Pathology dictionary

What does Fuhrman grade mean?

The Fuhrman grade is a system used for grading certain types of kidney cancer. This grading system is used for clear cell renal cell carcinomas and papillary renal cell carcinomas.

The Fuhrman nuclear grade is based on microscopic features of the tumour cells including the size and shape of the nucleus as well as the prominence of the nucleoli. The Fuhrman nuclear grading system divides kidney tumours into one of four grades:

  • Grade 1 – The cancer cell nuclei are small and round.  The nucleoli are difficult to see even when the cells are examined with a high magnification lens.
  • Grade 2 – The cancer cell nuclei are slightly larger and irregularly shaped.  Nucleoli are easier to see but only after the cells are examined with a high magnification lens.
  • Grade 3 – The cancer cell nuclei are obviously irregular and enlarged.  The nucleoli are very easy to see even when the cells are examined with a low magnification lens.
  • Grade 4 – The cancer cell nuclei are bizarre, extremely irregular and often multilobed. Sarcomatoid and rhabdoid cells are included in this category. ​

Why is this important? In general, high grade tumours (Fuhrman nuclear grades 3 and 4) have a worse prognosis than low grade tumours (Fuhrman nuclear grades 1 and 2).

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