Nephroureterectomy grossing

This article deals with the cut-up of nephroureterectomy specimens which include both a kidney and a ureter.

Total nephrectomy specimens (without the ureter) and partial nephrectomy specimens are dealt with separately.

Introduction

Nephrectomies are often done for urothelial carcinoma.

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.

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:

† 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.