Yang C, Shuch B, Serrano M, et al. - In this study, the frequency and extent of adverse histopathologic characteristics in clear cell renal cell carcinomas (CCRCCs) ≤ 4 cm were investigated. In addition, how these characteristics influence the patient outcome was determined. Researchers reviewed 631 consecutive cases who underwent nephrectomies for CCRCC. Findings revealed a significant correlation of adverse tumor histopathologic characteristics with size: more high nuclear grade (45% vs 15%), necrosis (46% vs 21%), and lymphovascular invasion (17% vs 3%) were observed in CCRCCs > 4 vs ≤ 4 cm. Although CCRCCs ≤ 4 cm less commonly display adverse histologic features, the presence of these features was associated with a worse prognosis. They suggest performing needle core biopsy examination to identify these features to guide clinical management, especially in patients for whom active surveillance is considered.