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 WHO Classification of Tumours • 5th Edition

i Urinary and Male

..J: . ' 7 ...

I Genital Tumours
*
、---- -------- ----- -—
\ Edited by the WHO Classification of Tumours Editorial Board

MenutxNMl for Utavdi on Cmcw

WHO Classification of Tumours . 5th Edition

Urinary and Male Genital

Tumours

WHO Classification of Tumours Editorial Board

International Agency for Research on Cancer

渤;瞄
mployed and the presentation of the me
itributinq agencies conceminq the legal
The WHO classification of urinary and male genital tumours presented in this book reflects
the views of the WHO Classification of Tumours Editorial Board that convened
via video conference 18-20 January 2021.
The WHO Classification of Tumours
Editorial Board

Expert members: Urinary and male genital tumours

Amin, Mahul B. Netto, George J.

University of Tennessee Health Science Center University of Alabama at Birmingham
Memphis Birmingham

Berney, Daniel Maurice Raspollini, Maria Rosaria

Barts Health NHS Trust Histopathology and Molecular Diagnostics, University Hospital Careggi
London Florence

Comperat, Eva Maria Rubin, Mark A.

Sorbonne University, Hopital Tenon Universitat Bern
Paris Bern

Hartmann, Arndt Tickoo, Satish K.

Institute of Pathology Memorial Sloan Kettering Cancer Center
Erlangen New York

Menon, Santosh Turajlic, Samra

Tata Memorial Centre Francis Crick Institute, Royal Marsden NHS Foundation Trust,
Mumbai and Institute of Cancer Research
London

For the complete list of all contributors and their affiliations, see pages 497-504.
The WHO Classification of Tumours
Editorial Board (continued)

Standing members

Cree, Ian A. (Editorial Board Chair) Moch, Holger*

International Agency for Research on Cancer University of Zurich and University Hospital Zurich
Lyon Zurich

Denton, Erika R.E. Rous, Brian

Norfolk and Norwich University Hospitals NHS Foundation Trust NHS Digital
Norwich Fulbourn, Cambridge

Field, Andrew S. Srigley, John R.*

St Vincent's Hospital Sydney University of Toronto, Trillium Health Partners
Darlinghurst Mississauga

Gill, Anthony J.* Tan, Puay Hoon*

Royal North Shore Hospital Singapore General Hospital
St Leonards Singapore

Khoury, Joseph D. Thompson, Lester D.R.

University of Texas MD Anderson Cancer Center Head and Neck Pathology Consultations
Houston Woodland Hills

Lax, Sigurd F. Tsuzuki, Toyonori*

General Hospital Graz II, Medical University of Graz Aichi Medical University Hospital
Graz Nagakute

Lazar, Alexander J. Washington, Mary K.

University of Texas MD Anderson Cancer Center Vanderbilt University Medical Center
Houston Nashville

Standing members marked with an asterisk also served as expert members for this volume.

For the complete list of all contributors and their affiliations, see pages 497-504.
WHO Classification of Tumours
Urinary and Male Genital Tumours

Edited by The WHO Classification of Tumours Editorial Board

IARC Editors Ian A. Cree

Gabrielle Goldman-L6vy
Dilani Lokuhetty
B. Vishal Rao
Valerie A. White

Epidemiology Ariana Znaor

Project Assistant Asiedua Asante

Assistants Anne-Sophie Bres

Laura Brispot

Production Editor Jessica Cox

Technical Editing Julia Slone-Murphy

Principal Information Assistant Alberto Machado

Information Assistant Catarina Marques

Layout Meaghan Fortune

Printed by Omni book

74370 Argonay, France

Publisher International Agency for Research on Cancer (IARC)

150 Cours Albert Thomas
69372 Lyon Cedex 08, France
Contents

List of abbreviations xi SMARCB1-deficient renal medullary carcinoma 84

Metanephric tumours
Foreword xii Metanephric adenoma 87
Metanephric adenofibroma 90
ICD-0 topographical coding 1 Metanephric stromal tumour 92
Mixed epithelial and stromal renal tumours
ICD-0 morphological coding 1 Mixed epithelial and stromal tumour of the kidney 94
Tumours of the kidney 2 Paediatric cystic nephroma 96
Tumours of the urinary tract 4 Renal mesenchymal tumours
Tumours of the prostate 6 Adult renal mesenchymal tumours
Tumours of the seminal vesicle 7 Classic angiomyolipoma / PEComa of the kidney 98
Tumours of the testis 8 Epithelioid angiomyolipoma / epithelioid PEComa of
Tumours of the testicular adnexa 10 the kidney 102
Tumours of the penis and scrotum 11 Renal haemangioblastoma 105
Neuroendocrine neoplasms 12 Juxtaglomerular cell tumour 107
Mesenchymal tumours 12 Renomedullary interstitial cell tumour 109
Haematolymphoid tumours 14 Paediatric renal mesenchymal tumours
Melanocytic lesions 15 Ossifying renal tumour of infancy 111
Congenital mesoblastic nephroma 112
TNM staging of urological tumours 16 Rhabdoid tumour of the kidney 114
Carcinomas of the penis 17 Clear cell sarcoma of the kidney 116
Adenocarcinomas of the prostate 18 Embryonal neoplasms of the kidney
Germ cell tumours of the testis 20 Nephroblastic tumours
Renal cell carcinoma 22 Nephrogenic rests 119
Carcinomas of the renal pelvis and ureter 23 Cystic partially differentiated nephroblastoma 121
Carcinomas of the urinary bladder 24 Nephroblastoma 123
Carcinomas of the urethra 25 Miscellaneous renal tumours
Germ cell tumours of the kidney 129
1 Introduction to urinary and male genital tumours 27
3 Tumours of the urinary tract 131
2 Tumours of the kidney 31 Introduction 132
Renal cell tumours Urothelial tumours
Introduction 32 Non-invasive urothelial neoplasms
Clear cell renal tumours Urothelial papilloma 134
Clear cell renal cell carcinoma 38 Inverted urothelial papilloma 136
Multilocular cystic renal neoplasm of low malignant Papillary urothelial neoplasm of low malignant
potential 43 potential 138
Papillary renal tumours Non-invasive papillary urothelial carcinoma, low-
Renal papillary adenoma 45 grade 140
Papillary renal cell carcinoma 47 Non-invasive papillary urothelial carcinoma, high­
Oncocytic and chromophobe renal tumours grade 143
Oncocytoma of the kidney 50 Urothelial carcinoma in situ 147
Chromophobe renal cell carcinoma 53 Invasive urothelial neoplasms
Other oncocytic tumours of the kidney 56 Invasive urothelial carcinoma 150
Collecting duct tumours Squamous cell neoplasms of the urinary tract
Collecting duct carcinoma 59 Squamous papilloma of the urothelial tract 166
Other renal tumours Squamous cell carcinomas of the urinary tract
Clear cell papillary renal cell tumour 61 Verrucous carcinoma of the bladder 167
Mucinous tubular and spindle cell carcinoma 63 Pure squamous carcinoma of the urothelial tract 169
Tubulocystic renal cell carcinoma 65 Glandular neoplasms
Acquired cystic disease-associated renal cell Adenomas
carcinoma 67 Villous adenoma 172
Eosinophilic solid and cystic renal cell carcinoma 69 Adenocarcinomas
Renal cell carcinoma NOS 71 Adenocarcinoma NOS 173
Molecularly defined renal carcinomas Urachal and diverticular neoplasms
7FE3-rearranged renal cell carcinomas 72 Urachal carcinoma 177
TFEB-altered renal cell carcinomas 74 Diverticular carcinoma 181
ELOC (formerly 7CEB7)-mutated renal cell carcinoma 76 Urethral neoplasms
Fumarate hydratase-deficient renal cell carcinoma 78 Urethral accessory gland carcinomas
Succinate dehydrogenase-deficient renal cell Litt怕 gland adenocarcinoma 183
carcinoma 80 Skene gland adenocarcinoma 185
>4/.^-rearranged renal cell carcinomas 82 Cowper gland adenocarcinoma 186
 Tumours of Mullerian type Sertoli cell tumours
Clear cell adenocarcinoma of the urinary tract 188 Sertoli cell tumour 302
Endometrioid carcinoma of the urinary tract 190 Large cell calcifying Sertoli cell tumour 305
Granulosa cell tumours
4 Tumours of the prostate 193 Adult granulosa cell tumour 307
Introduction 194 Juvenile granulosa cell tumour 309
Epithelial tumours of the prostate The fibroma thecoma family of tumours
Glandular neoplasms of the prostate Tumours in the fibroma thecoma group 311
Prostatic cystadenoma 196 Mixed and other sex cord stromal tumours
High-grade prostatic intraepithelial neoplasia 198 Mixed sex cord stromal tumour 313
Intraductal carcinoma of the prostate 200 Signet ring stromal tumour 315
Prostatic acinar adenocarcinoma 203 Myoid gonadal stromal tumour 317
Prostatic ductal adenocarcinoma 220 Sex cord stromal tumour NOS 319
Treatment-related neuroendocrine prostatic carci­
noma 223 7 Tumours of the testicular adnexa 321
Squamous neoplasms of the prostate Introduction 322
Adenosquamous carcinoma of the prostate 225 Ovarian-type tumours of the collecting ducts and rete testis
Squamous cell carcinoma of the prostate 227 Serous cystadenoma 326
Adenoid cystic (basal cell) carcinoma of the prostate 229 Serous tumour of borderline malignancy 327
Mesenchymal tumours unique to the prostate Serous cystadenocarcinoma 329
Stromal tumours of the prostate Mucinous cystadenoma 331
Prostatic stromal tumour of uncertain malignant Mucinous borderline tumour 333
potential 231 Mucinous cystadenocarcinoma 335
Prostatic stromal sarcoma 233 Endometrioid tumours 337
Clear cell adenocarcinoma 339
5 Tumours of the seminal vesicle 235 Brenner tumour 340
Introduction 236 Tumours of the collecting ducts and rete testis
Epithelial tumours Adenoma 341
Glandular neoplasms Adenocarcinoma 342
Cystadenoma 237 Paratesticular mesothelial tumours
Adenocarcinoma 238 Adenomatoid tumour 343
Squamous neoplasms Well-differentiated papillary mesothelial tumour 346
Squamous cell carcinoma 240 Mesothelioma 348
Other tumours Tumours of the epididymis
Mixed epithelial andstromal tumour 241 Cystadenoma 351
Papillary cystadenoma 352
6 Tumours of the testis 243 Adenocarcinoma 354
Introduction 244 Squamous cell carcinoma 356
Germ cell tumours derived from germ cell neoplasia in situ Melanotic neuroectodermal tumour 358
Non-invasive germ cell neoplasia
Germ cell neoplasia in situ 250 8 Tumours of the penis and scrotum 361
Specific forms of intratubular germ cell neoplasia 253 Introduction 362
Gonadoblastoma 255 Benign and precursor squamous lesions
The germinoma family of tumours Condyloma acuminatum 364
Seminoma 258 Squamous cell carcinoma precursors, HPV-associated
Non-seminomatous germ cell tumours Penile intraepithelial neoplasia, HPV-associated 366
Embryonal carcinoma 262 Squamous cell carcinoma precursors, HPV-independent
Yolk sac tumour, postpubertal-type 265 Differentiated penile intraepithelial neoplasia,
Choriocarcinoma 268 HPV-independent 369
Placental site trophoblastic tumour 271 Invasive epithelial tumours of the penis and scrotum
Epithelioid trophoblastic tumour 273 Invasive squamous epithelial tumours
Cystic trophoblastic tumour 275 HPV-associated squamous cell carcinoma 372
Teratoma, postpubertal-type 277 HPV-independent squamous cell carcinoma 375
Teratoma with somatic-type malignancy 281 Squamous cell carcinoma NOS 378
Mixed germ cell tumours of the testis Other epithelial tumours
Mixed germ cell tumours 284 Penile adenosquamous and mucoepidermoid carci­
Germ cell tumours of unknown type nomas 380
Regressed germ cell tumours 286 Extramammary Paget disease 381
Germ cell tumours unrelated to germ cell neoplasia in situ Other scrotal tumours
Spermatocytic tumour 288 Basal cell carcinoma of thescrotum 383
Teratoma, prepubertal-type 291
Yolk sac tumour, prepubertal-type 293 9 Neuroendocrine neoplasms 385
Testicular neuroendocrine tumour, prepubertal-type 295 Introduction 386
Mixed teratoma and yolk sac tumour, prepuber­ Neuroendocrine tumours
tal-type 297 Well-differentiated neuroendocrine tumour 387
Sex cord stromal tumours of the testis Neuroendocrine carcinomas
Leydig cell tumour Small cell neuroendocrine carcinoma 389
Leydig cell tumour 299 Large cell neuroendocrine carcinoma 392
 Mixed neuroendocrine neoplasms 394 13 Metastases in the genitourinary system 451
Paragangliomas Introduction 452
Paraganglioma 397 Metastasis to the urinary tract 455
Metastasis to the kidney 457
10 Mesenchymal tumours 401 Metastasis to the testis and paratestis 459
Introduction 402
Fibroblastic and myofibroblastic tumours 14 Genetic tumour syndromes of the urinary and male
The angiofibroma family of tumours 403 genital tracts 461
Solitary fibrous tumour 405 Introduction 462
Inflammatory myofibroblastic tumour 407 Von Hippel-Lindau syndrome 464
Vascular tumours Birt-Hogg-Dube syndrome 466
Haemangioma 409 Hereditary papillary renal carcinoma 469
Angiosarcoma 412 Hereditary leiomyomatosis and renal cell carcinoma
Pericytic (perivascular) tumours syndrome 471
Glomus tumour 414 Succinate dehydrogenase-deficient tumour syn­
Myointimoma 416 dromes 474
Myopericytoma 418 BAP1 tumour predisposition syndrome 479
Extrarenal PEComa 419 Hereditary phaeochromocytoma-paraganglioma
Smooth muscle tumours syndromes 481
Leiomyoma 421 Tuberous sclerosis 484
Leiomyosarcoma 423 Genitourinary system and Lynch syndrome 487
Skeletal muscle tumours Hereditary tumour syndromes associated with
Rhabdomyosarcoma 425 homologous recombination pathway mutations 490
Tumours of uncertain differentiation Carney complex 492
Synovial sarcoma 427 Peutz-Jeghers syndrome 494
Extrarenal rhabdoid tumour 429
Desmoplastic small round cell tumour 431 Contributors 497

11 Haematolymphoid tumours 433 Declaration of interests 503

Introduction 434
Mature B-cell lymphomas IARC/WHO Committee for ICD-0 504
Extranodal marginal zone lymphoma of MALT 436
Diffuse large B-cell lymphoma 439 Sources 505
Plasmacytoma 442
Histiocytic tumours References 511
Juvenile xanthogranuloma 445
Subject index 567
12 Melanocytic lesions 447
Mucosal melanoma 448 Previous volumes in the series 576
List of abbreviations

Al artificial intelligence MALT lymphoma extranodal marginal zone lymphoma of mucosa-

AIDS acquired immunodeficiency syndrome associated lymphoid tissue
AJCC American Joint Committee on Cancer MIM number Mendelian Inheritance in Man number
AR androgen receptor MITF melanogenesis-associated transcription factor
BCG vaccine bacillus Calmette-Guerin vaccine mpMRI multiparametric magnetic resonance imaging
cAMP cyclic adenosine monophosphate MRI magnetic resonance imaging
CNS central nervous system mRNA messenger ribonucleic acid
COG Children's Oncology Group MSI microsatellite instability
CT computed tomography N:C ratio nuclear-to-cytoplasmic ratio
DNA deoxyribonucleic acid ncRNA non-coding RNA
EBV Epstein-Barr virus NOS not otherwise specified
ER estrogen receptor NSE neuron-specific enolase
FISH fluorescence in situ hybridization PAS staining periodic acid-Schiff staining
FNA fine-needle aspiration PCR polymerase chain reaction
GG WHO/ISUP grade group PET-CT positron emission tomography-computed tomography
GUPS Genitourinary Pathology Society PR progesterone receptor
H&E haematoxylin and eosin RNA ribonucleic acid
HIV human immunodeficiency virus RPLND retroperitoneal lymph node dissection
HPV human papillomavirus SEER Program Surveillance, Epidemiology, and End Results
HR homologous recombination Program
HRR homologous recombination repair SIOP International Society of Paediatric Oncology
HVA homovanillic acid SNP single-nucleotide polymorphism
IARC International Agency for Research on Cancer TCGA The Cancer Genome Atlas
ICD-11 International Classification of Diseases, 11th TNM tumour, node, metastasis
revision TPS The Paris System for reporting urinary cytopathology
ICD-0 International Classification of Diseases for Oncology TRUS transrectal ultrasound
ig immunoglobulin TURBT transurethral resection of bladder tumour
IGCCCG International Germ Cell Cancer Collaborative Group UICC Union for International Cancer Control
旧SG Intergroup Rhabdomyosarcoma Study Group VI-RADS Vesical Imaging Reporting and Data System
ISUP International Society of Urological Pathology VMA vanillylmandelic acid
ITD internal tandem duplication WHO/ISUP grading WHO Classification of Tumours / International
Society of Urological Pathology (WHO/ISUP)
grading

List of abbreviations xi
Foreword
The WHO Classification of Tumours, published as a series of books (also known as the WHO Blue Books) and now as a website
(https://tumourclassification.iarc.who.int ), is an essential tool for standardizing diagnostic practice worldwide. It also serves as a
vehicle for the translation of cancer research into practice. The diagnostic criteria and standards that make up the classification
are underpinned by evidence evaluated and debated by experts in the field. About 200 authors and editors participate in the
production of each book, and they give their time freely to this task. I am very grateful for their help; it is a remarkable team effort.

This volume, like the rest of the fifth edition, has been led by the WHO Classification of Tumours Editorial Board, composed of stand­
ing and expert members. The standing members, who have been nominated by pathology organizations, are the equivalent of the
series editors of previous editions. The expert members for each volume, equivalent to the volume editors of previous editions, are
selected on the basis of informed bibliometric analysis and advice from the standing members. The diagnostic process is increas­
ingly multidisciplinary, and we are delighted that several radiology and clinical experts have joined us to address specific needs.

The most conspicuous change to the format of the books in the fifth edition is that tumour types common to multiple systems are
dealt with together - so there are separate chapters on neuroendocrine neoplasms, mesenchymal tumours, haematolymphoid
tumours, and melanocytic lesions. There is also a chapter on genetic tumour syndromes. Genetic disorders are of increasing impor­
tance to diagnosis in individual patients, and the study of these disorders has undoubtedly informed our understanding of tumour
biology and behaviour over the past decade.

We have attempted to take a more systematic approach to the multifaceted nature of tumour classification; each tumour type
is described on the basis of its localization, clinical features, epidemiology, etiology, pathogenesis, histopathology, diagnostic
molecular pathology, staging, and prognosis and prediction. We have also included information on macroscopic appearance and
cytology, as well as essential and desirable diagnostic criteria. This standardized, modular approach makes it easier for the books
to be accessible online, but it also enables us to call attention to areas in which there is little information, and where serious gaps in
our knowledge remain to be addressed.

The organization of the WHO Blue Books content now follows the normal progression from benign to malignant - a break with the
fourth edition, but one we hope will be welcome.

The volumes are still organized by anatomical site (digestive system, breast, soft tissue and bone, etc.), and each tumour type is
listed within a hierarchical taxonomic classification that follows the format below, which helps to structure the books in a systematic
manner:

Site: e.g. tumours of the kidney

Category: e.g. renal mesenchymal tumours
Family (class): e.g. paediatric renal mesenchymal tumours
Type: e.g. congenital mesoblastic nephroma
Subtype: e.g. cellular congenital mesoblastic nephroma

The issue of whether a given tumour type represents a distinct entity rather than a subtype continues to exercise pathologists, and
it is the topic of many publications in the literature. We continue to deal with this issue on a case-by-case basis, but we believe there
are inherent rules that can be applied. For example, tumours in which multiple histological patterns contain shared truncal mutations
are clearly of the same type, despite the differences in their appearance. Equally, genetic heterogeneity within the same tumour
type may have implications for treatment. A small shift in terminology in the fifth edition is that the term "variant" in reference to a
specific kind of tumour has been wholly superseded by "subtype", in an effort to more clearly differentiate this meaning from that of
“variant" in reference to a genetic alteration.

xii Foreword
Another important change in this edition of the WHO Classifica­ Table A Approximate number of fields per 1 mm2 based on the field diameter and its
tion of Tumours series is the conversion of mitotic count from the corresponding area
traditional denominator of 10 HPF to a defined area expressed Approximate number of
Field diameter (mm) Field area (mm2)
in mm2. This serves to standardize the true area over which fields per 1 mm2
mitoses are enumerated, because different microscopes have
0.40 0.126 8
high-power fields of different sizes. This change will also be
helpful for anyone reporting using digital systems. The approx­ 0.41 0.132 8
imate number of fields per 1 mm2 based on the field diameter 0.42 0.138 7
and its corresponding area is presented in Table A.
0.43 0.145 7
We are continually working to improve the consistency and 0.44 0.152 7
standards within the classification. In addition to having moved
0.45 0.159 6
to the International System of Units (SI) for all mitotic counts,
we have standardized genomic nomenclature by using Human 0.46 0.166 6
Genome Variation Society (HGVS) notation. We have also 0.47 0.173 6
further standardized our use of units of length, adopting the
0.48 0.181 6
convention used by the International Collaboration on Cancer
Reporting (https://www.iccr-cancer.org ) and the UK Royal Col­ 0.49 0.188 5
lege of Pathologists (https://www.rcpath.org/), so that the size of 0.50 0.196 5
tumours is now given exclusively in millimetres (mm) rather than
0.51 0.204 5
centimetres (cm). This is clearer, in our view, and avoids the use
of decimal points - a common source of medical errors. 0.52 0.212 5

0.53 0.221 5
The WHO Blue Books are much appreciated by pathologists
and of increasing importance to practitioners of other clini­ 0.54 0.229 4
cal disciplines involved in cancer management, as well as to 0.237 4
0.55
researchers. The editorial board and I certainly hope that the
0.56 0.246 4
series will continue to meet the need for standards in diagno­
sis and to facilitate the translation of diagnostic research into 0.57 0.255 4
practice worldwide. It is particularly important that cancers 0.58 0.264 4
continue to be classified and diagnosed according to the same
0.59 0.273 4
standards internationally so that patients can benefit from mul­
ticentre clinical trials, as well as from the results of local trials 0.60 0.283 4
conducted on different continents. 0.61 0.292 3

0.62 0.302 3

0.63 0.312 3

0.64 0.322 3

0.65 0.332 3
Dr Ian A. Cree 0.66 0.342 3

Head, WHO Classification of Tumours Programme 0.67 0.352 3

International Agency for Research on Cancer 0.68 0.363 3

May 2022 0.69 0.374 3

Foreword xiii
ICD-0 topographical coding of urinary
and male genital tumours

The ICD-0 topography codes for the main anatomical sites covered in this volume are as follows (1053(:

C60 Penis C65 Renal pelvis

C60.0 Prepuce C65.9 Renal pelvis
C60.1 Glans penis
060.2 Body of penis C66 Ureter
C60.8 Overlapping lesion of penis C66.9 Ureter
C60.9 Penis, NOS
C67 Bladder
C61 Prostate gland C67.0 Trigone of bladder
C61.9 Prostate gland C67.1 Dome of bladder
C67.2 Lateral wall of bladder
C62 Testis C67.3 Anterior wall of bladder
062.0 Undescended testis C67.4 Posterior wall of bladder
C62.1 Descended testis C67.5 Bladder neck
C62.9 Testis, NOS C67.6 Ureteric orifice
C67.7 Urachus
C63 Other and unspecified male genital organs C67.8 Overlapping lesion of bladder
C63.0 Epididymis C67.9 Bladder, NOS
063.1 Spermatic cord
C63.2 Scrotum, NOS C68 Other and unspecified urinary organs
C63.7 Other specified parts of male genital organs C68.0 Urethra
C63.8 Overlapping lesion of male genital organs C68.1 Paraurethral gland
C63.9 Male genital organs, NOS C68.8 Overlapping lesion of urinary organs
C68.9 Urinary system, NOS
C64 Kidney
C64.9 Kidney, NOS

ICD-0 morphological coding: Introduction

The ICD-0 coding system uses a topography (T) code and a morphology (M) code together, but these are presented in separate
lists for ease of use. Behaviour is coded /0 for benign tumours; /1 for unspecified, borderline, or uncertain behaviour; /2 for carci­
noma in situ and grade III intraepithelial neoplasia; /3 for malignant tumours, primary site; and 16 for malignant tumours, metastatic
site. Behaviour code /6 is not generally used by cancer registries. For various reasons, the ICD-0 morphology terms may not
always be identical to the entity names used in the WHO classification, but they should be sufficiently similar to avoid confusion.
The designation "NOS" ("not otherwise specified") is provided to make coding possible when subtypes exist but exact classification
may not be possible in small biopsies or certain other scenarios. Therefore, it is usual to have "NOS" even when a more specific
alternative term is listed in ICD-O.

ICD-0 coding of urinary and male genital tumours 1

ICD-0 coding of tumours of the kidney
ICD-O-3.2 ICD-0 label (subtypes are indicated in grey text, with the label indented);
Please note that the WHO classification of tumour types is more readily reflected in the table of contents

Renal cell tumours

Clear cell renal tumours
8310/3 Clear cell renal cell carcinoma
8316/1 Multilocular cystic renal neoplasm of low malignant potential

Papillary renal tumours

8260/0 Papillary adenoma
8260/3 Papillary renal cell carcinoma1

Oncocytic and chromophobe renal tumours

8290/0 Oncocytoma
8317/3 Chromophobe cell renal carcinoma
Other oncocytic tumours of the kidney

Collecting duct tumours

8319/3 Collecting duct carcinoma

Other renal tumours

8323/1 Clear cell papillary renal cell turnout
8480/3 Mucinous tubular and spindle cell carcinoma
8316/3 Tubulocystic renal cell carcinoma
8316/3 Acquired cystic disease-associated renal cell carcinoma
8311/3 Eosinophilic solid and cystic renal cell carcinoma
8312/3 Renal cell carcinoma, NOS

Molecularly defined renal carcinomas

8311/3 TFE3-rearranged renal cell carcinomas
8311/3 TFEB-altered renal cell carcinomas
8311/3 ELOC (formerly TCEB 7)-mutated renal cell carcinoma
8311/3 Fumarate hydratase-deficient renal cell carcinoma
8311/3 Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome-associated renal cell carcinoma
8311/3 Succinate dehydrogenase-deficient renal cell carcinoma
8311/3 ALKrearranged renal cell carcinomas
8510/3 Medullary carcinoma, NOS
8510/3 SMARCBI-deficient medullary-like renal cell carcinoma
8510/3 SMARCBI-deficient undifferentiated renal cell carcinoma, NOS
8510/3 SMARCBI-deficient dedifferentiated renal cell carcinomas of other specific subtypes

Metanephric tumours
8325/0 Metanephric adenoma
9013/0 Metanephric adenofibroma
8935/1 Metanephric stromal tumour

Mixed epithelial and stromal renal tumours

8959/0 Mixed epithelial and stromal tumour
8959/0 Adult cystic nephroma
8959/0 Paediatric cystic nephroma

2 ICD-0 coding of urinary and male genital tumours

ICD-O-3.2 ICD-0 label (subtypes are indicated in grey text, with the label indented);
Please note that the WHO classification of tumour types is more readily reflected in the table of contents

Renal mesenchymal tumours

Adult renal mesenchymal tumours
8860/0 Angiomyolipoma
8860/0 Oncocytic angiomyolipoma
8860/0 Angiomyolipoma with epithelial cysts
8860/1 Angiomyolipoma, epithelioid
9161/1 Haemangioblastoma
8361/0 Juxtaglomerular tumour
8361/0 Functioning juxtaglomerular cell tumour
8361/0 Non-functioning juxtaglomerular cell tumour
8966/0 Renomedullary interstitial cell tumour

Paediatric renal mesenchymal tumours

8967/0 Ossifying renal tumour of infancy
8960/1 Mesoblastic nephroma
8960/1 Classic congenital mesoblastic nephroma
8960/1 Cellular congenital mesoblastic nephroma
8960/1 Mixed congenital mesoblastic nephroma
8963/3 Malignant rhabdoid tumour of the kidney
8964/3 Clear cell sarcoma of kidney

Embryonal neoplasms of the kidney

Nephroblastic tumours
Nephrogenic rests
Perilobar nephrogenic rests
Intralobar nephrogenic rests
Nephroblastomatosis
8959/1 Cystic partially differentiated nephroblastoma
8960/3 Nephroblastoma

Miscellaneous renal tumours

Germ cell tumours of the kidney
9084/0 Prepubertal-type teratoma
9084/3 Teratoma with carcinoid (neuroendocrine tumour)
9071/3 Yolk sac tumour, NOS
9085/3 Mixed teratoma-yolk sac tumour

These morphology codes are from the International Classification of Diseases for Oncology, third edition, second revision (ICD-O-3.2)
(1457}. Behaviour is coded /0 for benign tumours; Z1 for unspecified, borderline, or uncertain behaviour; /2 for carcinoma in situ and
grade III intraepithelial neoplasia; /3 for malignant tumours, primary site; and /6 for malignant tumours, metastatic site. Behaviour code /6 is
not generally used by cancer registries.

This classification is modified from the previous WHO classification, taking into account changes in our understanding of these lesions,

n/a, not available (provisional entity).

* Codes marked with an asterisk were approved by the IARC/WHO Committee for ICD-0 at its meeting in Feb 2022.

十 Labels marked with a dagger have undergone a change in terminology of a previous code.

ICD-0 coding of urinary and male genital tumours 3

ICD-0 coding of tumours of the urinary tract
ICD-O-3.2 ICD-0 label (subtypes are indicated in grey text, with the label indented);
Please note that the WHO classification of tumour types is more readily reflected in the table of contents

Urothelial tumours
Non-invasive urothelial neoplasms
8120/0 Urothelial papilloma
8121/0 Urothelial papilloma, inverted
8130/1 Papillary urothelial neoplasm of low malignant potential
8130/1 Inverted papillary urothelial neoplasm of low malignant potential
8130/2 Non-invasive papillary urothelialcarcinoma, low-grade
8130/2 Low-grade papillary urothelial carcinoma with an inverted growth pattern
8130/2 Non-invasive papillary urothelial carcinoma, high-grade
8130/2 Non-invasive high-grade papillary urothelial carcinoma with an inverted growth pattern
8120/2 Urothelial carcinoma in situ

Invasive urothelial neoplasms

8120/3 Invasive urothelial carcinoma
8120/3 Conventional urothelial carcinoma
8120/3 Urotheliaf carcinoma with squamous differentiation
8120/3 Urothelial carcinoma with glandular differentiation
8120/3 Urothelial carcinoma with trophoblastic differentiation
8120/3 Nested urothelial carcinoma
8120/3 Large nested urothelial carcinoma
8120/3 Tubular and microcystic urothelial carcinomas
8131/3 Micropapilfary urothelial carcinoma
8082/3 Lymphoepitheiioma-like urothelial carcinoma
8122/3 Plasmacytoid urothelial carcinoma'7
8031/3 Giant cell urothelial carcinoma
8120/3 Lipid-rich urothelial carcinoma
8120/3 Clear cell (glycogen-rich) urothelial carcinoma
8120/3 Sarcomatoid urothelial carcinoma
8020/3 Poorly differentiated urothelial carcinoma

Squamous cell neoplasms of the urinary tract

8052/0 Squamous papilloma

Squamous cell carcinomas of the urinary tract

8051/3 Verrucous carcinoma
8070/3 Pure squamous carcinoma of the urothelial tract1

Glandular neoplasms
Adenomas
8261/0 Villous adenoma
8211/0 Tubular adenoma
8263/0 Tubulovillous adenoma
Adenocarcinomas
8140/3 Adenocarcinoma, NOS
8144/3 Enteric adenocarcinoma
8480/3 Mucinous adenocarcinoma
8323/3 Mixed adenocarcinoma
8490/3 Signet-ring cell adenocarcinoma
8140/2 Adenocarcinoma in situ

4 ICD-0 coding of urinary and male genital tumours

ICD-O-3.2 ICD-0 label (subtypes are indicated in grey text, with the label indented);
Please note that the WHO classification of tumour types is more readily reflected in the table of contents

Urachal and diverticular neoplasms

8010/3 Urachal carcinoma
8120/3 Invasive urothelial carcinoma (code to site)

Urethral neoplasms
Urethral accessory gland carcinomas
8140/3 Carcinoma of Littre glands
8140/3 Carcinoma of Skene glands
8140/3 Carcinoma of Cowper glands

Tumours of MOIIerian type

8310/3 Clear cell carcinoma
8380/3 Endometrioid carcinoma

These morphology codes are from the International Classification of Diseases for Oncology, third edition, second revision (ICD-O-3.2)
(1457). Behaviour is coded /0 for benign tumours; /1 for unspecified, borderline, or uncertain behaviour; /2 for carcinoma in situ and
grade III intraepithelial neoplasia; /3 for malignant tumours, primary site; and 16 for malignant tumours, metastatic site. Behaviour code /6 is
not generally used by cancer registries.
This classification is modified from the previous WHO classification, taking into account changes in our understanding of these lesions.

n/a, not available (provisional entity).

* Codes marked with an asterisk were approved by the IARC/WHO Committee for ICD-0 at its meeting in Feb 2022.

f Labels marked with a dagger have undergone a change in terminology of a previous code.

ICD-0 coding of urinary and male genital tumours 5

ICD-0 coding of tumours of the prostate
ICD-O-3.2 ICD-0 label (subtypes are indicated in grey text, with the label indented);
Please note that the WHO classification of tumour types is more readily reflected in the table of contents

Epithelial tumours of the prostate

Glandular neoplasms of the prostate
8440/0 Cystadenoma
8148/2 Prostatic intraepithelial neoplasia, high-grade
8500/2 Intraductal carcinoma
8140/3 Acinar adenocarcinoma
8490/3 Signet-ring cell-like acinar adenocarcinoma
8140/3 Pleomorphic giant cell acinar adenocarcinoma
8572/3 Sarcomatoid acinar adenocarcinoma
8140/3 Prostatic intraepithelial neoplasia-like carcinoma
8500/3 Ductal adenocarcinoma
8574/3 Adenocarcinoma with neuroendocrine differentiation

Squamous neoplasms of the prostate

8560/3 Adenosquamous carcinoma
8070/3 Squamous cell carcinoma
8147/3 Adenoid cystic (basal cell) carcinoma1

Mesenchymal tumours unique to the prostate

Stromal tumours of the prostate
8935/1 Stromal tumour of uncertain malignant potential
8935/3 Stromal sarcoma

These morphology codes are from the International Classification of Diseases for Oncology, third edition, second revision (ICD-O-3.2)
(1457). Behaviour is coded /0 for benign tumours; /1 for unspecified, borderline, or uncertain behaviour; /2 for carcinoma in situ and
grade III intraepithelial neoplasia; /3 for malignant tumours, primary site; and /6 for malignant tumours, metastatic site. Behaviour code /6 is
not generally used by cancer registries.
This classification is modified from the previous WHO classification, taking into account changes in our understanding of these lesions.

n/a, not available (provisional entity).

* Codes marked with an asterisk were approved by the IARC/WHO Committee for ICD-0 at its meeting in Feb 2022.

t Labels marked with a dagger have undergone a change in terminology of a previous code.

6 ICD-0 coding of urinary and male genital tumours

ICD-0 coding of tumours of the seminal vesicle
ICD-O-3.2 ICD-0 label (subtypes are indicated in grey text, with the label indented);
Please note that the WHO classification of tumour types is more readily reflected in the table of contents

Epithelial tumours of the seminal vesicle

Glandular neoplasms of the seminal vesicle
8440/0 Cystadenoma
8140/3 Adenocarcinoma

Squamous neoplasms of the seminal vesicle

8070/3 Squamous cell carcinoma

Other tumours of the seminal vesicle

8959/0 Mixed epithelial and stromal tumour

These morphology codes are from the International Classification of Diseases for Oncology, third edition, second revision (ICD-O-3.2)
(1457). Behaviour is coded /0 for benign tumours; /1 for unspecified, borderline, or uncertain behaviour; /2 for carcinoma in situ and
grade III intraepithelial neoplasia; /3 for malignant tumours, primary site; and /6 for malignant tumours, metastatic site. Behaviour code /6 is
not generally used by cancer registries.

This classification is modified from the previous WHO classification, taking into account changes in our understanding of these lesions.

n/a, not available (provisional entity).

* Codes marked with an asterisk were approved by the IARC/WHO Committee for ICD-0 at its meeting in Feb 2022.

f Labels marked with a dagger have undergone a change in terminology of a previous code.

ICD-0 coding of urinary and male genital tumours 7

ICD-0 coding of tumours of the testis
ICD-O-3.2 ICD-0 label (subtypes are indicated in grey text, with the label indented);
Please note that the WHO classification of tumour types is more readily reflected in the table of contents

Germ cell tumours derived from germ cell neoplasia in situ

Non-invasive germ cell neoplasia
9064/2 Germ cell neoplasia in situ
Specific forms of intratubular germ cell neoplasia
9061/2 Intratubular seminoma
9070/2 Intratubular embryonal carcinoma
9061/2 Intratubular trophoblast
9071/2 intratubular yolk sac tumour
9080/2 Intratubular teratoma
9073/1 Gonadoblastoma

The germinoma family of tumours

9061/3 Seminoma
9061/3 Seminoma with syncytiotrophoblastic cells

Non-seminomatous germ cell tumours

9070/3 Embryonal carcinoma
9071/3 Yolk sac tumour, postpubertal-type
9100/3 Choriocarcinoma
9104/3* Placental site trophoblastic tumour of the testis
9105/3 Epithelioid trophoblastic tumour
Cystic trophoblastic tumour
9080/3 Teratoma, postpubertal-type
9084/3 Teratoma with somatic-type malignancy

Mixed germ cell tumours of the testis

9085/3 Mixed germ cell tumours
9085/3 Polyembryoma
9085/3 Diffuse embryoma

Germ cell tumours of unknown type

9080/1 Regressed germ cell tumours

Germ cell tumours unrelated to germ cell neoplasia in situ

9063/3 Spermatocytic tumour
9063/3 Spermatocytic tumour with sarcomatous differentiation
9084/0 Teratoma, prepubertal-type
9084/0 Dermoid cyst
9084/0 Epidermoid cyst
9071/3 Yolk sac tumour, prepubertal-type
8240/3 Well-differentiated neuroendocrine tumour (monodermal teratoma)
9085/3 Mixed teratoma and yolk sac tumour, prepubertal-type

8 ICD-0 coding of urinary and male genital tumours

ICD-O-3.2 ICD-0 label (subtypes are indicated in grey text, with the label indented);
Please note that the WHO classification of tumour types is more readily reflected in the table of contents

Sex cord stromal tumours of the testis

Leydig cell tumour
8650/1 Leydig cell tumour
8650/3 Malignant Leydig cell tumour

Sertoli cell tumours

8640/1 Sertoli cell tumour
8640/3 Malignant Sertoli cell tumour
8642/1 Large cell calcifying Sertoli cell tumour

Granulosa cell tumours

8620/1 Adult granulosa cell tumour
8622/0 Juvenile granulosa cell tumour

The fibroma thecoma family of tumours

8600/0 Thecoma
8810/0 Fibroma

Mixed and other sex cord stromal tumours

8592/1 Mixed sex cord-stromal tumour
8590/0 Signet ring stromal tumour
8590/0 Myoid gonadal stromal tumour1
8590/1 Sex cord-stromal tumour, NOS

These morphology codes are from the International Classification of Diseases for Oncology, third edition, second revision (ICD-O-3.2)
{1457}. Behaviour is coded /0 for benign tumours; /1 for unspecified, borderline, or uncertain behaviour; /2 for carcinoma in situ and
grade III intraepithelial neoplasia; /3 for malignant tumours, primary site; and /6 for malignant tumours, metastatic site. Behaviour code /6 is
not generally used by cancer registries.
This classification is modified from the previous WHO classification, taking into account changes in our understanding of these lesions.

n/a, not available (provisional entity).

* Codes marked with an asterisk were approved by the IARC/WHO Committee for ICD-0 at its meeting in Feb 2022.

+ Labels marked with a dagger have undergone a change in terminology of a previous code.

ICD-0 coding of urinary and male genital tumours 9

ICD-0 coding of tumours of the testicular adnexa
ICD-O-3.2 ICD-0 label (subtypes are indicated in grey text, with the label indented);
Please note that the WHO classification of tumour types is more readily reflected in the table of contents

Ovarian-type tumours of the collecting ducts and rete testis

8441/0 Serous cystadenoma, NOS
8442/1 Serous borderline tumour, NOS
8441/3 Serous cystadenocarcinoma
8470/0 Mucinous cystadenoma
8472/1 Mucinous borderline tumour
8470/3 Mucinous cystadenocarcinoma
8380/1 Endometrioid tumour, borderline
8380/3 Endometrioid adenocarcinoma
8310/3 Clear cell adenocarcinoma
9000/0 Brenner tumour

Tumours of the collecting ducts and rete testis

8140/0 Adenoma
8140/3 Adenocarcinoma

Paratesticular mesothelial tumours

9054/0 Adenomatoid tumour
9052/0 Well-differentiated papillary mesothelial tumour
9050/3 Mesothelioma
9052/3 Epithelioid mesothelioma
9051/3 Sarcomatoid mesothelioma
9053/3 Biphasic mesothelioma

Tumours of the epididymis

8440/0 Cystadenoma of the epididymis
8450/0 Papillary cystadenoma
8140/3 Adenocarcinoma of the epididymis
8070/3 Squamous cell carcinoma
9363/0 Melanotic neuroectodermal tumour

These morphology codes are from the International Classification of Diseases for Oncology, third edition, second revision (ICD-O-3.2)
{1457}. Behaviour is coded /0 for benign tumours; /1 for unspecified, borderline, or uncertain behaviour; /2 for carcinoma in situ and
grade III intraepithelial neoplasia; /3 for malignant tumours, primary site; and /6 for malignant tumours, metastatic site. Behaviour code /6 is
not generally used by cancer registries.
This classification is modified from the previous WHO classification, taking into account changes in our understanding of these lesions.

n/a, not available (provisional entity).

* Codes marked with an asterisk were approved by the IARC/WHO Committee for ICD-0 at its meeting in Feb 2022.

+ Labels marked with a dagger have undergone a change in terminology of a previous code.

10 ICD-0 coding of urinary and male genital tumours

ICD-0 coding of tumours of the penis and scrotum
ICD-O-3.2 ICD-0 label (subtypes are indicated in grey text, with the label indented);
Please note that the WHO classification of tumour types is more readily reflected in the table of contents

Benign and precursor squamous lesions

Condyloma acuminatum

Squamous cell carcinoma precursors, HPV-associated

8077/2 High-grade squamous intraepithelial lesion

Squamous cell carcinoma precursors, HPV-independent

8071/2 Differentiated penile intraepithelial neoplasia

Invasive epithelial tumours of the penis and scrotum

Invasive squamous epithelial tumours
8085/3 Squamous cell carcinoma, HPV-associated
8083/3 Basaloid squamous cell carcinoma
8054/3 Warty carcinoma
8084/3 Clear cell squamous ceil carcinoma
8082/3 Lymphoepithelial carcinoma
8086/3 Squamous cell carcinoma, HPV-independent
8086/3 Squamous cell carcinoma, usual type
8051/3 Verrucous carcinoma (including carcinoma cuniculatum)
8052/3 Papillary squamous cell carcinoma
8074/3 Sarcomatoid squamous cell carcinoma
8070/3 Squamous cell carcinoma, NOS

Other epithelial tumours

8560/3 Adenosquamous carcinoma
8430/3 Mucoepidermoid carcinoma
8542/3 Paget disease, extramammary

Other scrotal tumours

8090/3 Basal cell carcinoma

These morphology codes are from the International Classification of Diseases for Oncology, third edition, second revision (ICD-O-3.2)
{1457}. Behaviour is coded /0 for benign tumours; /1 for unspecified, borderline, or uncertain behaviour; /2 for carcinoma in situ and
grade III intraepithelial neoplasia; /3 for malignant tumours, primary site; and /6 for malignant tumours, metastatic site. Behaviour code /6 is
not generally used by cancer registries.

This classification is modified from the previous WHO classification, taking into account changes in our understanding of these lesions.

n/a, not available (provisional entity).

* Codes marked with an asterisk were approved by the IARC/WHO Committee for ICD-0 at its meeting in Feb 2022.

十 Labels marked with a dagger have undergone a change in terminology of a previous code.

ICD-0 coding of urinary and male genital tumours 11

ICD-0 coding of neuroendocrine neoplasms
ICD-O-3.2 ICD-0 label (subtypes are indicated in grey text, with the label indented);
Please note that the WHO classification of tumour types is more readily reflected in the table of contents

Neuroendocrine tumours
8240/3 Neuroendocrine tumour, NOS
8240/3 Neuroendocrine tumour, grade 1
8249/3 Neuroendocrine tumour, grade 2

Neuroendocrine carcinomas
8041/3 Small cell neuroendocrine carcinoma
8013/3 Large cell neuroendocrine carcinoma
8154/3 Mixed neuroendocrine-non-neuroendocrine neoplasm
8045/3 Combined small cell neuroendocrine carcinoma
8013/3 Combined large cell neuroendocrine carcinoma

Paragangliomas
8693/3 Extra-adrenal paraganglioma

These morphology codes are from the International Classification of Diseases for Oncology, third edition, second revision (ICD-O-3.2)
{1457}. Behaviour is coded /0 for benign tumours; /1 for unspecified, borderline, or uncertain behaviour; /2 for carcinoma in situ and
grade III intraepithelial neoplasia; /3 for malignant tumours, primary site; and /6 for malignant tumours, metastatic site. Behaviour code /6 is
not generally used by cancer registries.
This classification is modified from the previous WHO classification, taking into account changes in our understanding of these lesions.

n/a, not available (provisional entity).

* Codes marked with an asterisk were approved by the IARC/WHO Committee for ICD-0 at its meeting in Feb 2022.

'Labels marked with a dagger have undergone a change in terminology of a previous code.

ICD-0 coding of mesenchymal tumours

ICD-O-3.2 (ICD-O-4.0) ICD-0 label (subtypes are indicated in grey text, with the label indented);
Please note that the WHO classification of tumour types is more readily reflected in the table of contents

Fibroblastic and myofibroblastic tumours

9160/0 (91600/0) Cellular angiofibroma
8825/0 (88250/0) Myofibroblastoma
8857/0 (88570/0) Spindle cell / pleomorphic lipoma
8815/0 (88150/0) Solitary fibrous tumour, benign
8815/1 (88150/1) Solitary fibrous tumour, NOS
8815/1 Lipomatous solitary fibrous tumour
8815/1 Dedifferentiated (anaplastic) solitary fibrous tumour
8815/3 (88150/3) Solitary fibrous tumour, malignant
8825/1 (88251/1) Inflammatory myofibroblastic tumour
/

12 ICD-0 coding of urinary and male genital tumours

ICD-O-3.2 ICD-0 label (subtypes are indicated in grey text, with the label indented);
Please note that the WHO classification of tumour types is more readily reflected in the table of contents

Vascular tumours
9120/0 Haemangioma, NOS
9121/0 Cavernous haemangioma
9131/0 Capillary haemangioma
9120/0 Anastomosing haemangioma
9125/0 Epithelioid haemangioma
9120/3 Angiosarcoma
9120/3 Epithelioid angiosarcoma

Pericytic (perivascular) tumours

8711/0 Glomus tumour, NOS
8712/0 Glomangioma
8713/0 Glomangiomyoma
8711/1 Glomangiomatosis
8711/1 Glomus tumour of uncertain malignant potential
8711/3 Malignant glomus tumour
9137/0 Myointimoma
8824/0 Myopericytoma
8714/0 PEComa, benign
8860/0 Sclerosing PEComa/angiomyolipoma
8714/3 Malignant PEComa

Smooth muscle tumours

8890/0 Leiomyoma, NOS
8897/1 Smooth muscle tumour of uncertain malignant potential
8890/3 Leiomyosarcoma, NOS
8890/3 Superficial leiomyosarcoma
8890/3 Deep leiomyosarcoma

Skeletal muscle tumours

8910/3 Embryonal rhabdomyosarcoma, NOS
8920/3 Alveolar rhabdomyosarcoma
8912/3 Spindle cell / sclerosing rhabdomyosarcoma

Tumours of uncertain differentiation

9040/3 Synovial sarcoma, NOS
9041/3 Synovial sarcoma, monophasic
9043/3 Synovial sarcoma, biphasic
9040/3 Synovial sarcoma, poorly differentiated
8963/3 Extrarenal rhabdoid tumour
8806/3 Desmoplastic small round cell tumour

These morphology codes are from the International Classification of Diseases for Oncology, third edition, second revision (ICD-O-3.2)
(1457). Behaviour is coded /0 for benign tumours; /1 for unspecified, borderline, or uncertain behaviour; /2 for carcinoma in situ and
grade III intraepithelial neoplasia; /3 for malignant tumours, primary site; and /6 for malignant tumours, metastatic site. Behaviour code /6 is
not generally used by cancer registries.
This classification is modified from the previous WHO classification, taking into account changes in our understanding of these lesions.

n/a, not available (provisional entity).

* Codes marked with an asterisk were approved by the IARC/WHO Committee for ICD-0 at its meeting in Feb 2022.

* Labels marked with a dagger have undergone a change in terminology of a previous code.

ICD-0 coding of urinary and male genital tumours 13

ICD-0 coding of haematolymphoid tumours
ICD-O-3.2 ICD-0 label (subtypes are indicated in grey text, with the label indented);
Please note that the WHO classification of tumour types is more readily reflected in the table of contents

Mature B-cell lymphomas

9699/3 Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue
9680/3 Diffuse large B-cell lymphoma, NOS
9734/3 Plasmacytoma, extramedullary

Histiocytic tumours
9749/1 Juvenile xanthogranuloma

These morphology codes are from the International Classification of Diseases for Oncology, third edition, second revision (ICD-O-3.2)
{1457}. Behaviour is coded /0 for benign tumours; /1 for unspecified, borderline, or uncertain behaviour; Z2 for carcinoma in situ and
grade III intraepithelial neoplasia; /3 for malignant tumours, primary site; and /6 for malignant tumours, metastatic site. Behaviour code /6 is
not generally used by cancer registries.
This classification is modified from the previous WHO classification, taking into account changes in our understanding of these lesions.

n/a, not available (provisional entity).

* Codes marked with an asterisk were approved by the IARC/WHO Committee for ICD-0 at its meeting in Feb 2022.

f Labels marked with a dagger have undergone a change in terminology of a previous code.

14 ICD-0 coding of urinary and male genital tumours

ICD-0 coding of melanocytic lesions
ICD-O-3.2 ICD-0 label (subtypes are indicated in grey text, with the label indented);
Please note that the WHO classification of tumour types is more readily reflected in the table of contents

8720/3 Mucosal melanoma

8746/3 Mucosal lentiginous melanoma
8721/3 Nodular melanoma

These morphology codes are from the International Classification of Diseases for Oncology, third edition, second revision (ICD-O-3.2)
{1457}. Behaviour is coded /0 for benign tumours; /1 for unspecified, borderline, or uncertain behaviour; /2 for carcinoma in situ and
grade III intraepithelial neoplasia; /3 for malignant tumours, primary site; and /6 for malignant tumours, metastatic site. Behaviour code /6 is
not generally used by cancer registries.

This classification is modified from the previous WHO classification, taking into account changes in our understanding of these lesions.

n/a, not available (provisional entity).

* Codes marked with an asterisk were approved by the IARC/WHO Committee for ICD-0 at its meeting in Feb 2022.

f Labels marked with a dagger have undergone a change in terminology of a previous code.

ICD-0 coding of urinary and male genital tumours 15

TNM staging of urological tumours

Urological Tumours

Introductory Notes Each site is described under the following headings:

The following sites are included: • Rules for classification with the procedures for assessing T, N,
• Penis and M categories; additional methods may be used when they
• Prostate enhance the accuracy of appraisal before treatment
• Testis • Anatomical sites and subsites where appropriate
• Kidney • Definition of the regional lymph nodes
• Renal pelvis and ureter • Distant metastasis
• Urinary bladder • TNM clinical classification
• Urethra • pTNM pathological classification
• G histopathological grading where applicable
• Stage

The information presented here has been excerpted from the 2017 TNM classification of malignant tumours, eighth edition (429,3242}. © 2017 UICC.
A help desk for specific questions about the TNM classification is available at https://www.uicc.org/tnm-help-desk.

16 TNM staging of urological tumours

TNM staging of carcinomas of the penis

Penis
(ICD-0-3 060)

Rules for Classification N - Regional Lymph Nodes

The classification applies only to carcinomas. There should be NX Regional lymph nodes cannot be assessed
histological confirmation of the disease. NO No palpable or visibly enlarged inguinal lymph nodes
The following are the procedures for assessing T, N, and M N1 Palpable mobile unilateral inguinal lymph node
categories: N2 Palpable mobile multiple or bilateral inguinal lymph nodes
N3 Fixed inguinal nodal mass or pelvic lymphadenopathy
T categories Physical examination and endoscopy
unilateral or bilateral
N categories Physical examination and imaging
M categories Physical examination and imaging
M 一 Distant Metastasis
MO No distant metastasis
M1 Distant metastasis
Anatomical Subsites
1. Prepuce (C60.0)
2. Glans penis (C60.1)
3. Body of penis (C60.2)
pTNM Pathological Classification
The pT categories correspond to the T categories. The pN
categories are based upon biopsy, or surgical excision.
pNX Regional lymph nodes cannot be assessed
Regional Lymph Nodes
pNO No regional lymph node metastasis
The regional lymph nodes are the superficial and deep inguinal
pN1 Metastasis in one or two inguinal lymph nodes
and the pelvic nodes.
pN2 Metastasis in more than two unilateral inguinal nodes or
bilateral inguinal lymph nodes
pN3 Metastasis in pelvic lymph node(s), unilateral or bilateral or
TNM Clinical Classification
extranodal extension of regional lymph node metastasis
T - Primary Tumour
TX Primary tumour cannot be assessed
TO No evidence of primary tumour
pM - Distant Metastasis*
pM1 Distant metastasis microscopically confirmed
Tis Carcinoma in situ (penile intraepithelial neoplasia - PelN)
Ta Non-invasive localized squamous cell carcinoma1
T1 Tumour invades subepithelial connective tissue2 Note
* pMO and pMX are not valid categories.
T1a Tumour invades subepithelial connective tissue
without lymphovascular invasion or perineural
invasion and is not poorly differentiated
T1 b Tumour invades subepithelial connective tissue Stage
Stage 0 Tis NO MO
with lymphovascular invasion or perineural
Ta NO MO
invasion or is poorly differentiated Stage I T1a NO MO
T2 Tumour invades corpus spongiosum with or without Stage IIA T1btT2 NO MO
invasion of the urethra Stage IIB T3 NO MO
T3 Tumour invades corpus cavernosum with or without Stage IIIA T1,T2,T3 N1 MO
invasion of the urethra Stage IIIB T1,T2,T3 N2 MO
Stage IV T4 Any N MO
T4 Tumour invades other adjacent structures
Any T N3 MO
Any T Any N M1
Notes
1 Including verrucous carcinoma
2 Glans: Tumour invades lamina propria
Foreskin: Tumour invades dermis, lamina propria or dartos fascia
Shaft: Tumour invades connective tissue between epidermis and
corpora and regardless of location

The information presented here has been excerpted from the 2017 TNM classification of malignant tumours, eighth edition (429,3242}. © 2017 UICC.
A help desk for specific questions about the TNM classification is available at https://www.uicc.org/tnm-help-desk.

TNM staging of urological tumours 17

TNM staging of adenocarcinomas of the prostate

Prostate
(ICD-O-3C61.9)

Rules for Classification N - Regional Lymph Nodes

The classification applies only to adenocarcinomas. Transitional NX Regional lymph nodes cannot be assessed
cell carcinoma of the prostate is classified as a urethral tumour NO No regional lymph node metastasis
(see p. 25). There should be histological confirmation of the N1 Regional lymph node metastasis
disease.
The following are the procedures for assessing T, N, and M Note
categories: Metastasis no larger than 0.2 cm can be designated pNmi.

Tcategories Physical examination, imaging, endoscopy,

biopsy, and biochemical tests
M - Distant Metastasis*
MO No distant metastasis
N categories Physical examination and imaging
M1 Distant metastasis
M categories Physical examination, imaging, skeletal studies,
M1a Non-regional lymph node(s)
and biochemical tests
M1b Bone(s)
M1c Other site(s)

Regional Lymph Nodes

Note
The regional lymph nodes are the nodes of the true pelvis,
* When more than one site of metastasis is present, the most
which essentially are the pelvic nodes below the bifurcation
advanced category is used. (p)M1c is the most advanced
of the common iliac arteries. Laterality does not affect the N
category.
classification.

pTNM Pathological Classification

TNM Clinical Classification
The pT and pN categories correspond to the T and N categories.
T 一 Primary Tumour
However, there is no pT1 category because there is insufficient
TX Primary tumour cannot be assessed
tissue to assess the highest pT category. There are no sub-cate­
TO No evidence of primary tumour
gories of pT2.
T1 Clinically inapparent tumour that is not palpable
T1a Tumour incidental histological finding in 5% or less
of tissue resected
pM - Distant Metastasis*
pM1 Distant metastasis microscopically confirmed
T1b Tumour incidental histological finding in more than
5% of tissue resected
Note
T1c Tumour identified by needle biopsy (e.g. because
* pMO and pMX are not valid categories.
of elevated PSA)
T2 Tumour that is palpable and confined within prostate
T2a Tumour involves one half of one lobe or less
T2b Tumour involves more than half of one lobe, but
G 一 Histopathological Grade Group12
GX Grade cannot be assessed
not both lobes
T2c Tumour involves both lobes
T3 Tumour extends through the prostatic capsule* Grade Group Gleason Score Gleason Pattern
T3a Extraprostatic extension (unilateral or bilateral) 《3 + 3
1 《6
including microscopic bladder neck involvement
T3b Tumour invades seminal vesicle(s) 2 7 3+4
T4 Tumour is fixed or invades adjacent structures other 3 7 4+3
than seminal vesicles: external sphincter, rectum, levator
4 8 4+4
muscles, and/or pelvic wall
5 9-10 4 +5, 5 +4, 5 + 5
Note
* Invasion into the prostatic apex or into (but not beyond) the
prostatic capsule is not classified as T3, but as T2.

The information presented here has been excerpted from the 2017 TNM classification of malignant tumours, eighth edition {429,3242}. © 2017 UICC.
A help desk for specific questions about the TNM classification is available at https://www.uicc.org/tnm-help-desk.

18 TNM staging of urological tumours

Stage* References
Stage I T1,T2a NO MO 1 Epstein JI, Egevad L, Amin MB, et al. The 2014
Stage II T2b,T2c NO MO International Society of Urological Pathology (ISUP)
Stage III T3.T4 NO MO Consensus Conference on Gleason Grading of Prostatic
Stage IV Any T N1 MO
Carcinoma: Definition of Grading Patterns and Proposal
Any T Any N M1
for a New Grading System. Am J Surg Pathol 2016; 40:
244-252.
Note
2 Humphrey PA, Egevard L, Netto GL, et al. Acinar
* The American Joint Committee on Cancer (AJCC) also publish
adenocarcinoma. In: WHO Classification of Tumours of the
a prognostic group for prostate tumours.
Urinary System and Male Genital Organs. Moch H, et al.,
eds. Lyon, France: IARC, 2016.

The information presented here has been excerpted from the 2017 TNM classification of malignant tumours, eighth edition (429,3242}. © 2017 UICC.
A help desk for specific questions about the TNM classification is available at https://www.uicc.org/tnm-help-desk.

TNM staging of urological tumours 19

TNM staging of germ cell tumours of the testis

Testis
(ICD-0-3 C62)

Rules for Classification N - Regional Lymph Nodes

The classification applies only to germ cell tumours of the testis. NX Regional lymph nodes cannot be assessed
There should be histological confirmation of the disease and NO No regional lymph node metastasis
division of cases by histological type. Histopathological grading N1 Metastasis with a lymph node mass 2 cm or less in
is not applicable. greatest dimension or multiple lymph nodes, none more
The presence of elevated serum tumour markers, including than 2 cm in greatest dimension
alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), N2 Metastasis with a lymph node mass more than 2 cm but
and lactate dehydrogenase (LDH), is frequent in this disease. not more than 5 cm in greatest dimension, or multiple
Staging is based on the determination of the anatomic extent of lymph nodes, any one mass more than 2 cm but not more
disease and assessment of serum tumour markers. than 5 cm in greatest dimension
The following are the procedures for assessing N, M, and S N3 Metastasis with a lymph node mass more than 5 cm in
categories： greatest dimension

N categories Physical examination and imaging

M categories Physical examination, imaging, and biochemical M - Distant Metastasis
MO No distant metastasis
tests
M1 Distant metastasis
S categories Serum tumour markers
M1a Non-regional lymph node(s) or lung metastasis
Stages are subdivided based on the presence and degree of M1b Distant metastasis other than non-regional lymph
elevation of serum tumour markers. Serum tumour markers are nodes and lung
obtained immediately after orchiectomy and, if elevated, should
be performed serially after orchiectomy according to the normal
decay for AFP (half-life 7 days) and hCG (half-life 3 days) to pTNM Pathological Classification
assess for serum tumour marker elevation. The S classification pT 一 Primary Tumour
is based on the nadir value of hCG and AFP after orchiectomy. pTX Primary tumour cannot be assessed (see T - Primary
The serum level of LDH (but not its half-life levels) has prognostic Tumour)
value in patients with metastatic disease and is included for pTO No evidence of primary tumour (e.g. histological scar in
staging. testis)
pTis Intratubular germ cell neoplasia (carcinoma in situ)
pT1 Tumour limited to testis and epididymis without vascular/
Regional Lymph Nodes lymphatic invasion; tumour may invade tunica albuginea
The regional lymph nodes are the abdominal para aortic but not tunica vaginalis*
(periaortic), preaortic, interaortocaval, precaval, paracaval, pT2 Tumour limited to testis and epididymis with vascular/
retrocaval, and retroaortic nodes. Nodes along the spermatic lymphatic invasion, or tumour extending through tunica
vein should be considered regional. Laterality does not affect the albuginea with involvement of tunica vaginalis
N classification. The intrapelvic nodes and the inguinal nodes are pT3 Tumour invades spermatic cord with or without vascular/
considered regional after scrotal or inguinal surgery. lymphatic invasion
pT4 Tumour invades scrotum with or without vascular/lymphatic
invasion
TNM Clinical Classification
T - Primary Tumour Note
Except for pTis and pT4, where radical orchiectomy is not always * The American Joint Committee on Cancer (AJCC) subdivides
necessary for classification purposes, the extent of the primary T1 by T1a and T1b depending on size no greater than 3 cm or
tumour is classified after radical orchiectomy; see pT. In other greater than 3 cm in greatest dimension.
circumstances, TX is used if no radical orchiectomy has been
performed.

The information presented here has been excerpted from the 2017 TNM classification of malignant tumours, eighth edition {429,3242}. © 2017 UICC.
A help desk for specific questions about the TNM classification is available at https://www.uicc.org/tnm-help-desk.

20 TNM staging of urological tumours

pN - Regional Lymph Nodes Prognostic Group
pNX Regional lymph nodes cannot be assessed Stage 0 pTis NO M0 SO
pNO No regional lymph node metastasis Stage I pT1-4 NO M0 SX
pN1 Metastasis with a lymph node mass 2 cm or less in Stage IA pT1 NO M0 SO
Stage 旧 pT2-4 NO M0 SO
greatest dimension and 5 or fewer positive nodes, none
Stage IS Any pT/TX NO M0 S1-3
more than 2 cm in greatest dimension Stage II Any pT/TX N1-3 MO SX
pN2 Metastasis with a lymph node mass more than 2 cm but Stage IIA Any pT/TX N1 MO SO
not more than 5 cm in greatest dimension; or more than Any pT/TX N1 MO S1
5 nodes positive, none more than 5 cm; or evidence of Stage IIB Any pT/TX N2 MO SO
extranodal extension of tumour Any pT/TX N2 MO S1
pN3 Metastasis with a lymph node mass more than 5 cm in Stage IIC Any pT/TX N3 MO SO
Any pT/TX N3 MO S1
greatest dimension
Stage III Any pT/TX Any N M1a SX
Stage IIIA Any pT/TX Any N M1a so
Any pT/TX Any N M1a S1
pM - Distant Metastasis* Stage IIIB Any pT/TX N1-3 MO S2
pM1 Distant metastasis microscopically confirmed Any pT/TX Any N M1a S2
Stage IIIC Any pT/TX N1-3 MO S3
Note Any pT/TX Any N M1a S3
Any pT/TX Any N M1b Any S
* pMO and pMX are not valid categories.

S - Serum Tumour Markers

SX Serum marker studies not available or not performed
SO Serum marker study levels within normal limits

LDH hCG (mIU/mL) AFP (ng/mL)

S1 < 1.5 x N and < 5000 and <1000

S2 1.5-10 xN or 5000-50 000 or 1000-10 000
S3 > 10 x N or > 50 000 or > 10 000

Note
N indicates the upper limit of normal for the LDH assay.

The information presented here has been excerpted from the 2017 TNM classification of malignant tumours, eighth edition {429,3242). © 2017 UICC.
A help desk for specific questions about the TNM classification is available at https://www.uicc.org/tnm-help-desk.

TNM staging of urological tumours 21

TNM staging of renal cell carcinoma

Kidney
(ICD-0-3 C64)

Rules for Classification N - Regional Lymph Nodes

The classification applies only to renal cell carcinoma. There NX Regional lymph nodes cannot be assessed
should be histological confirmation of the disease. NO No regional lymph node metastasis
The following are the procedures for assessing T, N, and M N1 Metastasis in regional lymph node(s)
categories:
T categories Physical examination and imaging M - Distant Metastasis
MO No distant metastasis
N categories Physical examination and imaging
M1 Distant metastasis
M categories Physical examination and imaging

Regional Lymph Nodes pTNM Pathological Classification

The pT and pN categories correspond to the T and N categories.
The regional lymph nodes are the hilar, abdominal para-aortic,
and paracaval nodes. Laterality does not affect the N categories.
pM - Distant Metastasis*
pM1 Distant metastasis microscopically confirmed

TNM Clinical Classification

Note
T - Primary Tumour
* pMO and pMX are not valid categories.
TX Primary tumour cannot be assessed
TO No evidence of primary tumour
T1 Tumour 7 cm or less in greatest dimension, limited to the
kidney Stage
Stage I T1 NO MO
T1a Tumour 4 cm or less
Stage II T2 NO MO
T1b Tumour more than 4 cm but not more than 7 cm Stage III T3 NO MO
T2 Tumour more than 7 cm in greatest dimension, limited to T1.T2.T3 N1 MO
the kidney Stage IV T4 Any N MO
T2a Tumour more than 7 cm but not more than 10 cm Any T Any N M1
T2b Tumour more than 10 cm, limited to the kidney
T3 Tumour extends into major veins or perinephric tissues
but not into the ipsilateral adrenal gland and not beyond
Gerota fascia
T3a Tumour extends into the renal vein or its segmental
branches, or tumour invades the pelvicalyceal
system or tumour invades perirenal and/or renal
sinus fat (peripelvic) fat but not beyond Gerota
fascia
T3b Tumour extends into vena cava below diaphragm
T3c Tumour extends into vena cava above the
diaphragm or invades the wall of the vena cava
T4 Tumour invades beyond Gerota fascia (including
contiguous extension into the ipsilateral adrenal gland)

The information presented here has been excerpted from the 2017 TNM classification of malignant tumours, eighth edition {429,3242). © 2017 IIICC.
A help desk for specific questions about the TNM classification is available at https://www.uicc.org/tnm-help-desk.

22 TNM staging of urological tumours

TNM staging of carcinomas of the renal pelvis and ureter

Renal Pelvis and Ureter

(ICD-O-3 C65, C66)

Rules for Classification N - Regional Lymph Nodes

The classification applies to carcinomas. Papilloma is excluded. NX Regional lymph nodes cannot be assessed
There should be histological or cytological confirmation of the NO No regional lymph node metastasis
disease. N1 Metastasis in a single lymph node 2 cm or less in greatest
The following are the procedures for assessing T, N, and M dimension
categories: N2 Metastasis in a single lymph node more than 2 cm, or
multiple lymph nodes
Tcategories Physical examination, imaging, and endoscopy
N categories Physical examination and imaging
M categories Physical examination and imaging M - Distant Metastasis
MO No distant metastasis
M1 Distant metastasis

Anatomical Sites
1. Renal pelvis (C65)
2. Ureter (C66) pTNM Pathological Classification
The pT and pN categories correspond to the T and N categories.

pM - Distant Metastasis*
Regional Lymph Nodes
pM1 Distant metastasis microscopically confirmed
The regional lymph nodes are the hilar, abdominal para-aortic,
and paracaval nodes and, for ureter, intrapelvic nodes. Laterality
Note
does not affect the N classification.
* pMO and pMX are not valid categories.

TNM Clinical Classification

T - Primary Tumour Stage
Stage Oa NO MO
TX Primary tumour cannot be assessed
Stage Ois NO MO
TO No evidence of primary tumour Stage I NO MO
Ta Non-invasive papillary carcinoma Stage II NO MO
Tis Carcinoma in situ Stage III NO MO
T1 Tumour invades subepithelial connective tissue Stage IV NO MO
T2 Tumour invades muscularis Any T N1.N2 MO
Any T Any N M1
T3 (Renal pelvis) Tumour invades beyond muscularis into
peripelvic fat or renal parenchyma
(Ureter) Tumour invades beyond muscularis into
periureteric fat
T4 Tumour invades adjacent organs or through the kidney into
perinephric fat

The information presented here has been excerpted from the 2017 TNM classification of malignant tumours, eighth edition {429,3242}. © 2017 UICC.
A help desk for specific questions about the TNM classification is available at https://www.uicc.org/tnm-help-desk.

TNM staging of urological tumours 23

TNM staging of carcinomas of the urinary bladder

Urinary Bladder
(ICD-O-3 C67)

Rules for Classification N - Regional Lymph Nodes

The classification applies to carcinomas. Papilloma is excluded. NX Regional lymph nodes cannot be assessed
There should be histological or cytological confirmation of the NO No regional lymph node metastasis
disease. N1 Metastasis in a single lymph node in the true pelvis
The following are the procedures for assessing T, N, and M (hypogastric, obturator, external iliac, or presacral)
categories: N2 Metastasis in multiple regional lymph nodes in the true
pelvis (hypogastric, obturator, external iliac, or presacral)
T categories Physical examination, imaging, and endoscopy
N3 Metastasis in a common iliac lymph node(s)
N categories Physical examination and imaging
M categories Physical examination and imaging
M - Distant Metastasis
MO No distant metastasis
M1 Distant metastasis
Regional Lymph Nodes
M1a Non-regional lymph nodes
The regional lymph nodes are the nodes of the true pelvis,
M1 b Other distant metastasis
which essentially are the pelvic nodes below the bifurcation
of the common iliac arteries. Laterality does not affect the
N classification.
pTNM Pathological Classification
The pT and pN categories correspond to the T and N categories.

TNM Clinical Classification

T - Primary Tumour pM 一 Distant Metastasis*
pM1 Distant metastasis microscopically confirmed
The suffix (m) should be added to the appropriate T category to
indicate multiple tumours. The suffix (is) may be added to any T
to indicate presence of associated carcinoma in situ. Note
TX Primary tumour cannot be assessed * pMO and pMX are not valid categories.
TO No evidence of primary tumour
Ta Non-invasive papillary carcinoma
Tis Carcinoma in situ: 'flat tumour' Stage
Stage Oa Ta NO
T1 Tumour invades subepithelial connective tissue
Stage Ois Tis NO
T2 Tumour invades muscularis propria T1 NO
Stage I
T2a Tumour invades superficial muscularis propria Stage II T2a,T2b NO
(inner half) Stage IIIA T3a,T3b,T4a NO
T2b Tumour invades deep muscularis propria (outer T1,T2,T3,T4a N1
half) Stage IIIB T1,T2,T3,T4a N2.N3
T3 Tumour invades perivesical tissue: Stage IVA T4b Any N
Any T Any N
T3a microscopically
Stage IVB Any T Any N
T3b macroscopically (extravesical mass)
T4 Tumour invades any of the following: prostate stroma,
seminal vesicles, uterus, vagina, pelvic wall, abdominal
wall
T4a Tumour invades prostate stroma, seminal vesicles,
uterus or vagina
T4b Tumour invades pelvic wall or abdominal wall

The information presented here has been excerpted from the 2017 TNM classification of malignant tumours, eighth edition (429,3242}. © 2017 UICC.
A help desk for specific questions about the TNM classification is available at https://www.uicc.org/tnm-help-desk.

24 TNM staging of urological tumours

TNM staging of carcinomas of the urethra

Urethra
(ICD-O-3C68.0, C61.9)

Rules for Classification N 一 Regional Lymph Nodes

The classification applies to carcinomas of the urethra (ICD-0-3 NX Regional lymph nodes cannot be assessed
C68.0) and transitional cell carcinomas of the prostate (ICD-0-3 NO No regional lymph node metastasis
C61.9) and prostatic urethra. There should be histological or N1 Metastasis in a single lymph node
cytological confirmation of the disease. N2 Metastasis in multiple lymph nodes
The following are the procedures for assessing T, N, and M
categories： M - Distant Metastasis
MO No distant metastasis
Tcategories Physical examination, imaging, and endoscopy
M1 Distant metastasis
N categories Physical examination and imaging
M categories Physical examination and imaging

pTNM Pathological Classification

The pT and pN categories correspond to the T and N categories.
Regional Lymph Nodes
The regional lymph nodes are the inguinal and the pelvic nodes.
Laterality does not affect the N classification.
pM - Distant Metastasis*
pM1 Distant metastasis microscopically confirmed

Note
TNM Clinical Classification
* pMO and pMX are not valid categories.
T - Primary Tumour
TX Primary tumour cannot be assessed
TO No evidence of primary tumour
Stage
Stage Oa NO MO
Urethra (male and female)
Stage Ois NO MO
Ta Non-invasive papillary, polypoid, or verrucous carcinoma Stage I NO MO
Tis Carcinoma in situ Stage II NO MO
T1 Tumour invades subepithelial connective tissue Stage III T1,T2 N1 MO
T2 Tumour invades any of the following: corpus spongiosum, N0.N1 MO
prostate, periurethral muscle Stage IV N0.N1 MO
Any T N2 MO
T3 Tumour invades any of the following: corpus cavernosum,
Any T Any N M1
beyond prostatic capsule, anterior vagina, bladder neck
(extraprostatic extension)
T4 Tumour invades other adjacent organs (invasion of the
bladder)

Urothelial (transitional cell) carcinoma of the prostate

Tis Carcinoma in situ, involving the prostatic urethra,
periurethral or prostatic ducts without stromal invasion
T1 Tumour invades subepithelial connective tissue (for
tumours involving prostatic urethra only)
T2 Tumour invades any of the following: prostatic stroma,
corpus spongiosum, periurethral muscle
T3 Tumour invades any of the following: corpus cavernosum,
beyond prostatic capsule, bladder neck (extraprostatic
extension)
T4 Tumour invades other adjacent organs (invasion of the
bladder or rectum)

The information presented here has been excerpted from the 2017 TNM classification of malignant tumours, eighth edition {429,3242}. © 2017 UICC.
A help desk for specific questions about the TNM classification is available at https://www.uicc.org/tnm-help-desk.

TNM staging of urological tumours 25

Introduction to urinary and male genital tumours
Edited by: Moch H, Tickoo SK
Introduction to urinary and Srigley JR
Amin MB

male genital tumours Gill AJ

Turajlic S

This fifth-edition volume of the WHO Classification of Tumours testing for markers such as PDL1 is rapidly evolving and may
series (the WHO Blue Books), devoted to tumours of the urinary assume increased importance. Additionally, alterations in DNA
and male genital tracts, is a complete revision of the fourth­ repair genes may be important in identifying patients, for instance
edition volume published in 2016 (2191). In the fourth-edition those with castration-resistant prostate cancer, who should
volume on urological tumours there were dramatic changes in receive PARP inhibitor therapy or other novel treatments {794}.
tumour classification across all anatomical sites, which is not In keeping with other volumes in the fifth edition, tumour
surprising considering that the third edition had been published categories that are not unique to the genitourinary organs are
some 12 years earlier (914). Although there is less change over­ handled in separate chapters after those dealing with the spe­
all in this newest volume, considerable advances have been cific anatomical sites. For instance, neuroendocrine neoplasms,
made since 2016 and, as appropriate, these have been incor­ which can occur in many organ systems and in several ana­
porated herein. Many approaches to classification used in the tomical sites within a given organ system, are handled in a dedi­
earlier edition have been validated, and new advances have cated chapter. The classification and terminology developed at
occurred. the 2017 International Agency for Research on Cancer (IARC)
In recent years, precision medicine and targeted therapies, neuroendocrine neoplasms consensus conference is used
and their increased adoption in clinical practice, have had a {2674}. Instead of having multiple separate sections about an
major impact in the field by complementing the role of histo­ entity such as small cell neuroendocrine carcinoma (SCNEC) in
pathology in the prognostication and prediction of cancer. The the kidney, bladder, upper urothelial tract, and prostate chap­
application of molecular profiling has also made a substantial ters, there is a single section devoted to SCNEC within the
impact on tumour taxonomy and the classification of human neuroendocrine neoplasms chapter; however, a separate sec­
malignancies, most notably observed in kidney cancer among tion on treatment-related neuroendocrine carcinoma (NEC) has
the urological malignancies. Thus, while morphology remains been included only in the prostate chapter, because this aspect
the foundation for the taxonomy in this new volume, there is in is unique to that site.
addition a group of molecularly defined renal tumour entities. There are also chapters devoted specifically to mesenchy­
This also extends to independent molecular approaches to the mal, haematolymphoid, melanocytic, and metastatic tumours,
classification of urothelial carcinoma (1308A,1603A(, which as well as a separate chapter on the diverse genetic syndromes
have provided a novel way of conceptualizing bladder cancer relevant to the urinary and male genital tracts.
beyond the traditional low- and high-grade categories for non- In recent years, there have been some major unresolved
invasive carcinomas. These approaches and the emerging role controversies in urological pathology that have led to the state
of immunotherapies for the management of select advanced where two separate societies now represent the field. The edi­
malignancies are also likely to influence future paradigms of torial leadership of the current volume has sought appropriate
tumour taxonomy. balance in assembling the authorship teams. These major
The increasing emphasis on molecular classification under­ controversies are in the field of prostate cancer and relate to
scores the importance of having appropriate ancillary tech­ intraductal carcinoma of the prostate and whether it should be
nology in our pathology laboratories. High-quality immuno­ included in the Gleason grading, as well as other nuances of
histochemistry and molecular testing have become crucial for grading and nomenclature. As much as possible, the current
accurate cancer diagnosis, prognosis, and prediction. This has WHO classification of urinary and male genital tumours strives
important implications for low- and middle-income countries, to use evidence in defining entities. A hierarchical approach
where it may be difficult to get high-quality routine histology, to evidence is used, with the following categories listed in
let alone contemporary ancillary testing. Even in high-income decreasing order of significance: systematic reviews, prospec­
countries, the availability of immunohistochemistry and molecu­ tive controlled trials, retrospective cohort studies, series and

一
lar testing may be limited because of geographical, fiscal, and case reports, and expert opinion. Understandably, for some
human resource issues. These facts have implications for the topics, decisions are based solely on expert opinion because
WHO Blue Books, because they are written for worldwide use. no other evidence exists expert opinion is still evidence, even
Therefore, major emphasis is placed on histopathological cri­ if prone to bias. It is also important to remember that this vol­
teria, and essential and desirable diagnostic criteria are listed ume represents a structured classification document for urinary
within each entity section. and male genital tumours and not a comprehensive textbook
Unlike for some anatomical sites (such as breast and lung) or atlas of urological pathology. Therefore, some details on
where predictive biomarker testing has become routine, and topics such as tumour grading and staging, and the complete
indeed critical for patient management, this has not been the morphological range for a given neoplastic entity, cannot be
case thus far for urological cancers. However, there is ongoing covered.
work related to the role of immunotherapies in advanced-stage In this volume, the anatomical sites are covered in the follow­
bladder cancer and other urological tumours. Thus, the role of ing order: kidney, urinary tract, prostate gland, seminal vesicle,

28 Introduction to urinary and male genital tumours

 testis, testicular adnexa, and penis and scrotum. Each chapter consistent with the recommended WHO nomenclature used in
contains its own introduction, in which major changes and con­ this volume for bladder, kidney, and penile carcinoma grading.
troversies are outlined. Furthermore, some introductions cover The issue of including (or excluding) intraductal carcinoma
topics and entities that do not have a dedicated section. In the in the Gleason grade is controversial because the two socie­
following paragraphs, some highlights of the classification are ties representing urological pathology have different views on
presented. this matter. Additional studies are required to compare the two
The adult renal tumour classification in the fourth edition was approaches from a prognostic perspective. In view of the lack
heavily based on the 2013 International Society of Urological of evidence supporting one position over the other, the deci­
Pathology (ISUP) Vancouver classification {3014). This taxon­ sion as to which to use is left up to the pathologist working in a
omy has evolved in the current iteration, with some new entities particular multidisciplinary environment.
added, including eosinophilic, solid, and cystic renal cell carci­ It is recognized that classic Gleason grading is an important
noma; ELOC (formerly TCEB7)-mutated renal cell carcinoma; independent prognostic factor that correlates with PSA level,
and SMARCB1 (INH)-deficient renal medullary carcinoma. The clinical recurrence, and survival; however, Gleason grading
last two belong to a new subcategory of molecularly defined has reproducibility issues, with only modest kappa scores. The
renal cell carcinomas. /A/-^-rearranged renal cell carcinoma fields of artificial intelligence (Al) and computational pathology
(RCC), which was included in the emerging RCC category in the hold great promise for improving both the effectiveness and
fourth edition, is now included as a recognized entity. Further­ reproducibility of grading, leading to their special mention in the
more, hereditary leiomyomatosis and RCC syndrome-associ­ current edition {3048,466}.
ated RCC is subsumed under the fumarate hydratase-deficient The classification of testicular germ cell neoplasms (TGCNs)
RCC category, which also includes some sporadic tumours. follows that in the fourth edition, using a combined pathogenetic
In the urothelial tract, the binary approach to morphological and morphological approach. Tumours associated with germ
grading of papillary carcinoma is maintained, which reflects to cell neoplasia in situ are type 2 in the pathogenetic classification
a great extent the two major pathways of evolution of urothelial {2385}. These tumours constitute the majority of adult TGCNs,
neoplasms. Furthermore, papillary urothelial neoplasm of low and they are separated from the less common prepubertal-
malignant potential is retained as a diagnostic category. In the type teratomas, yolk sac tumours and mixed teratoma-yolk sac
invasive urothelial carcinoma category, there is focus on the tumours (type 1 TGCNs), and spermatocytic tumours (type 3
importance of subtype histology, including aggressive sub­ TGCNs).
types such as plasmacytoid and micropapillary urothelial car­ Penile squamous cell carcinomas and associated precursor
cinoma. Beyond morphology, there is increasing emphasis on lesions are classified into HPV-associated and HPV-independ-
the molecular classification of urothelial carcinoma, with several ent categories, like the those used in the fourth-edition WHO
proposed omics schemes (2686,2185,1576). This approach classification. This approach reflects the different pathogenetic
may prove useful in stratifying prognosis in the morphologically mechanisms underlying penile cancer and is in keeping with the
defined low- and high-grade categories. classification of squamous tumours at other sites. The diverse
The prostate section sees no dramatic changes in the classifi­ morphological patterns of penile squamous cell carcinoma are
cation. However, there is a distinction (which may be somewhat grouped in appropriate pathogenetic categories, and (where
arbitrary) between histological patterns of acinar adenocarci­ indicated) an attempt has been made to simplify the morpho­
noma, such as atrophic, pseudohyperplastic, cystic, foamy logical classification. For the first time in the history of the geni­
gland, and mucinous, and special subtypes of acinar adenocar­ tourinary WHO Blue Book, a separate classification on tumours
cinoma, which include prostatic intraepithelial neoplasia-like, of the scrotum is included with a separate section on basal cell
plasmacytoid (signet ring-like), sarcomatoid, and pleomorphic carcinoma of the scrotum. The histology of squamous cell carci­
giant cell adenocarcinoma. The subtypes have implications noma and extramammary Paget disease of the scrotum follows
that relate to differential diagnosis and/or prognosis, whereas the same paradigm as that of the penile counterparts, so the
the patterns have no special prognostic significance beyond same terminology is adopted for these tumours.
their associated Gleason grade but are important because they Overall, the new WHO classification of urinary and male geni­
may simulate a benign histological pattern and may be under­ tal tumours is presented in a uniform format using standardized
recognized as malignant. subsections, and it is structured as a database that can be
A succinct segment deals with Gleason grading and empha­ easily modified going forward. As new clinical, morphological,
sizes the importance of providing the underlying Gleason grades and molecular genetic data and information are synthesized,
and not relying entirely on the derivative grade groups (ISUP the database can be modified and updated to form the basis of
grades), which may be heterogeneous (i.e. grade group 4). future editions of the WHO classification. Additionally, this book
Because a variety of names are used in the literature to indicate is available as an online resource, complete with digital illustra­
the grade grouping, it is suggested that the term "WHO grade" tions, whole slide images, and relevant hyperlinks, permitting
be used for the sake of simplicity and harmonization. This is also users to have an enriched real-time experience.

Introduction to urinary and male genital tumours 29

Tumours of the kidney
Edited by: Amin MB, Gill AJ, Hartmann A, Lazar AJ, Moch H, Tickoo SK, Turajlic S

Renal cell tumours Metanephric tumours

Clear cell renal tumours Metanephric adenoma
Clear cell renal cell carcinoma Metanephric adenofibroma
Multilocular cystic renal neoplasm of low malignant potential Metanephric stromal tumour
Papillary renal tumours Mixed epithelial and stromal renal tumours
Renal papillary adenoma Mixed epithelial and stromal tumour of the kidney
Papillary renal cell carcinoma Paediatric cystic nephroma
Oncocytic and chromophobe renal tumours Renal mesenchymal tumours
Oncocytoma of the kidney Adult renal mesenchymal tumours
Chromophobe renal cell carcinoma Classic angiomyolipoma / PEComa of the kidney
Other oncocytic tumours of the kidney Epithelioid angiomyolipoma / epithelioid PEComa
Collecting duct tumours of the kidney
Collecting duct carcinoma Renal haemangioblastoma
Other renal tumours Juxtaglomerular cell tumour
Clear cell papillary renal cell tumour Renomedullary interstitial cell tumour
Mucinous tubular and spindle cell carcinoma Paediatric renal mesenchymal tumours
Tubulocystic renal cell carcinoma Ossifying renal tumour of infancy
Acquired cystic disease-associated renal cell carcinoma Congenital mesoblastic nephroma
Eosinophilic solid and cystic renal cell carcinoma Rhabdoid tumour of the kidney
Renal cell carcinoma NOS Clear cell sarcoma of the kidney
Molecularly defined renal carcinomas Embryonal neoplasms of the kidney
7FE3-rearranged renal cell carcinomas Nephroblastic tumours
TT^B-altered renal cell carcinomas Nephrogenic rests
ELOC (formerly TCEB /)-mutated renal cell carcinoma Cystic partially differentiated nephroblastoma
Fumarate hydratase-deficient renal cell carcinoma Nephroblastoma
Succinate dehydrogenase-deficient renal cell carcinoma Miscellaneous renal tumours
MK-reairanged renal cell carcinomas Germ cell tumours of the kidney
SMARCB1-deficient renal medullary carcinoma
Renal cell tumours: Introduction Raspollini MR
Amin MB
Moch H
Tan PH
Turajlic S

Epidemiology of deaths was 89 620 in male patients and 48 910 in female

The incidence and mortality rates of renal cell tumours have patients (245). Kidney cancer is the 16th most common cause
been increasing in many countries, across different levels of of death from cancer worldwide. The case fatality rate is lower
socioeconomic development (see Table 2.01). in high-income countries (overall mortality-to-incidence ratio:
0.4) than in low- and middle-income countries (0.5). Only 3.1%
Incidence of the cases were diagnosed in Africa, but 5.7% of the deaths
Renal cell carcinoma (RCC) accounts for 2% of all cancers occurred in this region {245}.
globally and is the cause of 2% of cancer deaths {2417}. In
2020, there were 271 249 new cases in men (age-standardized Etiology
rate of 6.1 cases per 100 000 population) and 160 039 cases in Obesity
women (age-standardized rate of 3.2 cases per 100 000 popu­ Obesity is a risk factor for kidney cancer in both men and women
lation) (3070). The M:F ratio was 1.24:1 in 1990 and 1.58:1 in {228,1913). There is an association between baseline body mass
2017 {245). Kidney cancer currently ranks as the seventh most index and renal cancer risk, with increased risk when raised body
common cancer in men and the tenth most common in women mass index is documented at age 50. Weight gain of > 20 kg
{3076}. The incidence is higher in high-income countries than between the ages of 18 and 35 years or between the ages of 35
in low-income countries, with the highest rates in Belarus (age- and 50 years is correlated with renal cancer risk (23(. The propor­
standardized rate of 16.8 cases per 100 000 population) in tion of all cases of renal cancer attributable to being overweight
2018, followed by Latvia, Lithuania, and the Czech Republic or obese has been estimated at about 40% in the USA and up
(994). Elevated rates of kidney cancer are also found in northern to 40% in European countries {2653,2654). The mechanisms by
and eastern Europe, North America, and Australia. Low rates which obesity influences renal carcinogenesis are unclear, with
are reported in Africa and eastern Asia {245). chronic inflammation in adipose tissue and immune dysregula-
tion potentially promoting carcinogenesis (1843). Renal cell pro­
Mortality liferation may be caused by sex steroid hormones through direct
Globally, deaths from kidney cancer increased from 68 140 endocrine receptor-mediated effects. Obesity associated with
in 1990 to 138 530 in 2017 {245}, with those in male patients endocrine disorders, accompanied by decreased levels of sex
exceeding those in female patients： in 2017, the total number hormone-binding globulin and progesterone, insulin resistance,

Age standardized (World) incidence rates, kidney, males, all ages

Fig. 2.01 Renal cancer. Estimated age-standardized global incidence rates (World), per 100 000 person-years, of renal cancer in 2020 among males (all ages).

32 Tumours of the kidney

and increased levels of growth factors such as IGF1, may be cancer than never-smokers (638,1427), with a dose-dependent
factors in renal carcinogenesis. No convincing association has increase in risk related to the number of cigarettes smoked per
been found between the ingestion of red and processed meat­ day, and that risk decreases in the 5-year period after smoking
poultry, or seafood and the risk of RCC (1826,1827}. cessation. Epidemiological data on kidney cancer causation by
smoking are often biased because cancer registries do not typi­
Smoking cally differentiate between RCCs and urothelial carcinomas of
Cigarette smoking is causally related to renal cancer. Meta­ the renal pelvis, for which smoking is also a significant risk fac­
analyses indicate that ever-smokers have a higher risk of renal tor. In a study on smoking prevalence among 30 282 patients

Table2.01 Relative proportions of kidney cancer types3 recorded by population-based cancer registries by age and geogr叩hical region, cases diagnosed in 2001-2010bc

Age group (years)

Renal cancer type
0d 1-4 5-9 10-14 15-19

Total numbers of cases in each age group, all world regions combined

Wilms tumour (Vla1) 1812 8751 2813 462 181

Rhabdoid renal tumour (Vla2) 197 109 15 6 4

Kidney sarcomas (Vla3) 57 286 55 33 7

Renal cell carcinomas (Vlb) 13 69 155 306 564

Unspecified (Vic) 33 87 38 23 44

All malignant renal tumours 2112 9302 3076 830 800

Cases as a percentage of all malignant renal tumours

Wilms tumour 85.8% 94.1% 91.4% 55.7% 22.6%

Rhabdoid renal tumour 9.3% 1.2% 0.5% 0.7% 0.5%

Kidney sarcomas 2.7% 3.1% 1.8% 4.0% 0.9%

Renal cell carcinomas 0.6% 0.7% 5.0% 36.9% 70.5%

Unspecified 1.6% 0.9% 1.2% 2.8% 5.5%

Relative proportions of Wilms tumour and renal cell carcinomas (n = total number of renal cancer cases registered per region)

North America (n = 5943)

Wilms tumour 82.9% 93.8% 90.8% 48.6% 18.4%

Renal cell carcinomas 0.8% 0.6% 6.1% 46.5% 78.4%

Europe (n = 5682)

Wilms tumour 87.4% 95.1% 92.5% 60.7% 26.0%

Renal cell carcinomas 0.4% 0.5% 4.3% 34.0% 64.4%

Latin America and the Caribbean (n = 1174)

Wilms tumour 90.2% 93.4% 90.6% 58.7% 40.0%

Renal cell carcinomas 0.6% 0.9% 2.1% 24.0% 48.6%

Asia (n=1734)

Wilms tumour 84.2% 91.0% 89.6% 57.5% 33.3%

Renal cell carcinomas 1.2% 2.1% 5.5% 23.8% 52.4%

Africa (n = 1157)

Wilms tumour 90.7% 95.7% 95.8% 83.9% 21.7%

Renal cell carcinomas 0.0% 0.1% 2.5% 9.7% 60.9%

Oceania (n = 403)

Wilms tumour 86.3% 94.7% 96.1% 33.3% 36.4%

Renal cell carcinomas 0.0% 1.3% 1.3% 63.0% 54.5%

aTumours classified in group VI (renal tumours) according to the International Classification of Childhood Cancer (ICCC), third edition, 2017 update (ICCC-3-2017) (3077).
bNumbers derived from population-based cancer registry data submitted by International Incidence of Childhood Cancer 3 (IICC-3) contributors (3028}. cData extracted from sup­
plementary Table S3 of Nakata et al. (2020) (2282). dNumbers do not include the benign entity mesoblastic nephroma; this entity is reported by a collaborative effort of international
childhood renal tumour study groups to account for 54% of all renal tumours diagnosed in the first month, 33% in the second, 16% in the third, and < 10% of all tumours diagnosed
in the fourth and subsequent months of life (3276}.

Tumours of the kidney 33

 Age standardized (World) incidence rates, kidney, females, all ages

■ 2 5.4
■ 32-5.4
■■ 2.0>3.2
■■ 13-2.0
0.88-1.3
<0 88

Fig. 2.02 Renal cancer. Estimated age-standardized global incidence rates (World), per 100 000 person-years, of renal cancer in 2020 among females (all ages).

with renal cancer, 50.2% were current or former cigarette smok­ significant relative risks of 1.3 overall and 1.6 for high-exposure
ers. When correlated with histological types of RCC, the propor­ groups (1627,2864(. The International Agency for Research on
tions of current or former smokers ranged from 38% in patients Cancer (IARC) has classified trichloroethylene as Group 1 (car­
with chromophobe carcinoma to 61.9% in those with collecting cinogenic to humans) on the basis of it causing kidney cancer. It
duct / medullary carcinoma, suggesting that chromophobe car­ is unlikely that coffee has a substantial effect (3569) or that alco­
cinoma has a weaker association with smoking than do other holic drinks have an adverse effect on the risk of this cancer.
RCCs{1088}.
Genetic susceptibility
Hypertension In this fifth-edition volume, the importance of genetic tumour
Hypertension or its treatment has been shown to be associated syndromes in kidney neoplasia is emphasized in a dedicated
with risk of renal cancer (3426,518} independently of obesity, chapter (Chapter 14: Genetic tumour syndromes of the urinary
with an increased risk associated with hypertensive medication and male genital tracts).
including diuretics. Acute kidney injury has been shown to cor­
relate with papillary RCC (2483(. Classification
In this fifth edition, there is a new category of molecularly defined
Acquired cystic disease renal tumour entities. Tumour classification is a dynamic pro­
Patients on long-term haemodialysis due to end-stage renal cess, integrating multiple new areas of information based on
disease develop renal cysts and have an increased risk of enhanced molecular interrogations that have been conducted
renal cancer (3-7%) (841). They are 100 times more likely than by numerous investigators since the publication of the previous
people in the general population to develop renal cancer {841(. edition. Attempts to classify RCC have traditionally been based
Some renal cancer types occur exclusively in end-stage renal on defining subtypes according to the predominant cytoplas­
disease. These tumours show tubular, papillary, tubulopapillary, mic or architectural features, with the consecutive identification
microcystic, and solid patterns, with tumour cells having abun­ of specific genotype-phenotype correlations (e.g. clear cell
dant eosinophilic cytoplasm and large nuclei with conspicuous RCC, papillary RCC) or tumour location (e.g. collecting duct
nucleoli, including intracytoplasmic lumina and intercellular and renal medullary carcinomas), correlations with background
spaces that impart a cribriform (sieve-1 ike) appearance {3162, renal disease (e.g. acquired cystic disease-associated RCC),
2578,1701,2889). In addition to these acquired cystic disease- resemblance of the tumours to embryological structures such
associated RCCs, all other subtypes can also occur in end­ as the metanephros (e.g. metanephric adenoma), or a specific
stage renal disease. hereditary background (e.g. hereditary leiomyomatosis and
RCC syndrome-associated RCC). The 2004 WHO classification
Occupational exposure first introduced tumour subtypes defined on the basis of a spe­
A meta-analysis of the association between exposure to cific molecular alteration (e.g. translocation-associated RCC). In
trichloroethylene (a solvent widely used as a metal degreaser recent years, studies have shown that some of these molecularly
and chemical additive) and clear cell renal cancer reported defined tumours have an overly broad morphological spectrum

34 Tumours of the kidney

without an unequivocal genotype-phenotype correlation. contrast, although almost all metanephric adenomas, adenofi-
Therefore, molecular testing including next-generation sequenc­ bromas, and metanephric stromal tumours are defined by BRAF j
ing is increasingly used to classify RCC, and it has especially p.V600E alterations, they are still regarded as morphologically
broadened the differential diagnosis of tumours considered in defined neoplasms.
the oncocytoma and chromophobe RCC category, which now One important change in the fifth edition is the definition of
include fumarate hydratase-deficient RCC, epithelioid angio­ papillary RCC. In 2016, it was hypothesized that type 2 papillary I
myolipoma, TEE3-rearranged and TFEB-altered RCCs, and RCCs include different tumour entities. Since then, the essen­
eosinophilic solid and cystic RCC. Eosinophilic solid and cystic tial and desirable criteria useful for the differential diagnosis of
RCC can show TSC gene mutations or biallelic losses. Recent fumarate hydratase-deficient RCC, eosinophilic solid and cys­
studies have identified many tumours whose cells have eosino­ tic RCC, and translocation RCC have been further developed.
philic cytoplasm and oncocytic or chromophobe-like features Whereas the former type 1 papillary RCC is now regarded as
in the RCC-NOS group, with somatic inactivating mutations of the classic morphology of papillary RCC, the diagnostic crite­
TSC2 or activating mutations of MTOR as the primary molecular ria for type 2 papillary RCC need to be re-evaluated. Another
alterations. However, TSC-associated and MTO/?-associated change in the fifth edition is the name change from Mclear cell
neoplasms are a very heterogeneous group morphologically papillary renal cell carcinoma,^ to "clear cell papillary renal cell
and immunohistochemically. To gain a better understanding of tumour" (see Clear cell papillary renal cell tumour, p. 61), which
this heterogeneous group of oncocytic tumours, which are not was introduced in the fourth edition of the WHO classification.
classifiable as oncocytomas or chromophobe RCC, a category The name change was made because there are no reports of
of unclassified oncocytic tumours has been introduced. This metastatic events for this indolent tumour entity.
category of unclassified oncocytic tumours encompasses low- The categories of nephroblastic tumours described in this
grade and high-grade oncocytic tumours because the behav­ edition of the WHO classification of urogenital tumours are also
iour of such tumours is poorly understood. included in the WHO classification of paediatric tumours.
These developments demonstrate that some RCC subtypes Morphological data still remain of clinical relevance in the
represent completely different neoplasms, with differences in treatment of cancer patients. For example, sarcomatoid differ­
morphology, pathogenesis, molecular events, and prognosis, entiation, which has been recognized as a feature of aggres­
rather than purely morphologically defined subtypes. In con­ siveness, allows the selection of tailored therapy (immunother­
trast to brain tumours, it is not yet time for RCCs to undergo apy). Immune checkpoint inhibitors are under consideration for
a purely molecular classification. And in contrast to previous the first-line treatment of patients with sarcomatoid RCC.
editions of the WHO classification of urinary and male genital At present, molecular profiles do not influence the care of
tumours, in this edition the editorial board has decided to first patients with kidney cancer in the setting of either surgery or
divide RCC into morphologically and molecularly defined RCCs. systemic therapy. However, emerging data from clinical tri­
Molecularly defined RCCs include 7FE3-rearranged RCCs, als of immuno-oncology agents used in combination with or
>4/_/<-rearranged RCCs, TFEB-rearranged and TFEB-amplified compared against VEGF inhibitors suggest that distinct gene
RCC, ELOC(formerly TCEB7)-mutated RCC, SMARCB1 (INI1)- expression signatures reflecting a prominence of angiogenesis
deficient RCC, and others. or immune infiltration correlate with the response to therapy
RCCs with prominent leiomyomatous stroma frequently har­ (CheckMate 214, JAVELIN Renal 101, and IMmotion151 studies
bour mutations in TSC1, TSC2, MTOR, and/or ELOC (TCEB1). {2240,2238,2239)), and in the future this could support person­
These tumours may have considerable morphological overlap alized therapy choices. The exact correlation between genomic
with clear cell RCCs and clear cell papillary tumours, sup­ alterations (including mutations and copy-number alterations)
porting the hypothesis that ELOC (TCEB7)-mutated RCCs are and features of the tumour microenvironment is under inves­
identical and indistinguishable from a subset of hereditary tigation {2239,417}. In terms of morphological features, the
tuberous sclerosis-associated RCCs, originally described as presence of sarcomatoid differentiation is associated with an
"renal angiomyoadenomatous tumour-like RCC" or Utuberous increased benefit from immuno-oncology agents (2238,3114(.
sclerosis-associated papillary-type RCC". A clear diagnosis of It is worth noting that the evaluation of any potential biomarkers
ELOC (TCEB^-mutated RCC can only be made by complex in renal cell cancer is complicated by prominent intratumoural
molecular analyses. Therefore, it has been decided that this heterogeneity evident both at the genetic level (3225} and in
entity be put into the category of molecularly defined RCCs. In transcriptomic features (1220).

Table2.02 Emerging renal tumours and their associated gene alterations

Proposed entity Location in current WHO classification Mutations identified References

Thyroid-like follicular carcinoma Not present fusions (106}

Somatic 7^C2-inactivating mutations or

Eosinophilic vacuolated tumour Other oncocytic tumours (3167,604}
材TOR-activating mutation
Low-grade oncocytic tumour Other oncocytic tumours MTOR mutation (3208)

Biphasic hyaiinizing psammomatous renal

Not present NF2 mutations {185}
cell carcinoma

Papillary neoplasm with reverse polarity Subtype of papillary renal cell carcinoma Recurrent mutations of KRAS {1666,3177}

Tumours of the kidney 35

Another random document with
no related content on Scribd:
 “Excuse me, sir,” said the gentleman, looking hard into Leonard’s
face; “but unless these sharp eyes of mine are mistaken, which they
seldom are, I see a nephew whom, perhaps, I behaved to rather too
harshly, but who still has no right to forget Richard Avenel.”
“My dear uncle,” exclaimed Leonard, “this is indeed a joyful
surprise; at a time, too, when I needed joy! No; I have never
forgotten your kindness, and always regretted our estrangement.”
“That is well said; give us your fist again. Let me look at you—quite
the gentleman I declare!—still so good-looking too. We Avenels
always were. Good bye, Baron Levy. Need not wait for me; I am not
going to run away. I shall see you again.”
“But,” whispered Levy, who had followed Avenel across the street,
and eyed Leonard with a quick curious searching glance—“but it
must be as I say with regard to the borough; or (to be plain) you must
cash the bills on the day they are due.”
“Very well, sir—very well. So you think to put the screw upon me,
as if I were a poor ten-pound householder. I understand—my money
or my borough?”
“Exactly so,” said the Baron, with a soft smile.
“You shall hear from me—you shall hear from me. (Aside, as Levy
strolled away)—D——d tarnation rascal!”
Dick Avenel then linked his arm in his nephew’s, and strove for
some minutes to forget his own troubles, in the indulgence of that
curiosity in the affairs of another which was natural to him, and, in
this instance, increased by the real affection which he had felt for
Leonard. But still his curiosity remained unsatisfied; for long before
Leonard could overcome his habitual reluctance to speak of his
success in letters, Dick’s mind wandered back to his rival at
Screwstown, and the curse of “over-competition”—to the bills which
Levy had discounted, in order to enable Dick to meet the crushing
force of a capitalist larger than himself—and the “tarnation rascal”
who now wished to obtain two seats at Lansmere, one for Randal
Leslie, one for a rich Nabob whom Levy had just caught as a client;
and Dick, though willing to aid Leslie, had a mind to the other seat
for himself. Therefore Dick soon broke in upon the hesitating
confessions of Leonard, with exclamations far from pertinent to the
subject, and rather for the sake of venting his own griefs and
resentment than with any idea that the sympathy or advice of his
nephew could serve him.
“Well, well,” said Dick, “another time for your history. I see you
have thrived, and that is enough for the present. Very odd; but just
now I can only think of myself. I’m in a regular fix, sir. Screwstown is
not the respectable Screwstown that you remember it—all
demoralised and turned topsy-turvy by a demoniacal monster
capitalist, with steam-engines that might bring the falls of Niagara
into your back parlour, sir! And, as if that was not enough to destroy
and drive into almighty shivers a decent fair-play Britisher like
myself, I hear he is just in treaty for some patent infernal invention
that will make his engines do twice as much work with half as many
hands! That’s the way those unfeeling ruffians increase our poor-
rates! But I’ll get up a riot against him—I will! Don’t talk to me of the
law! What the devil is the good of the law if it don’t protect a man’s
industry—a liberal man, too, like me!” Here Dick burst into a storm
of vituperation against the rotten old country in general, and the
monster capitalist of Screwstown in particular.
Leonard started; for Dick now named, in that monster capitalist,
the very person who was in treaty for Leonard’s own mechanical
improvement on the steam-engine.
“Stop, uncle—stop! Why, then, if this man were to buy the
contrivance you speak of, it would injure you?”
“Injure me, sir! I should be a bankrupt—that is, if it succeeded; but
I daresay it is all a humbug.”
“No, it will succeed—I’ll answer for that!”
“You! You have seen it?”
“Why, I invented it.”
Dick hastily withdrew his arm from Leonard’s.
“Serpent’s tooth!” he said, falteringly, “so it is you, whom I warmed
at my hearth, who are to ruin Richard Avenel?”
“No—but to save him! Come into the city and look at my model. If
you like it, the patent shall be yours!”
“Cab—cab—cab,” cried Dick Avenel, stopping a “Hansom;” “jump
in, Leonard—jump in. I’ll buy your patent—that is, if it is worth a
straw; and as for payment—”
 “Payment! Don’t talk of that!”
“Well, I won’t,” said Dick, mildly; “for ’tis not the topic of
conversation I should choose myself, just at present. And as for that
black-whiskered alligator, the Baron, let me first get out of those
rambustious unchristian filbert-shaped claws of his, and then—But
jump in—jump in—and tell the man where to drive!”
A very brief inspection of Leonard’s invention sufficed to show
Richard Avenel how invaluable it would be to him. Armed with a
patent, of which the certain effects in the increase of power and
diminution of labour were obvious to any practical man, Avenel felt
that he should have no difficulty in obtaining such advances of
money as he required, whether to alter his engines, meet the bills
discounted by Levy, or carry on the war with the monster capitalist.
It might be necessary to admit into partnership some other monster
capitalist—What then? Any partner better than Levy. A bright idea
struck him.
“If I can just terrify and whop that infernal intruder on my own
ground, for a few months, he may offer, himself, to enter into
partnership—make the two concerns a joint-stock friendly
combination, and then we shall flog the world.”
His gratitude to Leonard became so lively that Dick offered to
bring his nephew in for Lansmere instead of himself; and when
Leonard declined the offer, exclaimed, “Well, then, any friend of
yours; you have only to say the word at the last hour, for I am sure of
both seats. I’m all for Reform against those high and mighty right
honourable boroughmongers; and what with loans and mortgages on
the small householders, and a long course of “free and easies,” with
the independent Freemen, I carry the town of Lansmere in my
breeches pocket.” Dick then, appointing an interview with Leonard at
his lawyer’s, to settle the transfer of the invention, upon terms which
he declared “should be honourable to both parties,” hurried off, to
search amongst his friends in the city for some monster capitalist,
who might be induced to extricate him from the jaws of Levy, and the
engines of his rival at Screwstown. “Mullins is the man, if I can but
catch him,” said Dick. “You have heard of Mullins?—A wonderful
great man; you should see his nails; he never cuts them! Three
millions, at least, he has scraped together with those nails of his, sir.
And in this rotten old country, a man must have nails a yard long to
fight with a devil like Levy! Good bye—good bye—GOOD bye, my DEAR
nephew!”
 CHAPTER XX.
Harley L’Estrange was seated alone in his apartments. He had just
put down a volume of some favourite classic author, and he was
resting his hand firmly clenched upon the book. Ever since Harley’s
return to England, there had been a perceptible change in the
expression of his countenance, even in the very bearing and attitudes
of his elastic youthful figure. But this change had been more marked
since that last interview with Helen which has been recorded. There
was a compressed resolute firmness in the lips—a decided character
in the brow. To the indolent careless grace of his movements had
succeeded a certain indescribable energy, as quiet and self-collected
as that which distinguished the determined air of Audley Egerton
himself. In fact, if you could have looked into his heart, you would
have seen that Harley was, for the first time, making a strong effort
over his passions and his humours; that the whole man was nerving
himself to a sense of duty. “No,” he muttered—“no—I will think only
of Helen; I will think only of real life! And what (were I not engaged
to another) would that dark-eyed Italian girl be to me?—What a mere
fool’s fancy is this! I love again—I who, through all the fair spring of
my life, have clung with such faith to a memory and a grave! Come,
come, come, Harley L’Estrange, act thy part as man amongst men, at
last! Accept regard; dream no more of passion. Abandon false ideals.
Thou art no poet—why deem that life itself can be a poem?”
The door opened, and the Austrian Prince, whom Harley had
interested in the cause of Violante’s father, entered with the familiar
step of a friend.
“Have you discovered those documents yet?” said the Prince. “I
must now return to Vienna within a few days. And unless you can
arm me with some tangible proof of Peschiera’s ancient treachery, or
some more unanswerable excuse for his noble kinsman, I fear that
there is no other hope for the exile’s recall to his country than what
lies in the hateful option of giving his daughter to his perfidious foe.”
“Alas!” said Harley, “as yet, all researches have been in vain; and I
know not what other steps to take, without arousing Peschiera’s
vigilance, and setting his crafty brains at work to counteract us. My
poor friend, then, must rest contented with exile. To give Violante to
the Count were dishonour. But I shall soon be married; soon have a
home, not quite unworthy of their due rank, to offer both to father
and to child.”
“Would the future Lady L’Estrange feel no jealousy of a guest so
fair as you tell me this young signorina is? And would you be in no
danger yourself, my poor friend?”
“Pooh!” said Harley, colouring. “My fair guest would have two
fathers; that is all. Pray do not jest on a thing so grave as honour.”
Again the door opened, and Leonard appeared.
“Welcome,” cried Harley, pleased to be no longer alone under the
Prince’s penetrating eye—“welcome. This is the noble friend who
shares our interest for Riccabocca, and who could serve him so well,
if we could but discover the document of which I have spoken to
you.”
“It is here,” said Leonard simply; “may it be all that you require!”
Harley eagerly grasped at the packet, which had been sent from
Italy to the supposed Mrs Bertram, and, leaning his face on his hand,
rapidly hurried through the contents.
“Hurrah!” he cried at last, with his face lighted up, and a boyish
toss of his right hand. “Look, look, Prince, here are Peschiera’s own
letters to his kinsman’s wife; his avowal of what he calls his ‘patriotic
designs;’ his entreaties to her to induce her husband to share them.
Look, look, how he wields his influence over the woman he had once
wooed; look how artfully he combats her objections; see how
reluctant our friend was to stir, till wife and kinsman both united to
urge him.”
“It is enough,—quite enough,” exclaimed the Prince, looking at the
passages in Peschiera’s letters which Harley pointed out to him.
“No, it is not enough,” shouted Harley as he continued to read the
letters with his rapid sparkling eyes. “More still! O villain, doubly
damned! Here, after our friend’s flight, here, is his avowal of guilty
passion; here he swears that he had intrigued to ruin his benefactor,
in order to pollute the home that had sheltered him. Ah! see how she
answers; thank Heaven her own eyes were opened at last, and she
scorned him before she died. She was innocent! I said so. Violante’s
mother was pure. Poor lady, this moves me! Has your Emperor the
heart of a man?”
“I know enough of our Emperor,” answered the Prince warmly, “to
know that, the moment these papers reach him, Peschiera is ruined,
and your friend is restored to his honours. You will live to see the
daughter, to whom you would have given a child’s place at your
hearth, the wealthiest heiress of Italy—the bride of some noble lover,
with rank only below the supremacy of kings!”
“Ah!” said Harley, in a sharp accent, and turning very pale—“ah, I
shall not see her that! I shall never visit Italy again!—never see her
more—never, after she has once quitted this climate of cold iron
cares and formal duties—never, never!” He turned his head for a
moment, and then came with quick step to Leonard. “But you, O
happy poet! No ideal can ever be lost to you. You are independent of
real life. Would I were a poet!” He smiled sadly.
“You would not say so, perhaps, my dear lord,” answered Leonard
with equal sadness, “if you knew how little what you call ‘the ideal’
replaces to a poet the loss of one affection in the genial human world.
Independent of real life! Alas! no. And I have here the confessions of
a true poet-soul, which I will entreat you to read at leisure; and when
you have read, answer if you would still be a poet!”
He took forth Nora’s MSS. as he spoke.
“Place them yonder, in my secrétaire, Leonard; I will read them
later.”
“Do so, and with heed; for to me there is much here that involves
my own life—much that is still a mystery, and which I think you can
unravel!”
“I!” exclaimed Harley; and he was moving towards the secrétaire,
in a drawer of which Leonard had carefully deposited the papers,
when once more, but this time violently, the door was thrown open,
and Giacomo rushed into the room, accompanied by Lady Lansmere.
“Oh, my lord, my lord!” cried Giacomo, in Italian, “the signorina!
the signorina!—Violante!”
“What of her? Mother, mother! what of her? Speak, speak!”
“She has gone—left our house!”
 “Left! No, no!” cried Giacomo, “She must have been deceived or
forced away. The Count! the Count! Oh, my good lord, save her, as
you once saved her father!”
“Hold!” cried Harley. “Give me your arm, mother. A second such
blow in life is beyond the strength of man—at least of mine. So, so!—I
am better now! Thank you, mother. Stand back, all of you—give me
air. So the Count has triumphed, and Violante has fled with him!
Explain all—I can bear it!”
 THE EARL OF DERBY’S APPEAL TO THE
COUNTRY.

When we addressed our readers, in the month of June last,[10] in a

very earnest, and perhaps a somewhat apprehensive spirit, we
declared that we did so “on the eve of a tremendous conflict, the
results of which, in our deliberately formed opinion, shared by every
thinking and experienced politician in the kingdom, affect the welfare
of the Empire to an extent almost unprecedented, and also, at
present, utterly incalculable.” That conflict has now taken place, or
rather it is yet—while we are writing, very far on in this memorable
month of July (the 24th inst.)—not quite over. It has been, indeed, a
signal conflict: but between whom? And what is the issue? Has there
been a victory, and consequently a defeat? Is it the Earl of Derby,
sitting dismayed in his cabinet, from whose lips these sad words are
at this moment falling, as he surveys the results of the general
election of 1852, on which he had staked so much?—or is it his rival
and opponent? But who is he?—or is his name legion? Is it Lord John
Russell?—or Sir James Graham?—or the Duke of Newcastle?—or
Lord Palmerston?—or, dropping for a moment to the dii minores, is it
—Mr Cobden?
One fact is certain, that the Earl of Derby, on the 1st of July 1852,
upon which day the writs were issued for a new election, deliberately
gave battle to them all; having four months previously declared that
he would do so. And on the occasion of making that declaration, he
furthermore declared, in terms which no one could mistake, that he
intended to do battle for the Constitution in Church and State—for
the Protestant Constitution; and against those who were secretly or
openly advancing to assail its integrity, under the baleful flag of
Democracy and Popery. He and his advisers had been calm and
quicksighted enough to see that such was the true nature of the great
electoral struggle ordained to take place in the month of July 1852;
and they had also sufficient sagacity and resolution to foresee and
defeat the cunning and desperate attempts which would be made by
their opponents, to disguise the true nature and real objects of the
contest, and shift the scene of it to a disadvantageous and deceptive
locality. Those, indeed, who made this attempt, were wise in their
generation, and did the very best thing that the nature of things
admitted. Conscious of occupying a discreditable and desperate
position, through their own imbecility and recklessness, the only
chance of regaining lost ground, and making a tolerated appearance
before the country, lay in attempting to enlist popular sympathies;
and the felicitous device was, to persuade the millions that their
bread was in danger;—but this was to be done, if at all successfully, so
very suddenly, that the falsehood should not be found out before it
had gained its object. The Earl of Derby was to be exhibited before
women and children as a vampyre, but only for a moment, lest the
false colours should dissolve away while they were being looked at,
and a wise and benevolent statesman appear in his true figure and
colours. Hence the convulsive effort that was made, the moment it
was announced that his gracious Mistress had summoned him in a
critical emergency to her counsels, to precipitate him into a contest
before he had had a moment’s time to survey his new position, to
summon his advisers about him—to tell friends from foes—and see
what were the precise objects which they had to keep in view. “If,”
said they, “Lord Derby be allowed to go to the country at his own
time, and in his own way, the country will welcome him as a deliverer
from mischievous misrule. Let us, therefore, force him to select our
time, and our place, for fighting the battle. If we hesitate, we are lost;
for he is strong and skilful, and the country acute and honest.” In vain
the Earl said to his eager opponents, “By your leave, gentlemen; for a
moment, by your leave. What is the meaning of all this feverish
fidget? What are you afraid of?” “That you will take away the people’s
bread; reverse a wise and beneficent policy; and not only bid the sun
of commercial prosperity stand still, but go back, and so plunge us all
into confusion and despair.” “I assure you,” quoth the Earl, “I am not
going to attempt any of these things. I love the people as much as
yourselves, and, with you, am one of them. My interests, like your
own, are identical with theirs: I wish only to secure the safety of our
institutions, the common interests of the Queen and the people,
against certain perils which I see distinctly, though you may not. And
as to the corn question, in which you would tie up, and hide, and
crush all others, I will have none of it. I have opinions of my own on
the subject of corn laws, thinking it would be infinitely to the benefit
of the community if I could at once derive a revenue for it from
foreigners, and enable our own corn-growers to supply us with bread
at a reasonable price, and foster and stimulate the energies of
producers, and provide a safe, quick-paying home-market for them:
thus protecting the interests of both the great classes of the
community—producers and consumers. If, however, your long-
continued and systematic agitation and misrepresentations have
succeeded in persuading the masses of society that my own views on
that subject are at variance with theirs, and that theirs they are
resolved shall prevail, be it so; I will do all I can, less than which I
should desert my duty in doing;—I will take care to submit that
particular question, in order to dissipate all doubt, to the deliberate
decision of the country; and whatever that decision may be, I will
cordially carry it out. But do you seriously suppose that this question
is the only one by which I must stand or fall?—the only one for which
the Queen called me to her counsels? O no, gentlemen. Whichever
way the pleasure of the country may lie upon this question, it is but
one, and that a subordinate one, of several—nay, of many; it is but
one, and a subordinate interest among several intrusted to my
consideration and my keeping. Suppose the corn question totally set
aside, and at rest, and yourselves called to advise the Sovereign, and
carry on the government of the country, what would you do, then?
You may pause; but I know well what you would do. Judging from
your own repeated declarations, you would, under the pretence of
liberalising our institutions, intrust power to incompetent hands, to
be used only for the furtherance of your own selfish purposes; they
would nominally, and you as demagogues practically,[11] be the
depositaries of power. Your avowed principles are inconsistent with
the maintenance of our national independence; of the connection
between Church and State; of the Protestant character of our
institutions: the Queen’s throne would be shaken, and her crown
quiver upon her sacred brow, if you were intrusted with the power for
which you are so anxious. I see distinctly before me the crimsoned
darkness of anarchy, and through it the fabric of a republic crumbling
under a military despotism. Now, gentlemen, I fear God and honour
the Queen; I am heart and soul a Protestant; I am satisfied with our
institutions, civil and religious, and believe that so are the people; but
let them speak out for themselves on all these subjects, which I will
submit to them with deliberate distinctness, despising your efforts to
misrepresent my objects and principles, and await the decision with
composure.” “Well, but, my Lord, how is this? Be so good as to tell us
in detail what you are going to do if you should be continued in
power; do not set us running about in search of shadows; do not
amuse us with a series of dissolving views; give us something visible
and tangible, in order that we may deal with it in our own way before
the people.” “That is, in order that you may misrepresent it. No, my
friends: you would have me do exactly what I will not do. It was by
your own voluntary act that I am where I am. You should have
considered consequences. I did, and have formed my purposes, and
organised my plans. My character and principles are before the
country, so are those of my colleagues. These principles I will reassert
as emphatically as you please; and I pledge myself to carry them out
in practice, if I have the opportunity.” “But you will delude the
country: you will set them scampering in every direction after will-o’-
the-wisps, while you and your myrmidons are quietly stealing their
bread, and forging chains and dungeons for them.” “Well, gentlemen,
tell the country as much: see whether they will believe you. It is a fair
question between us. You say that yourselves, and your doings are
thoroughly well known to them. Well, if that be so, go and prosper
with the constituencies, for they will give you their confidence if they
think that you deserve it. But observe, my good friends: if, thus
knowing you and your doings, those constituencies should decide
against you, and in favour of me, my friends, and our principles, even
though I expressly withhold a distinct declaration of the way in which
I purpose to act upon them, what will you then say? That those whom
they knew they reject, and have chosen others?” It is an ugly
dilemma! “But, my Lord, you impute to us principles and purposes
which we repudiate: we are not wolves in sheep’s clothing; we are
good, honest folk, the best friends the people ever had—in fact, their
true, as you their false friends.” “Well, gentlemen, what is easier than
to tell them so? You are only losing time yourselves, and making me
lose precious time myself; for all our hands are full, having the
Queen’s business to do in every quarter of the globe. Good morning,
my friends, away to the constituencies.” On this, one may conceive
that the colloquy ended, and the people’s imaginary deputation
withdrew, with flushed faces, anxious brows, and disconcerted looks,
to their council-chamber in Chesham Place. After a troubled silence,
one lean flippant fellow among them possibly rose up, with his arms
stuck a-kimbo, and said—“Lord Derby shall dissolve instanter: we
will kick his people out of the House of Commons the very first day
we meet, and so force him to dissolve; and I will bring out our trusty
fellows of the League, subscribe a hundred thousand pounds, and in
one month’s time annihilate the crazy Cabinet, and then there is an
end of him!” But these wild counsels did not altogether prevail. The
more steadily that matters were looked at by long-headed people, the
more embarrassing was found the position which had been occupied.
If the Earl of Derby should succeed in presenting himself to the
people in his own way, and if they should think fit to say, “We will
have no return to protective duties, but we feel that there is a great
derangement of financial affairs which we believe you capable of
rectifying; and, above all, we believe you a man of honour, and agree
with you as to the existence of a dangerous conspiracy between
Popery and Democracy:” where would then be those who had
themselves driven him to appeal to the country? And as time wore on,
it saw Faction baffled and crushed, and the new Ministers developing
extraordinary aptitude for business; exhibiting uniform tact, temper,
and firmness; overcoming obstacle after obstacle, formerly deemed
insuperable; winning majorities in division after division, forced on
them by their opponents; while no amount of newspaper stimulus
could succeed in flurrying the spirits of the country into distrust or
alarm. Not an opportunity was lost in either House of Parliament for
gibing, taunting, misrepresenting, sedulously echoed by the Radical
press out of doors, both metropolitan and provincial. In four months’
time, a skilfully-slandered Ministry succeeded in conducting to a
satisfactory conclusion such a splendid amount of legislation as will
ever render those four months memorable; and at the close of that
eventful period, the Earl of Derby saw that the proper moment for
appealing to the country had at length arrived: at the voice of the
Queen, her Parliament dissolved away; and her people were free to
choose another.
Now had arrived indeed the tug of war. Now was to be seen the
fruit of those seeds which all parties had been sowing during the
interval, with a view to propitiating the people. Those seeds had been
scattered by many hands, and were of various kinds. A large
proportion of that seed consisted solely of distrust of Lord Derby,
because he was Lord Derby, without principles or a policy; and this
seed was deemed the most attractive and hopeful of any, by its
venerable and volatile sower, who scattered it freely everywhere,
watching its growth with deep solicitude, for he had laid out all the
little he had left, of political capital, in order to purchase that seed.
Said he to himself, with sometimes a sigh, and sometimes a smile,
this will grow up, if at all, flexible and chameleon-hued, according to
the condition of the political atmosphere; and the vast extent to which
it is sown must, at all events, show the spirit and resources of the
sower, and keep that personage prominently before the public eye.
Another class of seeds had fallen from a desponding and anxious
sower, who had been deposed by former followers and supporters
from a proud position, and accused of having rendered necessary the
sowing of any seed at all, at that particular conjuncture. He moved
tremulously along, scattering his little seed, the growth of which, he
evidently hoped, might be suitable for all purposes, and alarm no one
prematurely. He was rudely jostled, however, by surly impudent
fellows, who furiously stamped on what he had sown, and flung down
thickly large crimson-coloured seed, which should by and by choke
and overpower the other by its baleful and glaring crop. A few timid
hands scattered seeds stealthily, those of parasitical plants, following
in the wake of a burly sower in scarlet, full of deceit and insolence,
dropping, as he went, dark and deadly seed, heedless of the alarm, the
scorn, and the hatred which he by turns provoked. That seed was
destined, in the sower’s expectation, to produce ere long a forest,
overshadowing the land, with all manner of obscene birds lodging in
its gloomy branches.
To drop metaphor, however, the appeal to the constituencies was
undoubtedly made under circumstances calculated to occasion much
anxiety to the Queen’s Ministers, under whose auspices that appeal
was made. They were in a great minority in the House of Commons,
and had been thrown into that minority by reason of their having
been opposed to a measure which, by whatever means, had brought
popularity to their opponents, the majority. The latter had astutely
identified themselves with the most palatable topic that can ever be
urged to the masses of the community—cheap food, without reference
to all those deep and extensive political arrangements, necessarily
involved in the discussion concerning the import of foreign corn. Mr
Cobden, for instance, was aware of being a mere cipher, disconnected
with that question, the agitation of which had alone given him
political importance, and an independent fortune, securing him
leisure for all kinds of mischief; and it was his interest, and that of all
those who were, with him, opposed to the Government, to interweave
that popular topic with all other political topics, giving them, and
those urging them, the hue of its popularity. Thus was the
constituency carefully familiarised with a contrast between the
friends of free and fettered trade, with all their respective advantages
and disadvantages, and the applause or odium which either entailed.
A second source of anxiety to the well-wishers of the Government,
and unquestionably a great one, was that Government’s steady
adherence to the expressed determination of its chief, on first
assuming the reins of power, that he would indicate only the general
PRINCIPLES on which his policy was founded, reserving all measures
and details, till the period when he should be able to carry his plans
and measures into effect. This was a severe test to be borne by any
class whatever of aspirants to popular confidence and favour. It was
saying, “We stand on character and principle; if you distrust either,
withhold your support.” And this furnished such endless topics of
effective ridicule and invective to the opponents of the Government,
as required no small amount of moral courage in its supporters to
encounter. These topics were used with systematic energy by a
bitterly hostile press for several months previously to, as well as
during, the momentous contest with which we are dealing; and it
were idle to disguise that these efforts were made with great ability,
and a very great measure of success. When, therefore, the struggle
commenced, we ourselves said, It is a very critical one, entered upon
under circumstances most unfavourable to the Government: and if,
in spite of those immense disadvantages, the Government should be
victorious, it will be a triumph indeed, and calculated to secure them
both strength and permanence. A calm observer, however, of the
position of parties and the course of events, could not fail to detect,
on the other hand, certain disturbing forces inevitably affecting the
tactics of the opponents of Ministers. The rashness of Lord John
Russell in resigning the Government as he did; immediately
recommending his gracious Mistress to summon Lord Derby to her
counsels; and, instantly afterwards, suddenly repenting of what he
had done, and, stung by the keen reproaches of his supporters,
organising an opposition to Lord Derby, simply because he had
obeyed the royal command—alienated from him a great amount of
that secret support on which he had so long been borne buoyant, and
averted from him the countenance of men, though professing Liberal
principles, yet characterised by independence and moderation. To
attempt a coalition with such a man as Mr Cobden, and at the
particular moment selected for the experiment, was one of the
maddest tricks of modern politicians on record; alienating for ever a
steady support, in the vain attempt to conciliate a contemptuous and
distrustful patronage! If Lord John Russell were honest, and Mr
Cobden honest, and both firm, what would be the inference?
Again, when the late members of the House of Commons were
reduced to the rank of private citizens, they had belonged to various
sects and parties, as the representatives of opinions not over easy to
define and distinguish for practical electioneering purposes. There
were fervent and lukewarm Conservatives, with corresponding
Liberals; high church, low church, dissenters, Protestants, Roman
Catholics, both in reality, and in name only. All these were now to
present themselves to the country as worthy of its confidence, a
considerable majority of them, however, being unable to state what
public man they owned as leader, or to what party they professedly
attached themselves. And many, indeed, wished themselves to be
thenceforth regarded as leaders and founders of parties! And each
individual’s ambition would suggest to him the necessity of
considering how he intended hereafter, if elected into Parliament,
practically to carry out his views, with reference to a sphere of action
where unfortunately all could not be leaders. How, then, were all
these to “go to the country?” And that country, too, a somewhat
shrewd one!
The last Session of the Parliament of 1852 closed very quietly.
Neither Lord Derby in the House of Lords, nor any of his colleagues
or friends in the House of Commons, seized an opportunity for
making, as with their power they could have made, a dazzling ad
captandum appeal to the country. Very many of their supporters
expected that this would have been done; but we are of opinion that,
in not doing so, they acted with a dignity and self-reliance entitling
them to the highest respect. They might, indeed, have pointed to a
glittering catalogue of their doings during the Session—afforded their
supporters many rallying points, and secured among them a
conspicuous consistency of means and objects; but these advantages
appeared to be deliberately foregone. Never before, in our memory,
did a Ministry, especially one so critically situated, and professedly on
its trial, go to the country with less apparent effort to secure a
favourable verdict. It amounted to an apparently indolent over-
confidence, susceptible of being resolved by their enemies into a
conscious unworthiness, and distrust alike of themselves, of their
cause, and of the issue.
The Earl of Derby having distinctly announced, in the month of
February, that he should be guided by the legitimately expressed
voice of the country, in reimposing, or abstaining from reimposing,
duties on corn; and, moreover, that he would not attempt to do so,
unless the country should decide in favour of such a policy by an
unequivocal and even a great majority, some two months afterwards
made another announcement, in answer to one of the many
interpellations with which he was perseveringly harassed by his
opponents in the House of Lords. He said that, if it would afford them
any satisfaction, he already distinctly saw that the voice of the country
would be pronounced against the reimposition of duties on corn,
whether for purposes of protection or revenue. Forthwith there arose
a cry among his opponents and their advocates, “Then at once retire,
as avowedly vanquished Protectionists!” and nothing could exceed
the rancorous reiteration of the demand. Lord Derby, however,
remained unmoved; and his enemies, beginning to fear that they had
to deal with one of thoroughly settled purpose, anxiously cast about
for other topics of disparagement against the coming elections. The
public themselves, however, seemed so provokingly indifferent to
their efforts, that it was deemed unsafe to attempt an open
organisation of opposition, or to inaugurate it by formal appeals to
the country, in the shape of public meetings. Not one was called
throughout the length and breadth of the land! although it was
occasionally whispered that a great staff of agitators at Manchester,
amply officered, and largely supplied with the sinews of war, were
ready to start into action at a moment’s notice. But in defence of
what? Lord Derby had already declared that the corn laws were out of
his reach, and his supporters were almost everywhere using the same
language; many of them accompanying it, however, with avowals that
their opinions were unchanged, though the temper of the masses of
society rendered it impossible to act up to those opinions. Then—said
his enemies—is not this monstrous? The cause of Free Trade is now in
the keeping of false friends, or rather of its enemies, who are only
apparently surrendering their opinions and intentions, in order
subtlely and indirectly to effectuate them by and by! and there arose
the cry that this was to be done by the juggle of readjusting taxation.
On this point the Ministers and their friends avowed that they were
concentrating their attention with a view to redress glaring injustice;
but beyond that general declaration they could be induced to say
nothing. In the mean time, the nation began to speak out for itself
unequivocally on another great subject of its anxiety—the safety of
our Protestant institutions, threatened by Dr Wiseman and his allies
in Ireland, in a spirit of deadly hatred and unwavering resolution.
They did not condescend to conceal or disguise their intention of
securing a large accession of force in the new House of Commons—a
course of procedure, however, calculated directly to strengthen the
hands of the Government, who were at all events known to be
thoroughly in earnest upon the subject of Protestantism.
Concurrently with this, there existed another subject of anxiety
among moderate men of all parties—the sweeping changes, of a
democratic tendency, proposed by Lord John Russell and his new
friends to be effected in our political institutions. The Earl of Derby
took several opportunities of declaring publicly and unequivocally his
determination to resist all attempts of this kind, come in whatever
shape, and from whatever quarter, they might; and the practical
result of all this was, that he stood, on the eve of the all-important
appeal to the country, in the character of a Protestant Conservative
Minister. That appeal, it was declared by his opponents, would at
once annihilate him and his Government. But the assertion was
always accompanied by a certain small difficulty in suggesting who
was to succeed him, and what was the exact combination of parties by
which that successor was to be made, and to be kept, Minister. At all
events, it was said, get rid of Lord Derby. Strip off his disguises, and
expose him and his friends to the country as charlatans and
impostors; and, when the proper time comes, it will be sure to find
the proper man. The organs of the Peel party began now to make
themselves heard a little; we were told that that was the quarter in
which the coming man was to be looked for; and it was whispered at
Clubs, and intimated in the papers, that the Duke of Newcastle had
the list of his Cabinet complete!—Thus, then, stood matters when the
writs were delivered into the hands of the returning officers
throughout the kingdom; and when the vital struggle commenced, the
attitude of Ministers was at once firm and modest.
The Times of Wednesday the 7th July thus announced, in its
leading article, the commencement of the grand struggle:—“So far as
regards the disputed seats, the general election begins this morning,
and a few hours will place beyond doubt our probable masters for the
next five or six years”—words very exciting to all ardent politicians,
and fraught with no little truth. That the editor, when he wrote them,
expected the result to be a defeat of Ministers, no one who has read
what had been said before, and has been said subsequently, and with
increasing bitterness, in the eloquent leading columns of the Times,
can doubt. The first week was devoted to the English borough
elections; and here the opponents of the Government expected a long
series of triumphs. It is not consistent with our space or purpose to
present a detailed retrospect of the general elections. We shall
content ourselves with indicating a few salient points, fraught with
great political significance in respect of both persons and places—the
sayings and doings of the chief electors and elected.
A calm voice from Calne first caught the attentive ear. The Earl of
Shelburne, the son and heir of the Marquis of Lansdowne, was re-
elected without opposition on Tuesday the 6th July. What said he, on
returning thanks for his re-election? That he had “thought it desirable
to try the experiment of Free Trade; saw nothing to shake his faith in
it—much to confirm it; but had always thought that the change had
been very abrupt. There were persons who had been seriously
affected by the rapidity of the change, and he should therefore be
ready to give his attention to any proposed remedy for their distress.”
“He was not a supporter of the present Government, but should offer
no factious opposition to them; and although there were other men
quite competent to conduct the government of the country, to whom
he could more readily give assistance, yet, until those men were
established in power, he by no means said, that if the present
Government brought forward measures of which he could approve,
he would not give them his support. He felt that it was his duty, as
their representative, to abstain from all factious opposition to the
present Government, until some other Government became possible.”
If the Earl of Derby had been one of Lord Shelburne’s auditors, he
ought to have been perfectly satisfied with these declarations; yet the
speaker has been ever since set down in the daily lists given, in both
the Conservative and Liberal newspapers, amongst the opponents of
the Government, as though he were one of those certain of being
found among the “ayes” on that “want of confidence” motion which a
whisper from Sheffield was at the same time telling us would be the
first step taken by the triumphant Liberal majority in the new
Parliament. Weighing the political considerations likely to sway such
a man as Lord Shelburne, can it be doubted that his tendencies are
Conservative, though moderate, and that his public utterance of his
sentiments was designed to be regarded as timely and significant?
Lord Shelburne was in the late Parliament, and consequently aware
of all that had been said by, on behalf of, and against Ministers; and
he was also, when he thus spoke, aware of what would be the
consequence of an instant, blind, unscrupulous act of opposition—
one shameful in itself, as factious, and calculated to be attended by
consequences most serious to the State. He therefore gave public
notice that those inclined to act thus are to look for no countenance
from him. Thus much for what fell from the Earl of Shelburne, and
which, as in full accordance with the temperate, dignified, and
friendly course adopted by his noble father in the House of Lords,
since the accession of Lord Derby, is by no means unworthy of
attention. But the very temperate tone of the member for Calne has
distinguished many others of the re-elected or newly-elected
members for both boroughs and counties; who have in express terms
repudiated factious opposition to the Government, recognising the
necessity of carefully reconsidering our fiscal policy, in consequence
of the suddenness with which the late changes were effected, and the
severe sufferings they have entailed upon particular classes. Yet all
such members duly take their places in the aforesaid “lists”—
gentlemen of fortune, of position, of attainments, of high personal
character, with a large stake in the welfare of the country—as though
they were “safe cards” for an unscrupulous Opposition, and always at
the beck and bidding of such statesmen as a Cobden or a Bright!
These are, indeed, fond but fallacious calculations, as the result will
very shortly show.
Turn we now to Tiverton, where, on the ensuing day, (Wednesday
the 7th July,) a very distinguished person was re-elected for
Parliament—we mean Lord Palmerston. The noble lord declared his
political opinions in considerable detail; and no one can read what
fell from him without admiring the fascinating ease and playfulness
which adorned the manifestation of intellectual power and great
political knowledge. Not one syllable was uttered by Lord Palmerston
of a hostile, disparaging, or offensive character, with reference to
Lord Derby or his Government. He did not stoop to borrow those
vulgar and degrading terms of opprobrium in which so many of his
co-aspirants for political power suffered themselves to indulge,
thereby disentitling themselves to the consideration of gentlemen. He
undoubtedly spoke of Protection as “a question long since settled,”
admitting that he himself had been in favour of such “a small duty as
would not have raised in any perceptible degree the price of food, but
which would never be again submitted to the choice of the
agriculturists.” He deprecated hasty reforms, earnestly advocating
“steady progressive improvement of our institutions, going slowly and
deliberately about them,” and deprecating “rashly and hastily
overturning those ancient institutions under which this country has
long flourished and prospered.” He utterly repudiated vote by ballot
and triennial Parliaments, justified his support of the ministerial
Militia Bill, and spoke with extreme caution on the subject of the
Maynooth grant. He made no allusion to any political leaders, nor
indicated any possible situation or combination of parties in the new
Parliament, nor what was the course which he himself might feel
bound or disposed to pursue. Thus much for this eminent person,
who said nothing which might not also have been said by any even
decided supporter of the Ministry. The indignity which had been
inflicted upon himself by Lord Derby’s predecessor, he passed over in
dignified silence. Lord Palmerston, again, is claimed by the Liberal
journals as an undoubted opponent of the Ministry, whatever
measures they may or may not propose!
On the ensuing day Lord John Russell was declared re-elected,
after a suddenly-announced contest. He said that he relied on his past
career as the best guarantee of his probable future career; spoke of
the question of Free Trade as finally disposed of; and added, that
“that contest being removed out of the way, questions of religious
liberty—of Parliamentary reform—reform of our courts of law and
equity—of sanitary reform—and others of vast and deep importance
to the people at large, will have due attention bestowed upon them,
and time given for their consideration.” When challenged on the
subject of Papal Aggression, he answered coldly and drily, in a single
sentence—“I never will allow any interference with the supremacy
and independence of the Crown and of the nation; but, on the other
hand, I will never punish any man for his religious opinions.” Into
this shrivelled sentence had shrunk the lusty letter to the Bishop of
Durham! He declared himself determined to remove “all religious
disabilities,” especially those alleged to affect the Jews; and that “one
simple oath, the same for persons of all religious faiths,” should be
substituted for the existing oaths—of course including every class of
heathens and pagans! He declared himself opposed to vote by ballot;
and when pressed on the subject of extending the franchise and
shortening the duration of Parliament, spoke with marked
guardedness, thus:—“With regard to these two questions, I must ask
the indulgence of the electors. With regard to any measure I may
bring forward, or may support, in Parliament, I have to consider,
first, what is best for the country; and next, what other men will
support, and what I have a chance of carrying. If fit to be your
representative, I am fit to be intrusted with discretion on those
subjects.” It is worthy of notice, that whereas Lord John Russell, in
1847, had 7137 votes, he polled in 1852 only 5537 votes—i. e., 1660
votes fewer than in 1847; while Mr Masterman was returned at the
head of the poll by 6195 votes—i. e., a majority of 658 votes over Lord
John Russell—Mr Rothschild having gravitated to the bottom of the
poll, where he lay pressed down by a majority over him, by Sir James
Duke, of 522 votes. In 1847, Mr Rothschild had 6792—in 1852, only
4748 votes. All these are highly significant facts, not to be accounted
for by the mere suddenness of the struggle. In noticing these facts,
and also recording the triumphant return, at the head of the poll, of
the Government candidate at Greenwich, the Times observed—“Thus
far the changes, such as they are, are in favour of Lord Derby.” On
that day, however, the Times had unexpectedly to record, in letters of
mourning, a very splendid triumph for Lord Derby, in the result of a
contest on which, as if by common consent, the eyes of the whole
kingdom had for many weeks been fixed with intense anxiety. It was
the deliberately-selected battle-field between the Earl of Derby and
his combined Peelite and ultra-liberal opponents. This was, indeed, a
pitched battle between parties; and the field was Liverpool. Lord
Derby sent one of his own lieutenants to fight it, and in conjunction
with an eminent, and very able, and highly-respected resident
supporter at Liverpool; the opponents being an equally honourable
Liverpool resident, and Mr Cardwell, the late member, and favourite
lieutenant of the late Sir Robert Peel. All parties admitted that the
issue of this contest, especially if of a decisive character, would be of
immense political importance; and the general impression
undoubtedly was, that the Ministerial candidates had undertaken too
much for their strength. All other elections were thrown into the
shade while this was pending; the result of which was conveyed
hourly to London, during the London election, by the electric
telegraph. The result dismayed our opponents. Lord Derby’s
candidate headed Mr Cardwell by 1130 votes, and his other opponent
by 1467 votes; while the other Ministerial candidate, Mr Turner,
headed Mr Cardwell by 1446 votes, and Mr Cardwell’s comrade by
1783 votes! Such was the decision deliberately pronounced by the
great and enlightened constituency of Liverpool; and it has been, and
will be, attended by consequences of magnitude.
Mr Cardwell’s defeat at Liverpool has been followed by the signal
discomfiture of that small party in the late House of Commons, of
which he had been a distinguished member—Mr Green, Mr Smythe,
Mr Roundell Palmer, (an amiable and most accomplished man, who,
after an arduous canvass, fled without a struggle,) Mr Pusey, Mr
Townley, Mr Tollemache, Mr Mackinnon, Lord Mahon, Lord Norreys,
Sir C. Douglas, Sir George Clerk, and others—as though there had
been a sort of political murrain among them; and the Morning
Chronicle has had to gnash its little teeth, day after day, in despair, as
its friends disappeared; declaring, at length,[12] in a solemn, funereal
strain—“A competent Ministry might be formed from the candidates
who, at the present election, have been rejected principally in
consequence of their political honesty and intellectual superiority!”
On the same day on which Lord John Russell expounded his
political opinions, on having been declared re-elected for London, Sir
James Graham presented himself to the constituency of Carlisle, and
made a very remarkable appearance. At that period not a few
regarded him as most likely to be fixed upon as the leader of the
combined forces of the Opposition—and, on defeating Lord Derby—as
his successor; and what might fall from him on the present occasion
was regarded with some curiosity. Respect for the private personal
character of the right honourable baronet would incline one to speak
with forbearance of his chequered and erratic public career; but it
must be owned that he has by turns belonged to, aided, and damaged,
almost every party in the State—adopting and abandoning political
principles, whenever a candidate for office, with a levity that is
lamentable to all interested in the public character of statesmen. His
habit of replying with a sort of jaunty jocularity, to taunts on the score
of his having boxed the political compass, tells heavily against him in
the estimation of a sincere and staid people like ourselves, especially
when he himself comes forward, at the eleventh hour, to level
elaborate sarcasms at those whom he may deem obnoxious to similar
imputations. He has of late been peculiarly bitter in his reproaches
against the present Ministers, on the subject of their imputed
inconsistencies on the subject of Protection. If Sir James were to cast
his eyes over pp. 669–695, of the 46th volume of Hansard,[13] where
stands recorded a lengthened, elaborate, and most able speech of his,
in opposition to Mr Villiers’ motion to consider the question of
repealing the corn laws, we cannot but think that it would, for a
moment, bring the colour into his cheek, and make him indeed
doubtful as to his political, if not even personal, identity. He is there
seen sternly vindicating the landlords against false imputations of
cowardice and selfishness. “If the advocates of Free Trade expected
them to yield to fear, he mistook their character greatly, if he could
not confidently pronounce, that from such motives as these they
ought not, so they never would act;” and he reprobated agitation on
the subject of the corn laws, as productive of disastrous
consequences. “Commerce, credit, floating capital, were exotics which
flourished in the sunshine of national tranquillity; and if a struggle,
such as was contemplated on the other side, were pushed to
extremities, the very manufactures which they sought to encourage
would take to themselves wings, and fly away to lands where they
might hope that national peace would be preserved, and life and
society be secured.” He heard “with astonishment, the President of
the Board of Trade declare that he had encouraged agitation; a
declaration well worthy of the member for Manchester, but utterly
unworthy of a Minister of the Crown.” “If they endeavoured by force
of law to establish, that in a year of comparative scarcity the home-
corn grower should not have a price which would cover the cost of
production, they aimed a deadly blow at British native agriculture,
which, after all, depend upon it, was the foundation of national power
and prosperity, and the mainstay of national greatness.”
 The peroration of his speech consisted of a touching and beautiful
picture of the corn lands of this country thrown out of cultivation, and
agricultural labour superseded. “After the best reflection which he
could bestow upon the subject [!] and viewing it in every possible
light [!] he did not hesitate to declare his conviction, that a free
importation of corn must produce the same effect in England that the
law of agistment had produced in Ireland.... Let them but once
diminish the consumption of British-grown corn, and from that
moment the consumption of iron, of hardware, of cotton, and of
woollens must decline. Then would come a fresh displacement of
labour, and a fresh lowering of wages; and discontent, disturbance,
and misery would prove its inevitable consequences.... Little could
they estimate the wretchedness which sprung from change of habit, of
house, of manners, of the mode of life itself. What change more cruel
could despotism itself inflict, than a change from ‘the breezy call of
incense-breathing morn,’ to a painful and grievous obedience to the
sad sound of the factory bell—the relinquishment of the thatched
cottage, the blooming garden, and the village green, for the foul garret
or the dark cellar of the crowded city—the enjoyment of the rural walk
of the innocent rustic Sabbath, for the debauchery, the temptations,
the pestilence, the sorrows, and the sins of a congregated multitude?
Where were their moralists, that their voices were not raised against
the fearful consequences which the proposed change brought in its
train? Talk to him of sending the Poles to Siberia, or the hill coolies
from the Coromandel to the Mauritius! the authors of the intended
change contemplated the perpetration, within the limits of their
native land, of a cruelty far more atrocious. It was the first step
towards making England, the workshop of the world, dependent for
its daily food upon Continental supplies. He hoped that the
proposition would not be successful. Were it to succeed, he should say
with his friend Lord Ashburton, that this was the last country which
he should wish to inhabit.”[14] And for these reasons he concluded by
“not hesitating to give his cordial and decided opposition to the
motion.”
Was this the Sir James Graham who, only thirteen years
afterwards, could venture to scatter sarcasms over the Earl of Derby
and his supporters?
When Sir James presented himself, shortly after the accession of
the present Government, before his present constituents, he declared
himself a convert, at length, to vote by ballot; or, at all events, as in a
situation to become an immediate convert! Both in and out of the
House, he has ever since been one of the most sedulous and skilful of
those who have striven to lower the Government and their friends in
the estimation of the country, timing his appearance with great
exactness, so as to seize the moment for most effective action; striving
to disguise his earnestness and anxiety beneath the mask of a jocular
contempt, but ever studiously keeping himself in the foreground.
When before the constituency of Carlisle on the 8th of July, he
appeared to feel the necessity of diverting attention from the political
wanderings of his whole life, by taking the lion’s share of credit for
almost all the great measures of modern times. He had, however,
transparently another object—to paint his own portraiture upon the
eyes of the country, as THE practical statesman of the age, of
enlightened sagacity and extended experience, with both the will and
the power to do whatever might be expected of one aspiring to lead
the motley throng combined against Lord Derby. We suspect,
however, that the portrait, though finished off by the sitter’s own
masterly hand, with a loving warmth of colouring, has only been eyed
askance by those whom it had been intended to charm; while the
Times criticised it severely. “After perambulating England,” said Sir
James, “I have come home at last, and once more appear before the
Carlisle constituency. I have no personal object to gratify. I see a great
public interest at stake; and I think it of the last importance that this
capital of the Borders should send no doubtful voice to the
approaching Parliament.... If the electors of this city shall be of
opinion that the time has arrived when, with reference to the public
interest, I should withdraw from the public service, I will respectfully
retire. If, on the other hand, they be of opinion that my labour may
still be useful to the public, I am content, for a short time longer, to
give to the public my best exertions. I cannot promise you that they
will be more zealous, more energetic than they have been; nor am I
vain enough to expect that my exertions can be attended with greater
success than has crowned my past efforts.” We regard this as neat,
and unequalled. Such a cool bidding for power was probably never
before made by a man of Sir James Graham’s mark in this country.—
A certain Dr Lonsdale then assumed the functions of catechist of Sir
James Graham, whose ears he first soothed with the dulcet assurance
that “Sir James Graham was sure to hold the highest place in the next
Administration!” and the venerable catechumen answered the
courteous catechist very smoothly on the subject of foreign politics;
but the latter concluded by saying—“The right honourable gentleman
has shown that he is neither a Derby-ite nor a Russell-ite. Then what
ite are you?” Sir James replied, “It is true I am not a Derby-ite, nor a
Russell-ite: Dr Lonsdale asks what ‘ite’ I now am. I have been a
Peelite; but am now resolved not to bind myself in the fetters of any
party, but will do my best as a private member of Parliament, or in
any situation which it may be in the pleasure of the Crown to
call upon me to fill.” We ask again, when was this equalled? Had
Sir James and the Doctor arranged this little scene beforehand? Sir
James said not a word, having been kindly not asked a word, on the
subject uppermost in the mind of the country—the insolent and
dangerous machinations of Popery against our civil and religious
liberties; but on the subject of Reform, he declared stoutly that he had
been dissatisfied “with the new Reform Bill introduced by the late
Whig Government;” that the Reform Act of 1832 (for which he
claimed a large share of credit) “was marked by great imperfections,”
and “a revision of the measure was indispensable.” The new Reform
Bill ought “to disfranchise decayed boroughs, and extend the
franchise to large communities not at present enjoying it.” And, “with
respect to cities and boroughs, it appeared to him that residence and
rating should be the legitimate foundation of any future extension of
the suffrage.” Sir James then bade high for popular favour; but, as we
showed in our April number,[15] he is necessarily opposed, in his
attempts to unsettle the Reform Act, to some of the greatest Whig
supporters of the late Government; one of whom, Earl Fitzwilliam,
declared in his place in Parliament, since the accession of Lord Derby,
his strong disapproval of Lord John Russell’s recent Reform Bill—
adding, “It will not do for the Government to be thus continually
tampering with constitutional rights.” As the English borough
elections went on, notwithstanding the Ministers succeeded in a great
number of instances in which they attacked Liberal seats, they
appeared to have suffered no inconsiderable losses; but they
displaced numerous staunch and able supporters of the late
Government, as well as several of the Radical members. One of the
Liberal papers (the Daily News) of the day on which we are writing,
following the tristful example of the Morning Chronicle in respect of
its Peelite friends, mourns over the following victims:—Mr Bernal, Mr
Greene, Mr Horsman, Sir Edward Buxton, Mr Hardcastle, Lord
Ebrington, Lord Duncan, Mr W. J. Fox, Mr Anstey, Sir John Romilly,
Sir William Somerville, Colonel Thompson, Mr D’Eyncourt, Mr
George Thompson—to which he might have added a long catalogue of
others; and may now greatly increase the list—Sir George Grey being
a host in himself! and thus concludes: “Still, even with these losses,
our ranks are crowded; and we shall give Lord Derby battle, with no
fear as to where will be the victory.” This, however, was said on the
21st July, after the ranks of Lord Derby had been swollen with
reinforcements from the English counties and from Ireland, without,
at the same time, losing ground in Scotland. So long as the English
borough returns, which came in almost all at once, or within two or
three days of each other, showed a considerable numerical superiority
for the opponents of Lord Derby, notwithstanding his gains, the
Liberal papers, as if agreeing to close their eyes against the distant
but inevitable county returns! were loud in their exultations,
occasionally slipping into even truculent expressions. “Thus ends,”
says one, “somewhat prematurely too, the farce of a Derby Ministry.”
“Will Lord Derby venture to meet the new Parliament?” asked
another. “The Derbyites begin now to feel the absurd appearance they
make before the country which they have so long striven in vain to
mystify and amuse.” “How do you like the returns, my Lord Derby?”—
And so forth. On the other hand, the friends of the Ministry began
also to quake, and go about with downcast looks, uttering
despondency; and one of their own ablest organs was forced to
“remind its friends that they were not to run away disheartened by
the idea that they had suffered a loss on every occasion on which they
had simply failed to wrest a seat from their opponents;” and its
readers were assured “that, all things considered, matters wore by no
means an unpromising aspect.” Another able journal concluded by
the solemn assurance, that, “great as were Lord Derby’s difficulties,
those of the leaders, whoever they might be, of the heterogeneous
opposition, were at least as great”—a passage quoted the next day by a
triumphant Liberal contemporary, with the words “cold comfort!”
prefixed. A week’s time, however, began to tell startling tidings for the
opponents of the Ministry. Unexpected success in Ireland,
notwithstanding almost unprecedented difficulties and obstacles
arising out of the demoniacal conduct of the Papal emissaries, to
whom we shall presently again allude; and the counties, pouring in
their contingents by threes and twos at a time, soon gave a totally
different aspect to the field of battle. In almost every instance,
moreover, where Lord Derby’s county friends were assailed, they
triumphantly maintained their ground; and in nearly every case
where they were assailants, they were successful. It was amusing to
note how suddenly Lord Derby’s opponents in the press drew in their
horns; and after the “boldest” had “held their breath for a time,” they
began to comfort one another by fearful tales of intimidation; of
divers gross irregularities pervading the whole proceedings; of
divisions among the Liberal party, letting in the common enemy; the
defective state of the registries; and the still more defective and
unsatisfactory condition of the franchise!
Having, however, heard what Lord Shelburne, Lord John Russell,
Lord Palmerston, and Sir James Graham thought proper to address,
concerning their opinions and purposes, to their respective
constituencies, let us hasten on to a very eager, bustling, and
ambitious personage, making his appearance much later in the field
as a candidate for re-election for a county—we mean Mr Richard
Cobden; who, on Saturday the 17th July, presented himself on the
hustings at Wakefield, to go through the pleasant ceremony of an
unopposed re-election. He was accompanied by—Sir Charles Wood,
Lord John Russell’s late Chancellor of the Exchequer, and then
chairman of Mr Cobden’s committee, of which he had taken pains to
show himself a conspicuous and active member. Several points of the
former gentleman’s appearance on this occasion challenge particular
observation; chiefly as indicative of his intense vanity and egotism;
his virulent hatred of the Ministerial party, especially of the brilliant
Chancellor of the Exchequer, under whose knout he had so frequently
writhed; his absorbed one-ideadness; his consciousness of the palsied
condition of the “Liberal” party, and the necessity of powerful
stimulants to revive it; and the absence of any, even the slightest
indication of triumph at the state of the elections. Before the electors,
at the hustings, he was content to appear in his capacity as a Free-
Trader only, reserving the other more special matters for a
subsequent occasion, when sure of a safe and favourable reception
from his own supporters only, under the auspices of Sir Charles
Wood. On the former occasion he deliberately glorified himself on
account of “his name being so prominently connected with Free
Trade,” and “having the honour, privilege, and glory to see himself
individualising, as it were, a great and permanent principle!” He
proceeded to charge the Ministerial party with “undisguised
selfishness in advocating a change of taxation for the benefit of
particular interests;” “transferring the taxation now paid by the land,
to the shoulders of those who have no land at all”—which was
“protection in a new form, ten thousand times less tenable than in its
former aspect.” He hoped “that forty-eight hours would not elapse
after the meeting of Parliament before the present Government, and
the party that belongs to it, are brought fairly to issue upon the
question of Free Trade or Protection.” This sort of worn-out dreary
drivel was all that he thought it prudent to say upon the hustings
before the electors of the West Riding; but it was far otherwise
afterwards, at the “luncheon” at the Corn Exchange, presided over by
Sir Charles Wood, and given to Mr Cobden by his “friends and
supporters.” He there ventured to launch out into general politics;
“and as Parliament was likely to meet in November,” he said it “would
be as well to calculate beforehand what the state of parties would be.”
He immediately betrayed his fears of returning to the condition of a
political cipher, in the absence of Free Trade agitation. “The subject of
Free Trade being disposed of, the state of parties would be found
exceedingly embarrassing to the old political leaders! The House
would not answer the helm; and the question was, how they should
take a new tack!”—“I do not think there is anything in the temper of
the country which should precipitate any decision on the point”—he
had seen the then rapidly-altered aspect of the election returns!—“for
with the exception of the feeling as regards [sic] Free Trade, I do not
think there is much political feeling in the country on any question!
There will be, in the House of Commons, no party so strong as to be
able to form a Government which can be bargained [!] to stand for
three months, if the old rule is to be acted on as to Government
majorities. The question then is, how are parties to be reconstituted?
Consequently our friends of the statesman and functionary class must
take counsel to themselves, and see what is to be done in order to
inspire some fresh enthusiasm, by and by, in the country, on
behalf of the old Liberal party!” This was the same gentleman
who, on attempting to reorganise the League, upon Lord Derby’s
accession to power, unwittingly acknowledged, in terms, the extreme
difficulty of “keeping up the excitement of the people, on the subject
of Free Trade, for more than a few weeks!” Mr Cobden then favoured