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Breast carcinoma is the most common malignant tumor in women in North America and Europe. Invasive mammary carcinoma, like the pre-invasive tumors that typically precede it, can be readily recognized and graded in surgically removed or biopsied tissue samples. The grading and staging of these tumors are of considerable clinical significance and are performed routinely.

The grading of tumors plays a less significant role in the hematopoietic and lymphoid systems than perhaps for any other organ system. While grading was once an integral part of the classification of non-Hodgkin lymphomas, it is now considered more relevant to give a precise classification to provide the information that the clinician requires for prognosis and treatment planning. Nonetheless, for certain neoplasms grading plays an accepted and sometimes important role. In the future, ancillary methods such as immunohistochemistry, flow cytometry, and cytogenetics (already of great importance), as well as gene profiling, will likely play an even more critical role in determining prognosis and response to therapy in lymphoid and hematopoietic neoplasms.

Tumors of the soft tissues and bones form a heterogeneous group that includes common benign neoplasms as well as other less common, variably malignant neoplasms (sarcomas). Recent advances in molecular and cell biology have influenced considerably the present clinical approach to these tumors. As the classifications of these tumors, most notably that of soft tissue sarcomas, are constantly refined by the addition of new data, the grading of soft tissue and bone sarcomas remains a work in progress (, ). Accordingly, only the most established grading systems used in daily surgical pathology practice are presented here.

Although skin tumors are common, they are rarely graded. This chapter covers only the grading of basal cell carcinoma, squamous cell carcinoma, and some mesenchymal and pigmented lesions.

The first significant histologic classification of tumors of the central nervous system (CNS) was proposed by Bailey and Cushing in 1926. Thereafter, several major revisions were introduced, and numerous consensus conferences were held. The grading of CNS tumors is an integral part of these revisions and is routinely applied to primary intracranial and spinal tumors. Rare tumors will not be discussed in this concise chapter.