Cystoprostatectomy grossing
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.
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 - green Y-shaped.
- Right prostate - blue.
- Left prostate - green.
- 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.
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 on edge.
- Ureteral surgical (or specimen) margins (left and right).
- 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
- The parasagittal sections of the bladder and prostate are important for staging.