cne21th

Criteria and diagnostic terms for uterine smooth muscle tumors (adapted from the work of Richard Kempson )

Coagulative necrosis

Mitotic count per 10 HPF

Atypia

Diagnosis

Present

Greater than 10

Moderate to severe (focal or diffuse)

Leiomyosarcoma

None to mild

Leiomyosarcoma

Equal or less than 10

Moderate to severe (focal or diffuse)

Leiomyosarcoma

None to mild

STUMP (1)

Absent

Greater than 10

Moderate to severe, focal

Leiomyosarcoma

Moderate to severe diffuse

STUMP (2)

None to mild

Mitotically active leiomyoma (up to 15 mitoses/10 HPF are allowed)

Equal or less than 10

Moderate to severe, focal

STUMP (3)

Moderate to severe diffuse

Leiomyoma (4)

None to mild

Leiomyoma

(1) Of the three tumors here placed in the STUMP category, this is the one most likely to behave in a malignant fashion. Actually, it is regarded as a probable leiomyosarcoma in Kempson's scheme. The alternative possibility of an infarction in a leiomyoma due to torsion or other factors should be considered.
(2) In Kempson's scheme, this is designated as STUMP if the mitotic activity is higher than 15.
(3) This is referred to as "atypical leiomyoma with low risk of recurrence" in Kempson's scheme.
(4) This is designated as "leiomyoma with limited experience" in Kempson's scheme.

 

Liver transplantation

REJECTION ACTIVITY INDEX (RAI)

Criteria which can be used to score liver allograft biopsies with acute rejection, as defined by the World Gastroenterology Consensus Document.

Category

Criteria

Score

Portal Inflammation

Mostly lymphocytic inflammation involving, but not noticeably expanding, a minority of the triads

1

Expansion of most or all of the triads, by a mixed infiltrate containing lymphocytes with occasional blasts, neutrophils and eosinophils

2

Marked expansion of most or all of the triads by a mixed infiltrate containing numerous blasts and eosinophils with inflammatory spillover into the periportal parenchyma

3

Bile Duct Inflammation Damage

A minority of the ducts are cuffed and infiltrated by inflammatory cells and show only mild reactive changes such as increased nuclear:cytoplasmic ratio of the epithelial cells

1

Most or all of the ducts infiltrated by inflammatory cells. More than an occasional duct shows degenerative changes such as nuclear pleomorphism, disordered polarity and cytoplasmic vacuolization of the epithelium

2

As above for 2, with most or all of the ducts showing degenerative changes or focal lumenal disruption

3

Venous Endothelial Inflammation

Subendothelial lymphocytic infiltration involving some, but not a majority of the portal and/or hepatic venules

1

Subendothelial infiltration involving most or all of the portal and/or hepatic venules

2

As above for 2, with moderate or severe perivenular inflammation that extends into the perivenular parenchyma and is associated with perivenular hepatocyte necrosis

3

Total RAI Score = _/9

Reference Anonymous. Banff Schema for Grading Liver Allograft Rejection: An International Consensus Document. Hepatology 1997;25(3):658-63.

 
 

Labial salivary gland biopsy in Sjögren's disease
Chisholm Mason scale

Grade

Lymphocytes per 4 sq mm of Salivary Tissue

0

Absent

1

Slight infiltrate

2

Moderate infiltrate or less than one focus

3

One focus

4

More than one focus

 

Focus = an aggregate of 50 or more lymphocytes and histiocytes

    Nuclear Grade of Renal Cell Carcinoma

Grade 1

tumors had small, round nuclei with inconspicuous nucleoli visible
only at x400 magnification

Grade 2

tumors contained round to slightly irregular nuclei with mildly
enlarged nucleoli visible at x200

Grade 3

tumors had round to irregular nuclei with prominent nucleoli
visible at x100

Grade 4

tumors contained enlarged pleomorphic or giant cells

 

Consensus system of risk grading for GIST
	Tumor size (cm)	Mitotic count
Very low risk	<2	≤5/50 HPF
Low risk	2-5	≤5/50 HPF
Intermediate risk	≤5	6-10/50 HPF
	>5 to ≤10	≤5/50 HPF
High risk	>5	> 5/50 HPF
	>10	Any mitotic rate
	Any size	>10/50 HPF

 

2007 WHO Grading Scheme for Meningiomas*
WHO grade	Histological Subtype	Histological Features
I	meningothelial, fibroblastic, transitional, angiomatous, microcystic, secretory, lymphoplasmacytic metaplastic, psammomatous	does not fulfill criteria for Grade II or III
II (atypical)	chordoid, clear cell	4 or more mitotic cells per 10 hpf and/or 3 or more of the following: increased cellularity, small cells, necrosis, prominent nucleoli, sheeting, &/or brain invasion in an otherwise Grade I tumor
III (anaplastic)	papillary, rhabdoid	20 or more mitoses per 10 hpf and/or obviously malignant cytological characteristics such that tumor cell resembles carcinoma, sarcoma, or melanoma

*From Perry A, et al : Meningiomas, in Louis DN, Ohgaki H, Wiestler OD, Cavenee
WK, Burger PC, Jouvet A, et al. (eds): World Health Organization Classification
of Tumours of the Central Nervous System, ed 4. Lyon: IARC, 2007, pp 164–172.

 Elston and Ellis grading system

Feature

score   

Tubule and gland formation

 

(more than 75%)

(10%~75%)

(Less than 10%)

1

2

3

Nuclear pleomorphism

 

Uniform or regular, small nuclei

Moderate degree of variation in nuclear size and shape and occasional nucleoli

Marked variation in nuclear size and shape and those containing bizarre nuclei, often with irregular chromatin distribution and one or more prominent nucleoli

1

2

3

 

Mitotic count  a diameter of 0.59 mm and an area of 0.274 mm2

 

0–9 mitotic figures per 10 hpf

10-19 mitotic figures per 10 hpf

> 20 mitotic figures per 10 hpf

1

2

3