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.

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.

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.

§ 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).