Difference between revisions of "Nephroureterectomy grossing"

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This article deals with the [[cut-up]] of '''nephroureterectomy''' specimens which include both a [[kidney]] and a [[ureter]].
This article deals with the '''nephroureterectomy grossing''', also the [[cut-up]] of '''nephroureterectomy''' specimens.  These specimens include both a [[kidney]], a [[ureter]] and a [[urinary bladder]] cuff.


''[[Total nephrectomy]]'' specimens (without the ureter) and ''[[partial nephrectomy]]'' specimens are dealt with separately.
''[[Total nephrectomy]]'' specimens (without the ureter) and ''[[partial nephrectomy]]'' specimens are dealt with separately.


==Introduction==
==Introduction==
Nephrectomies are often done for [[urothelial carcinoma]].
Nephroureterectomies are done for [[urothelial carcinoma]] of the ureter and/or renal pelvis.  
 
The false positive/negative for tumour rate is reported as high as 2.9%.<ref name=pmid25408605>{{Cite journal  | last1 = Hong | first1 = S. | last2 = Kwon | first2 = T. | last3 = You | first3 = D. | last4 = Jeong | first4 = IG. | last5 = Hong | first5 = B. | last6 = Hong | first6 = JH. | last7 = Ahn | first7 = H. | last8 = Kim | first8 = CS. | title = Incidence of benign results after laparoscopic radical nephroureterectomy. | journal = JSLS | volume = 18 | issue = 4 | pages =  | month = Oct | year = 2014 | doi = 10.4293/JSLS.2014.00335 | PMID = 25408605 }}</ref>


==Specimen opening==
==Specimen opening==
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#Open the kidney in the frontal plane (from lateral to medial).
#Open the kidney in the frontal plane (from lateral to medial).
#*The cut should go through the renal pelvis.
#*The cut should go through the renal pelvis.
#Place specimen(s) in [[formalin]].


==Protocol==
==Protocol==
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*Renal artery (length x diameter): ___ x ___ cm.
*Renal artery (length x diameter): ___ x ___ cm.
*Adrenal gland: [___ x ___ x ___ cm / not identified].
*Adrenal gland: [___ x ___ x ___ cm / not identified].
*Inking of surface: [colour].
*Inking of kidney: [colour].
*Inking of proximal ureter: [colour]. ¶
*Inking of mid ureter: [colour]. ¶
*Inking of distal ureter: [colour]. ¶
*Inking of bladder cuff/resection margin: [colour].
*Size of kidney (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
*Size of kidney (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
*Perinephric fat (maximal dimension): ___ cm.
*Perinephric fat (maximal dimension): ___ cm.
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*Margin: [nearest margin ___, distance ___ cm / positive margin, location ___].  
*Margin: [nearest margin ___, distance ___ cm / positive margin, location ___].  
*Extension into perinephric fat: [absent / not identified-pushing border / suspicious / present].
*Extension into perinephric fat: [absent / not identified-pushing border / suspicious / present].
*Extension into the renal parenchyma system: [absent / suspicious / present].
*Extension into the renal parenchyma: [absent / suspicious / present].
*Extension into renal sinus fat: [absent / not identified-pushing border / suspicious / present].
*Extension into renal hilar fat: [absent / not identified-pushing border / suspicious / present].
*Extension into renal vein: [absent / suspicious / present].
*Extension into renal vein: [absent / suspicious / present].


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Representative sections are submitted:
Representative sections are submitted:
*Renal vein margin and renal artery margin (en face)
*Renal vein margin and renal artery margin ([[en face margin|en face]]).
*Urinary bladder cuff margin (en face).
*Urinary bladder cuff margin ([[on edge margin|on edge]]). §
*Urinary bladder cuff.
*Urinary bladder cuff.
*Ureter - representative sections.
*Ureter - representative sections.
*Tumour with nearest margin.
*Tumour with nearest margin.
*Tumour in relation to perinephric fat. †
*Tumour in relation to perinephric fat. †
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===Protocol notes===
===Protocol notes===
*§ Bladder cuff margin may be done en face.
*¶ The ureter should be cross sections - ''not'' longitudinal sections. It is advantageous to ink the ureter three different colours; this allows one to determine where the remaining ureter is from.
**If ''proximal ureter'' is blue, ''mid ureter'' is ''red'' and ''distal ureter'' is ''green'': blue-red is proximal, red-green is distal; the orientation and anatomical location is important if one submits more tissue.
*† This typically upstages to pT4. It is uncommon that the tumour goes through the kidney and into the perinephric fat.
*† This typically upstages to pT4. It is uncommon that the tumour goes through the kidney and into the perinephric fat.
*†† Invasion into the renal parenchyma typically upstages to pT3. This can be difficult to judge on [[cut-up]]. If renal parenchymal invasion is ''not'' seen grossly at least three sections should be taken.
*†† Invasion into the renal parenchyma typically upstages to pT3. This can be difficult to judge on [[cut-up]]. If renal parenchymal invasion is ''not'' seen grossly at least three sections should be taken. Small tumours are usually [[submitted in toto]].


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

Latest revision as of 16:14, 31 July 2024

This article deals with the nephroureterectomy grossing, also the cut-up of nephroureterectomy specimens. These specimens include both a kidney, a ureter and a urinary bladder cuff.

Total nephrectomy specimens (without the ureter) and partial nephrectomy specimens are dealt with separately.

Introduction

Nephroureterectomies are done for urothelial carcinoma of the ureter and/or renal pelvis.

The false positive/negative for tumour rate is reported as high as 2.9%.[1]

Specimen opening

  1. Paint surface of specimen (optional).
  2. Take the vascular margins - renal artery and renal vein (both en face) and place in one tissue cassette.
  3. Open the kidney in the frontal plane (from lateral to medial).
    • The cut should go through the renal pelvis.
  4. Place specimen(s) in formalin.

Protocol

Dimensions, weight and inking:

  • Type: nephroureterectomy.
  • Laterality: [left / right].
  • Weight: ___ grams.
  • Size of specimen (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
  • Ureter (length x diameter): ___ x ___ cm.
  • Size of bladder cuff: ___ 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 kidney: [colour].
  • Inking of proximal ureter: [colour]. ¶
  • Inking of mid ureter: [colour]. ¶
  • Inking of distal ureter: [colour]. ¶
  • Inking of bladder cuff/resection margin: [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 / lower pole / renal pelvis / ureter].
  • Colour: [white / tan / yellow].
  • 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 the renal parenchyma: [absent / suspicious / present].
  • Extension into renal hilar fat: [absent / not identified-pushing border / suspicious / present].
  • Extension into renal vein: [absent / suspicious / present].

Other:

  • Non-tumour renal parenchyma: [cortex unremarkable / thinned].
  • Non-tumour 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 and renal artery margin (en face).
  • Urinary bladder cuff margin (on edge). §
  • Urinary bladder cuff.
  • Ureter - representative sections. ¶
  • Tumour with nearest margin.
  • Tumour in relation to perinephric fat. †
  • Tumour in relation to renal parenchyma. ††
  • Tumour and sinus fat.
  • Normal kidney.
  • Adrenal gland.

Protocol notes

  • § Bladder cuff margin may be done en face.
  • ¶ The ureter should be cross sections - not longitudinal sections. It is advantageous to ink the ureter three different colours; this allows one to determine where the remaining ureter is from.
    • If proximal ureter is blue, mid ureter is red and distal ureter is green: blue-red is proximal, red-green is distal; the orientation and anatomical location is important if one submits more tissue.
  • † This typically upstages to pT4. It is uncommon that the tumour goes through the kidney and into the perinephric fat.
  • †† Invasion into the renal parenchyma typically upstages to pT3. This can be difficult to judge on cut-up. If renal parenchymal invasion is not seen grossly at least three sections should be taken. Small tumours are usually submitted in toto.

Alternate approaches

See also

Related protocols

References

  1. Hong, S.; Kwon, T.; You, D.; Jeong, IG.; Hong, B.; Hong, JH.; Ahn, H.; Kim, CS. (Oct 2014). "Incidence of benign results after laparoscopic radical nephroureterectomy.". JSLS 18 (4). doi:10.4293/JSLS.2014.00335. PMID 25408605.