Difference between revisions of "Nephroureterectomy grossing"
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This article deals with the '''nephroureterectomy grossing''', also the [[cut-up]] of '''nephroureterectomy''' specimens. These specimens include both a [[kidney]] and a [[ | 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. | ||
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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=== | ||
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
- Paint surface of specimen (optional).
- Take the vascular margins - renal artery and renal vein (both en face) and place in one tissue cassette.
- Open the kidney in the frontal plane (from lateral to medial).
- The cut should go through the renal pelvis.
- 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
- ↑ 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.