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Orchiectomy grossing (view source)
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This article deals with | [[Image:Seminoma_of_the_Testis.jpg|thumb|150px|Orchiectomy specimen showing testis replaced by tumour (proven to be [[seminoma]]). (WC/Ed Uthman)]] | ||
This article deals with '''orchiectomy grossing'''. | |||
==Introduction== | ==Introduction== | ||
Orchiectomies are typically done for [[testicular tumours]]. | Orchiectomies are typically done for [[testicular tumours]]. | ||
They may be done for chronic pain or to control [[prostate cancer]]. | They may be done for chronic pain<ref name=pmid23929499>{{Cite journal | last1 = Rönkä | first1 = K. | last2 = Vironen | first2 = J. | last3 = Kokki | first3 = H. | last4 = Liukkonen | first4 = T. | last5 = Paajanen | first5 = H. | title = Role of orchiectomy in severe testicular pain after inguinal hernia surgery: audit of the Finnish Patient Insurance Centre. | journal = Hernia | volume = 19 | issue = 1 | pages = 53-9 | month = Feb | year = 2015 | doi = 10.1007/s10029-013-1150-3 | PMID = 23929499 }}</ref> or to control [[prostate cancer]]. Occasionally done in the context of a [[hernia repair]].<ref name=pmid3425809>{{cite journal |authors=Curtsinger LJ, Page CP, Aust JB |title=Orchiectomy during herniorrhaphy: what should we tell the patient? |journal=Am J Surg |volume=154 |issue=6 |pages=636–9 |date=December 1987 |pmid=3425809 |doi=10.1016/0002-9610(87)90232-7 |url=}}</ref> | ||
==Specimen opening== | |||
*Orient the specimen. | |||
**Follow cord to hilum of testis and [[epididymis]]. | |||
*Bisect the testis with one cut toward the hilum. | |||
**Do not cut through. | |||
**If tumour is a large do additional cuts parallel to the first cut to ensure proper [[fixation]]. | |||
*Place specimen(s) in [[formalin]]. | |||
Note: | |||
*Cutting easier if blade wet before cutting. | |||
*[[Marking ink|Inking]] the cord at the margin and mid section of the cord in different colours allows one to reconstruct the location if one has to go back to the gross. | |||
==Protocol== | ==Protocol== | ||
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Tumour: | Tumour: | ||
*Size: ___ x ___ x ___ cm. | *Size: ___ x ___ x ___ cm. | ||
*Colour: [tan / white / variable]. | *Colour: [ tan / white / variable ]. | ||
*Firmness: [firm / soft]. | *Firmness: [ firm / soft ]. | ||
*Morphology: [solid / cystic / solid and cystic]. | *Morphology: [solid / cystic / solid and cystic - with ___ % cystic]. | ||
*Circumscription: [circumscribed / infiltrative border]. | *Circumscription: [circumscribed / infiltrative border ]. | ||
*Hemorrhage: [absent / present]. | *Hemorrhage: [ absent / present ]. | ||
*Necrosis: [absent / present]. | *Necrosis: [ absent / present ]. | ||
*Extension into tunica albuginea: [not identified/indeterminate/present]. | *Extension into tunica albuginea: [ not identified / indeterminate / present ]. | ||
*Extension into the epididymis: [not identified/indeterminate/present]. | *Extension into the epididymis: [ not identified / indeterminate / present ]. | ||
Other - after sectioning: | |||
*Testicular parenchyma: [ brown-tan, unremarkable / ___ ]. | |||
*Spermatic cord: [ unremarkable / ___ ]. | |||
Representative sections are submitted as follow: | |||
Spermatic cord | *Spermatic cord resection margin, [[en face margin|en face]]. | ||
*Spermatic cord mid-section, cross section. | |||
*Spermatic cord close to testis. | |||
*Tumour in relation to epididymis. | |||
*Tumour and rete testis. | |||
*Tumour with testicular coverings. | |||
*Additional tumour sections. | |||
*Testis distant from the tumour. | |||
===Protocol notes=== | ===Protocol notes=== | ||
*The tumour should be [[submitted in total]] if this can be done in less than 10 cassettes. | |||
*Lester's book (2nd Ed.) recommends 1 cassette per cm of maximal tumour dimension.<ref>{{Ref Lester|409}}</ref> | |||
====Staging==== | |||
{{Main|Testicular cancer staging}} | |||
Based on AJCC 7th Edition:<ref>URL: [https://en.wikibooks.org/wiki/Radiation_Oncology/Testis/Staging https://en.wikibooks.org/wiki/Radiation_Oncology/Testis/Staging]. Accessed on: 15 December 2014.</ref><ref name=cancer_org>URL: [http://www.cancer.org/cancer/testicularcancer/detailedguide/testicular-cancer-staging http://www.cancer.org/cancer/testicularcancer/detailedguide/testicular-cancer-staging]. Accessed on: 15 December 2014.</ref> | |||
*pT1 - confined to the testis or epididymis, no [[lymphovascular invasion]]. | |||
*pT2 - into tunica vaginalis or lymphovascular invasion. | |||
*pT3 - into [[spermatic cord]]. | |||
*pT4 - into the [[scrotum]]. | |||
===Alternate approaches=== | ===Alternate approaches=== | ||
==See also== | ==See also== | ||
*[[Testicular cancer staging]]. | |||
===Related protocols=== | ===Related protocols=== | ||
==References== | ==References== | ||
{{Reflist|1}} | {{Reflist|1}} | ||