The most common malignant renal neoplasm is renal cell carcinoma. It is estimated that renal cell carcinoma accounts for 1% of all primary malignancies in Korea Rell cell carcinoma presents diverse clinical courses with gross, histopathologic features. It has been known to bo very difficult tumor to predict its clinical progno-sis. In Korea, many studies have been reported concern-ing the clinical aspects of renal cell carcinoma. How-ever, pathological studies of renal cell carcinoma are very few even though studies of nuclear grade have been attempted recently. We reviewed 93 cases of renal cell carcinoma examined in the period from 1978 to 1987 in the department of pathology, yonsei university college of medicine and analyzed the histopathologic classification, including nuclear grade according to the Fuhrman`s method. We abtained the following results by studying the relationship of the factors which had been known as correlated with the prognosis. 1) The ages of patients ranged from 9 to 74 years with a peak in the 6th decade. 2) The most common symptoms of the patients were hematuria, mass and pain, in that oder, and 7 patients complained no specific symptoms. The incidentally found cases characterized stage Ⅰ, nuclear grade 2, small tumor size (not more than 4cm) and clear cell type. 3) The renal cell carcinoma was more frequently located in the left kidney than the right by a ratio of 1.25:1. The incidence of intrarenal location was divided to the upper pole, 40%: mid portion, 29%: lower pole , 23%:diffuse involvement, 8%. The tumor shoing diffuse growth pattern had a large size, high nuclear grade and mixed cells. 4) The tumor size averaged 8cm and there was no signigicant relationship between the size and stage. Seven cases of neoplasms not more than 3cm were seen, of which 2 cases revealed an outcome of distant metas-tasis 5) The histological pattern showed major solid, 53%:tubular, 11%: mixed, 18%: papillary, 9% and sar-comatoid type 9%. The sarcomatoid type was char-acterized by grade 4, a larger size(more than 10cm), advanced stage. 6) There was mo special relationship between the stage and grade but mostly grade 2 occupied the stage Ⅰ. 7) The clear cell type was predominantly noted at grade 2(65%), at the stage Ⅰ(63%), granular or mixed cell type at grade 3(87%), 4 (70%). According to these results, the tumors showing a sarcomatoid histologic pattern, diffuse growth pattern had unfavorable prognostic factors, and are thus esti-mated to have a poor prognosis. But the cases which were incidentally found have favorable prognostic fac-tors and probably a better prognosis. The tumor sized alone can not exactly predict the metastasis and is not correlated with the stage. Small renal cell neoplasm (not more than 3cm) generally has unfavorable prognostic factors and should be considered potentially malignant. The high grade frequently has granular cytoplasm. This represents the relationship between grade and cyto-plasm, poor prognosis in the granular cell than the clear. The renal cell carcinoma shows variable prognosis and thus the prognosis should be estimated by all the factors. Nuclear grade com be used as one of the useful prognostic factor.
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