Total nephrectomy for tumour grossing

This article deals with the cut-up of total nephrectomy for tumour specimens. It also includes radical nephrectomy with or without an adrenal gland.

Partial nephrectomy specimens are dealt with separately.

Introduction

Nephrectomies are often done for kidney tumours.

They come in three basics flavours:

• Partial nephrectomy.
• Total nephrectomy.
• Radical nephrectomy - includes Gerota's fascia.
  • Gerota's fascia is the fascia overlying the perinephric fat).

Resections for tumours generally are radical nephrectomies or partial nephrectomies.

Protocol

Dimensions, weight and inking:

• Type: [total nephrectomy/radical nephrectomy].
• Laterality: [left / right].
• Weight: ___ grams.
• Size of specimen (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
• Ureter (length x diameter): ___ x ___ cm.
• Renal vein (length x diameter): ___ x ___ cm.
• Renal artery (length x diameter): ___ x ___ cm.
• Adrenal gland: [___ x ___ x ___ cm / not identified].
• Inking of surface: [colour].
• Size of kidney (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
• Perinephric fat (maximal dimension): ___ cm.

Tumour:

• Dimensions (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
• Location: [upper pole / mid / lower pole].
• Colour: [yellow / tan / white].
• Morphology: [solid / cystic / solid and cystic - with ___ % cystic].
• Friability: [friable / not friable].
• Circumscription: [well circumscribed / indeterminate / infiltrative border].
• Hemorrhage: [present / absent].
• Necrosis: [present / absent].
• Margin: [nearest margin ___, distance ___ cm / positive margin, location ___].
• Extension into perinephric fat: [absent / not identified-pushing border / suspicious / present].
• Extension into renal hilar fat: [absent / not identified-pushing border / suspicious / present].
• Extension into the collecting system: [absent / suspicious / present].
• Extension into renal vein: [absent / suspicious / present].

Other:

• Non-tumour parenchyma: [cortex unremarkable / thinned].
• Collecting system mucosa: [smooth and regular / granular / irregular / dilated].
• Lymph nodes: [number of lymph nodes with [unremarkable cut surface / tumour] / not identified].

Representative sections are submitted:

• Renal vein margin.
• Ureter margin and renal artery margin.
• Tumour with nearest margin.
• Tumour and perinephric fat.
• Tumour and hilar fat.
  • If fat invasion obvious = 1 section.
  • Suspicion of fast invasion = 3 sections.
• Normal kidney.
• Adrenal gland.

Protocol notes

• Tumour stage size cut points: <=4 cm, <=7 cm.
• It is important to sample the renal vein wall if tumour thrombus projecting out of the renal vein, as a positive margin is called based on microscopic involvement of the vein wall.
  • Tumour projecting out of the vein (i.e. at surface of specimen), at the time of grossing, is presumed to be due to retraction of the vein after it is cut.

See also

Related protocols

• Partial nephrectomy.