Difference between revisions of "Total nephrectomy for tumour grossing"

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===Protocol notes===
===Protocol notes===
*Tumour [[stage]] size cut points: <=4 cm, <=7 cm.
*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.<ref name=pmid24025521>{{Cite journal  | last1 = Trpkov | first1 = K. | last2 = Grignon | first2 = DJ. | last3 = Bonsib | first3 = SM. | last4 = Amin | first4 = MB. | last5 = Billis | first5 = A. | last6 = Lopez-Beltran | first6 = A. | last7 = Samaratunga | first7 = H. | last8 = Tamboli | first8 = P. | last9 = Delahunt | first9 = B. | title = Handling and staging of renal cell carcinoma: the International Society of Urological Pathology Consensus (ISUP) conference recommendations. | journal = Am J Surg Pathol | volume = 37 | issue = 10 | pages = 1505-17 | month = Oct | year = 2013 | doi = 10.1097/PAS.0b013e31829a85d0 | PMID = 24025521 }}</ref>
*‡ 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/adherence to the vein wall.<ref name=pmid24025521>{{Cite journal  | last1 = Trpkov | first1 = K. | last2 = Grignon | first2 = DJ. | last3 = Bonsib | first3 = SM. | last4 = Amin | first4 = MB. | last5 = Billis | first5 = A. | last6 = Lopez-Beltran | first6 = A. | last7 = Samaratunga | first7 = H. | last8 = Tamboli | first8 = P. | last9 = Delahunt | first9 = B. | title = Handling and staging of renal cell carcinoma: the International Society of Urological Pathology Consensus (ISUP) conference recommendations. | journal = Am J Surg Pathol | volume = 37 | issue = 10 | pages = 1505-17 | month = Oct | year = 2013 | doi = 10.1097/PAS.0b013e31829a85d0 | PMID = 24025521 }}</ref>
**Tumour projecting out of the vein (i.e. at the surface of specimen), at the time of grossing, is presumed to be due to retraction of the vein after it is cut.
**Tumour projecting out of the vein (i.e. at the surface of specimen), at the time of grossing, is presumed to be due to retraction of the vein after it is cut.
*† If fat invasion obvious = 1 section.
*† If fat invasion obvious = 1 section.
**Suspicion of fat invasion = 3 sections.
**Suspicion of fat invasion = 3 sections.


===Alternate approaches===
===Alternate approaches===

Revision as of 16:22, 3 September 2014

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. †
  • 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/adherence to the vein wall.[1]
    • Tumour projecting out of the vein (i.e. at the surface of specimen), at the time of grossing, is presumed to be due to retraction of the vein after it is cut.
  • † If fat invasion obvious = 1 section.
    • Suspicion of fat invasion = 3 sections.

Alternate approaches

See also

Related protocols

References

  1. Trpkov, K.; Grignon, DJ.; Bonsib, SM.; Amin, MB.; Billis, A.; Lopez-Beltran, A.; Samaratunga, H.; Tamboli, P. et al. (Oct 2013). "Handling and staging of renal cell carcinoma: the International Society of Urological Pathology Consensus (ISUP) conference recommendations.". Am J Surg Pathol 37 (10): 1505-17. doi:10.1097/PAS.0b013e31829a85d0. PMID 24025521.