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]] and a [[ureter]]. | ||
''[[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> |
Revision as of 16:43, 28 November 2014
This article deals with the nephroureterectomy grossing, also the cut-up of nephroureterectomy specimens. These specimens include both a kidney and a ureter.
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.
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 surface: [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 system: [absent / suspicious / present].
- Extension into renal sinus 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 (en face).
- 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
- † 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.
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.