Nephroureterectomy grossing

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This article deals with the nephroureterectomy grossing, also the cut-up of nephroureterectomy specimens. These specimens include both a kidney, a ureter and a urinary bladder cuff.

Total nephrectomy specimens (without the ureter) and partial nephrectomy specimens are dealt with separately.

Introduction

Nephroureterectomies are done for urothelial carcinoma of the ureter and/or renal pelvis.

The false positive/negative for tumour rate is reported as high as 2.9%.[1]

Specimen opening

  1. Paint surface of specimen (optional).
  2. Take the vascular margins - renal artery and renal vein (both en face) and place in one tissue cassette.
  3. Open the kidney in the frontal plane (from lateral to medial).
    • The cut should go through the renal pelvis.

Protocol

Dimensions, weight and inking:

  • Type: nephroureterectomy.
  • Laterality: [left / right].
  • Weight: ___ grams.
  • Size of specimen (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
  • Ureter (length x diameter): ___ x ___ cm.
  • Size of bladder cuff: ___ x ___ cm.
  • Renal vein (length x diameter): ___ x ___ cm.
  • Renal artery (length x diameter): ___ x ___ cm.
  • Adrenal gland: [___ x ___ x ___ cm / not identified].
  • Inking of surface: [colour].
  • Size of kidney (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
  • Perinephric fat (maximal dimension): ___ cm.

Tumour:

  • Dimensions (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
  • Location: [upper pole / lower pole / renal pelvis / ureter].
  • Colour: [white / tan / yellow].
  • Morphology: [solid / cystic / solid and cystic - with ___ % cystic].
  • Friability: [friable / not friable].
  • Circumscription: [well circumscribed / indeterminate / infiltrative border].
  • Hemorrhage: [present / absent].
  • Necrosis: [present / absent].
  • Margin: [nearest margin ___, distance ___ cm / positive margin, location ___].
  • Extension into perinephric fat: [absent / not identified-pushing border / suspicious / present].
  • Extension into the renal parenchyma: [absent / suspicious / present].
  • Extension into renal hilar fat: [absent / not identified-pushing border / suspicious / present].
  • Extension into renal vein: [absent / suspicious / present].

Other:

  • Non-tumour renal parenchyma: [cortex unremarkable / thinned].
  • Non-tumour collecting system mucosa: [smooth and regular / granular / irregular / dilated].
  • Lymph nodes: [number of lymph nodes with [unremarkable cut surface / tumour] / not identified].

Representative sections are submitted:

  • Renal vein margin and renal artery margin (en face).
  • Urinary bladder cuff margin (on edge).§
  • Urinary bladder cuff.
  • Ureter - representative sections.
  • Tumour with nearest margin.
  • Tumour in relation to perinephric fat. †
  • Tumour in relation to renal parenchyma. ††
  • Tumour and sinus fat.
  • Normal kidney.
  • Adrenal gland.

Protocol notes

  • † This typically upstages to pT4. It is uncommon that the tumour goes through the kidney and into the perinephric fat.
  • †† Invasion into the renal parenchyma typically upstages to pT3. This can be difficult to judge on cut-up. If renal parenchymal invasion is not seen grossly at least three sections should be taken. Small tumours are usually submitted in toto.
  • § Margin may be done en face.

Alternate approaches

See also

Related protocols

References

  1. Hong, S.; Kwon, T.; You, D.; Jeong, IG.; Hong, B.; Hong, JH.; Ahn, H.; Kim, CS. (Oct 2014). "Incidence of benign results after laparoscopic radical nephroureterectomy.". JSLS 18 (4). doi:10.4293/JSLS.2014.00335. PMID 25408605.