Orchiectomy grossing

This article deals with orchiectomy grossing.

Orchiectomy specimen showing testis replaced by tumour (proven to be seminoma).

Introduction

Orchiectomies are typically done for testicular tumours.

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

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, rete testis or tunica albuginea does not change the stage.

See also