal pelvic carcinoma, AJCC 8th edition
Definition / general
  • All carcinomas of the renal pelvis are covered by this staging system
Essential features
  • AJCC 7th edition staging was sunset on December 31, 2017; as of January 1, 2018, use of the 8th edition is mandatory
ICD coding
  • ICD-10: C65.9 - renal pelvis
Primary tumor (pT)
  • pTX: cannot be assessed
  • pT0: no evidence of primary tumor
  • pTa: noninvasive papillary carcinoma
  • pTis: carcinoma in situ
  • pT1: invades subepithelial connective tissue
  • pT2: invades muscle
  • pT3: invades peripelvic fat or renal parenchyma
  • pT4: invades adjacent organs or perinephric fat
Regional lymph nodes (pN)
  • pNX: cannot be assessed
  • pN0: no regional lymph node metastasis
  • pN1: 1 lymph node with tumor deposit ≤ 2 cm
  • pN2: 1 lymph node with tumor deposit > 2 cm or metastases in multiple nodes

Notes:
  • Regional lymph nodes include hilar, paracaval, aortic and retroperitoneal
Distant metastasis (pM)
  • pM1: distant metastasis
Prefixes
  • y: preoperative radiotherapy or chemotherapy
  • r: recurrent tumor stage
AJCC prognostic stage groups
Stage group 0a:TaN0M0
Stage group 0is:TisN0M0
Stage group I:T1N0M0
Stage group II:T2N0M0
Stage group III:T3N0M0
Stage group IV:T4NX - 2M0 - 1
TX - 4N1 - 2M0 - 1
TX - 4NX - 2M1
Registry data collection variables
  • Extranodal extension
  • Size of largest tumor deposit within a lymph node
  • Total number of lymph nodes
  • Presence of carcinoma in situ
  • Presence of noninvasive papillary carcinoma
  • Lymphovascular invasion
  • Urothelial carcinoma grade (high / low)
  • Squamous cell / adenocarcinoma grade (1 - 3)
  • Intratubular renal in situ spread
Histologic grade (G)
  • Urothelial carcinoma
    • LG: low grade
    • HG: high grade
  • Squamous cell / adenocarcinoma
    • GX: cannot be assessed
    • G1: well differentiated
    • G2: moderately differentiated
    • G3: poorly differentiated
Histopathologic type
  • Noninvasive urothelial carcinoma
    • Low grade papillary urothelial carcinoma
    • High grade papillary urothelial carcinoma
    • Urothelial carcinoma in situ
  • Invasive urothelial carcinoma
    • Conventional urothelial carcinoma
    • Urothelial carcinoma variants
  • Squamous cell carcinoma
  • Adenocarcinoma
  • Small cell carcinoma
Board review question #1
A urothelial carcinoma of the renal pelvis at the deepest point of invasion involves the renal parenchyma. Which is the correct pT category?

  1. pT1
  2. pT2
  3. pT3
  4. pT4
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