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Difference between revisions of "Cystoprostatectomy grossing"
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This article deals with | This article deals with '''cystoprostatectomy grossing''', also '''cystoprostatectomy''' [[cut-up]]. | ||
==Introduction== | ==Introduction== | ||
Cystoprostatectomies are done for [[bladder cancer]]. Granular areas of the [[urinary bladder|bladder]] often correlate with [[urothelial carcinoma in situ|carcinoma in situ]]. | Cystoprostatectomies are done for [[bladder cancer]]. Granular areas of the [[urinary bladder|bladder]] often correlate with [[urothelial carcinoma in situ|carcinoma in situ]]. | ||
Lack of a tumour is common in muscle invasive cases that had neoadjuvant therapy; approximately 15% of cases are ypT0.<ref name=pmid22915241>{{Cite journal | last1 = D'Souza | first1 = AM. | last2 = Pohar | first2 = KS. | last3 = Arif | first3 = T. | last4 = Geyer | first4 = S. | last5 = Zynger | first5 = DL. | title = Retrospective analysis of survival in muscle-invasive bladder cancer: impact of pT classification, node status, lymphovascular invasion, and neoadjuvant chemotherapy. | journal = Virchows Arch | volume = 461 | issue = 4 | pages = 467-74 | month = Oct | year = 2012 | doi = 10.1007/s00428-012-1249-4 | PMID = 22915241 }}</ref> | |||
==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. | |||
***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. | |||
*Place specimen(s) in [[formalin]]. | |||
==Protocol== | ==Protocol== | ||
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*Left seminal vesicle: ___ x ___ x ___ cm. | *Left seminal vesicle: ___ x ___ x ___ cm. | ||
*Right 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: | Tumour: | ||
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Representative sections: | Representative sections: | ||
*Urethral resection margin on edge. | *Urethral resection margin/apex of prostate [[on edge margin|on edge]]. § | ||
*Ureteral surgical (or specimen) margins - left and right ‡ ([[en face margin|en face]]). | |||
*Sagittal section of posterior prostate, posterior bladder neck and posterior-inferior bladder divided into multiple blocks. | *Sagittal section of posterior prostate, posterior bladder neck and posterior-inferior bladder divided into multiple blocks. | ||
*Left prostate - mid part of gland. | *Left prostate - mid part of gland. | ||
*Right prostate - mid part of gland. | *Right prostate - mid part of gland. | ||
*Left parasagittal section of the bladder neck and prostate gland. | *Left parasagittal section † of the bladder neck and prostate gland. | ||
*Right parasagittal section of the bladder neck and prostate gland. | *Right parasagittal section † of the bladder neck and prostate gland. | ||
*Bladder tumour - 1 section/cm. | *Bladder tumour - 1 section/cm. | ||
**Section with deepest invasion. | **Section with deepest invasion. | ||
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*Left bladder wall. | *Left bladder wall. | ||
*Right bladder wall. | *Right bladder wall. | ||
*Anterior bladder wall. | |||
*Posterior bladder wall. | |||
*Dome of bladder. | *Dome of bladder. | ||
*Trigone of bladder. | *Trigone of bladder. | ||
===Protocol notes=== | ===Protocol notes=== | ||
*The parasagittal sections of the bladder and prostate are important for staging. | *§ This is how it is done in [[prostatectomy|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). | |||
===Alternate approaches=== | ===Alternate approaches=== | ||