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Difference between revisions of "Nephroureterectomy grossing"
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This article deals with the [[cut-up]] of '''nephroureterectomy''' specimens | 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== | ||
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> | 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> | ||
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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 | *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 | *Extension into the renal parenchyma: [absent / suspicious / present]. | ||
*Extension into renal | *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 ( | *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=== | ||