Difference between revisions of "Cystoprostatectomy grossing"
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==Introduction== | ==Introduction== | ||
Cystoprostatectomies are done for [[bladder cancer]]. Granular areas of the [[urinary bladder|bladder]] often correlate with [[urothelial carcinoma in situ|carcinoma in situ]]. | Cystoprostatectomies are done for [[bladder cancer]]. Granular areas of the [[urinary bladder|bladder]] often correlate with [[urothelial carcinoma in situ|carcinoma in situ]]. | ||
Lack of a tumour is common in muscle invasive cases that had neoadjuvant therapy; approximately 15% of cases are ypT0.<ref name=pmid22915241>{{Cite journal | last1 = D'Souza | first1 = AM. | last2 = Pohar | first2 = KS. | last3 = Arif | first3 = T. | last4 = Geyer | first4 = S. | last5 = Zynger | first5 = DL. | title = Retrospective analysis of survival in muscle-invasive bladder cancer: impact of pT classification, node status, lymphovascular invasion, and neoadjuvant chemotherapy. | journal = Virchows Arch | volume = 461 | issue = 4 | pages = 467-74 | month = Oct | year = 2012 | doi = 10.1007/s00428-012-1249-4 | PMID = 22915241 }}</ref> | |||
==Specimen opening== | ==Specimen opening== | ||
*Orientation | *Orientation: | ||
**Posterior - typically has serosa (shiny). | **Posterior - typically has serosa (shiny). | ||
**Seminal vesicles - should be identified on the posterior. | **Seminal vesicles - should be identified on the posterior. | ||
Line 14: | Line 16: | ||
***Line 2: anterior bladder base toward upper right. | ***Line 2: anterior bladder base toward upper right. | ||
**Right prostate - blue. | **Right prostate - blue. | ||
**Left prostate - | **Left prostate - black. | ||
*Opening: | *Opening: | ||
**Cut along urethra through anterior prostate (bisect green stripe painted on anterior prostate). | **Cut along urethra through anterior prostate (bisect green stripe painted on anterior prostate). | ||
**Continue cut through urethra upward to left and upward to right - such that anterior bladder wall can be flipped upward. | **Continue cut through urethra upward to left and upward to right - such that anterior bladder wall can be flipped upward. | ||
**Should be pinned open on a large block of paraffin wax. | |||
***A paper towel should be placed behind the specimen - between the specimen and paraffinx wax. | |||
*Place specimen(s) in [[formalin]]. | |||
==Protocol== | ==Protocol== | ||
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Representative sections: | Representative sections: | ||
*Urethral resection margin on edge. | *Urethral resection margin/apex of prostate [[on edge margin|on edge]]. § | ||
*Ureteral surgical (or specimen) margins | *Ureteral surgical (or specimen) margins - left and right ‡ ([[en face margin|en face]]). | ||
*Sagittal section of posterior prostate, posterior bladder neck and posterior-inferior bladder divided into multiple blocks. | *Sagittal section of posterior prostate, posterior bladder neck and posterior-inferior bladder divided into multiple blocks. | ||
*Left prostate - mid part of gland. | *Left prostate - mid part of gland. | ||
*Right prostate - mid part of gland. | *Right prostate - mid part of gland. | ||
*Left parasagittal section of the bladder neck and prostate gland. | *Left parasagittal section † of the bladder neck and prostate gland. | ||
*Right parasagittal section of the bladder neck and prostate gland. | *Right parasagittal section † of the bladder neck and prostate gland. | ||
*Bladder tumour - 1 section/cm. | *Bladder tumour - 1 section/cm. | ||
**Section with deepest invasion. | **Section with deepest invasion. | ||
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===Protocol notes=== | ===Protocol notes=== | ||
*The parasagittal sections of the bladder and prostate are important for staging. | *§ This is how it is done in [[prostatectomy|prostatectomies]]. | ||
*† The parasagittal sections of the bladder and prostate are important for staging. | |||
**Invasion into the prostatic stroma is pT4. | |||
*‡ Should be in separate blocks ''or'' inked with different colours (such that they can be separated at time of microscopy). | |||
===Alternate approaches=== | ===Alternate approaches=== |
Latest revision as of 23:39, 6 May 2015
This article deals with cystoprostatectomy grossing, also cystoprostatectomy cut-up.
Introduction
Cystoprostatectomies are done for bladder cancer. Granular areas of the bladder often correlate with carcinoma in situ.
Lack of a tumour is common in muscle invasive cases that had neoadjuvant therapy; approximately 15% of cases are ypT0.[1]
Specimen opening
- Orientation:
- Posterior - typically has serosa (shiny).
- Seminal vesicles - should be identified on the posterior.
- Inking:
- Anterior midline of prostate - green stripe.
- Anterior urinary bladder site of openning.
- Line 1: anterior bladder base toward upper left.
- Line 2: anterior bladder base toward upper right.
- Right prostate - blue.
- Left prostate - black.
- Opening:
- Cut along urethra through anterior prostate (bisect green stripe painted on anterior prostate).
- Continue cut through urethra upward to left and upward to right - such that anterior bladder wall can be flipped upward.
- Should be pinned open on a large block of paraffin wax.
- A paper towel should be placed behind the specimen - between the specimen and paraffinx wax.
- Place specimen(s) in formalin.
Protocol
Specimen:
- Type: cystoprostatecomy.
- Specimen weight: ___ grams.
- Specimen dimensions (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
- Prostate dimensions (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
- Left seminal vesicle: ___ x ___ x ___ cm.
- Right seminal vesicle: ___ x ___ x ___ cm.
- Inking: green - anterior prostate, blue - right prostate, black - left prostate, green - urinary bladder openning.
Tumour:
- Size of tumour (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
- Location of tumour: [dome, left, right, anterior, posterior, trigone].
- Nearest margin: [soft tissue margin / urethral / ureteric ].
- Distance to nearest margin: ___.
- Configuration: [ulcerated / exophytic].
- Appearance: [tan/brown / white], [firm / friable].
- Extension into perivescicular adipose tissue: [not identified, present].
Representative sections:
- Urethral resection margin/apex of prostate on edge. §
- Ureteral surgical (or specimen) margins - left and right ‡ (en face).
- Sagittal section of posterior prostate, posterior bladder neck and posterior-inferior bladder divided into multiple blocks.
- Left prostate - mid part of gland.
- Right prostate - mid part of gland.
- Left parasagittal section † of the bladder neck and prostate gland.
- Right parasagittal section † of the bladder neck and prostate gland.
- Bladder tumour - 1 section/cm.
- Section with deepest invasion.
- One section if fat invasion obvious, three sections if it is suspicious.
- Suspicious granular areas.
- Left bladder wall.
- Right bladder wall.
- Anterior bladder wall.
- Posterior bladder wall.
- Dome of bladder.
- Trigone of bladder.
Protocol notes
- § This is how it is done in prostatectomies.
- † The parasagittal sections of the bladder and prostate are important for staging.
- Invasion into the prostatic stroma is pT4.
- ‡ Should be in separate blocks or inked with different colours (such that they can be separated at time of microscopy).
Alternate approaches
See also
Related protocols
References
- ↑ D'Souza, AM.; Pohar, KS.; Arif, T.; Geyer, S.; Zynger, DL. (Oct 2012). "Retrospective analysis of survival in muscle-invasive bladder cancer: impact of pT classification, node status, lymphovascular invasion, and neoadjuvant chemotherapy.". Virchows Arch 461 (4): 467-74. doi:10.1007/s00428-012-1249-4. PMID 22915241.