Orchiectomy grossing

Orchiectomy specimen showing testis replaced by tumour (proven to be seminoma). (WC/Ed Uthman)

This article deals with orchiectomy grossing.

Introduction

Orchiectomies are typically done for testicular tumours.

They may be done for chronic pain or to control prostate cancer.

Specimen opening

• Orient the specimen.
  • Follow cord to hilum of testis and epididymis.
• Bisect the testis with one cut toward the hilum.
  • Do not cut through.
  • If tumour is a large do additional cuts parallel to the first cut to ensure proper fixation.

Note:

• Cutting easier if blade wet before cutting.

Protocol

Dimensions and weight:

• Laterality: [ left / right ].
• Weight: ___ grams.
• Testis: ___ x ___ x ___ cm.
• Epididymis: ___ x ___ x ___ cm.
• Spermatic cord - length: __ cm, diameter: ___ cm.
• Inking: [colour].

Tumour:

• Size: ___ x ___ x ___ cm.
• Colour: [ tan / white / variable ].
• Firmness: [ firm / soft ].
• Morphology: [solid / cystic / solid and cystic - with ___ % cystic].
• Circumscription: [circumscribed / infiltrative border ].
• Hemorrhage: [ absent / present ].
• Necrosis: [ absent / present ].
• Extension into tunica albuginea: [ not identified / indeterminate / present ].
• Extension into the epididymis: [ not identified / indeterminate / present ].

Other - after sectioning:

• Testicular parenchyma: [ brown-tan, unremarkable / ___ ].
• Spermatic cord: [ unremarkable / ___ ].

Representative sections are submitted as follow:

• Spermatic cord resection margin, en face.
• Spermatic cord mid-section, cross section.
• Spermatic cord close to testis.
• Tumour in relation to epididymis.
• Tumour and rete testis.
• Tumour with testicular coverings.
• Additional tumour sections.
• Testis distant from the tumour.

Protocol notes

• The tumour should be submitted in total if this can be done in less than 10 cassettes.
• Lester's book (2nd Ed.) recommends 1 cassette per cm of maximal tumour dimension.

Staging

Based on AJCC 7th Edition:

• pT1 - confined to the testis or epididymis, no lymphovascular invasion.
• pT2 - into tunica vaginalis or lymphovascular invasion.
• pT3 - into spermatic cord.
• pT4 - into the scrotum.

Notes:

• Invasion into the epididymis and/or tunica albuginea does not change the stage.
• Rete testis involvement and testicular hilum involvement may be seen or suspected at the time of cut-up. Both of these are poor prognosticators; however, they to do not affect the (AJCC 7th Ed.) stage.
  • Involvement of the testicular hilum is pT1, if there is no LVI and the tumour is otherwise confined to the testis/epididymis.