Difference between revisions of "Radical cystectomy grossing"
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'''radical cystectomy''', also | This article deals with '''radical cystectomy grossing''', also '''radical cystectomy''' [[cut-up]]. | ||
A '''[[cystectomy]]''' is removal of the [[urinary bladder]]; however, it may refer to the removal of a cyst, e.g. ''ovarian cystectomy''. | |||
==Introduction== | ==Introduction== | ||
| Line 5: | Line 7: | ||
In men, the [[urinary bladder]] is usually removed along with the [[prostate gland]] (see [[cystoprostatectomy]]). | In men, the [[urinary bladder]] is usually removed along with the [[prostate gland]] (see [[cystoprostatectomy]]). | ||
The [[ureter]]s in these cases are often are assessed [[frozen section|intraoperatively]]. The occurrence of [[urothelial carcinoma in situ|CIS]] is strongly associated with CIS in the [[urinary bladder]].<ref name=pmid25374918>{{Cite journal | last1 = Zhou | first1 = H. | last2 = Ro | first2 = JY. | last3 = Truong | first3 = LD. | last4 = Ayala | first4 = AG. | last5 = Shen | first5 = SS. | title = Intraoperative frozen section evaluation of ureteral and urethral margins: studies of 203 consecutive radical cystoprostatectomy for men with bladder urothelial carcinoma. | journal = Am J Clin Exp Urol | volume = 2 | issue = 2 | pages = 156-60 | month = | year = 2014 | doi = | PMID = 25374918 }}</ref> | |||
==Specimen opening== | |||
*Orientation: | |||
**Posterior - typically has serosa (shiny). | |||
**Uterus, uterine tubes and ovaries posterior to bladder. | |||
*[[Inking]]: | |||
**Urethra margin - green ink. | |||
**Anterior urinary bladder site of opening (blue ink): | |||
***Line 1: anterior bladder base toward upper left. | |||
***Line 2: anterior bladder base toward upper right. | |||
**If total hysterectomy - soft tissue margin - black ink. | |||
*Opening: | |||
**Open anteriorly through the urethra and follow the ink upward to left and upward to right - such that anterior bladder wall can be flipped upward. | |||
**Open the uterus - if present - with scissors through the external os with cuts on the lateral walls. | |||
*Specimen should be pinned open on a large block of paraffin wax. | |||
**A paper towel should be placed behind the specimen - between the specimen and paraffin wax. | |||
*Place specimen(s) in [[formalin]]. | |||
==Protocol== | ==Protocol== | ||
Specimen: | Specimen: | ||
*Type: | *Type: cystectomy [with vagina / uterus / uterine tubes / ovaries]. | ||
*Specimen weight: ___ grams. | *Specimen weight: ___ grams. | ||
*Specimen dimensions (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm. | *Specimen dimensions (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm. | ||
Tumour: | Tumour: | ||
*Size (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm. | *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 ]. | *Nearest margin: [soft tissue margin / urethral / ureteric ]. | ||
*Distance to nearest margin: ___. | *Distance to nearest margin: ___. | ||
*Configuration: [ulcerated / exophytic]. | *Configuration: [ulcerated / exophytic]. | ||
*Appearance: | *Appearance: [tan/brown / white], [firm / friable]. | ||
*Extension into perivescicular adipose tissue: [not identified, present]. | |||
Other: | |||
*[None / granular areas / hemorraghic areas / polypoid areas / polyps]. | |||
Representative sections: | Representative sections: | ||
*Urethral resection margin on edge. | *Urethral resection margin on edge. | ||
*Ureteral surgical (or specimen) margins (left and right). | |||
*Bladder tumour - 1 section/cm. | *Bladder tumour - 1 section/cm. | ||
*Section with deepest invasion. | *Section with deepest invasion. | ||
*One section if fat invasion obvious, three sections if it is suspicious. | *One section if fat invasion obvious, three sections if it is suspicious. | ||
*Suspicious granular areas. | *Suspicious granular areas and polyps. | ||
*Left bladder wall. | *Left bladder wall at site of ureteric oriface. | ||
*Right bladder wall. | *Right bladder wall at site of ureteric oriface. | ||
*Anterior bladder wall. | |||
*Posterior bladder wall. | |||
*Dome of bladder. | *Dome of bladder. | ||
*Trigone of bladder. | *Trigone of bladder. | ||
Sections of additional structures (if applicable): | |||
*Ovaries. | |||
*Uterine tubes - esp. fibriated ends. | |||
*Vagina - esp. in relation to tumour. | |||
*Uterus: | |||
**Cervix. | |||
**Corpus - anterior & posterior walls. | |||
===Protocol notes=== | ===Protocol notes=== | ||
===Alternate approaches=== | ===Alternate approaches=== | ||
==See also== | ==See also== | ||
===Related protocols=== | ===Related protocols=== | ||
*[[Partial cystectomy]]. | |||
*[[Cystoprostatectomy]]. | *[[Cystoprostatectomy]]. | ||
Latest revision as of 03:13, 11 October 2016
This article deals with radical cystectomy grossing, also radical cystectomy cut-up.
A cystectomy is removal of the urinary bladder; however, it may refer to the removal of a cyst, e.g. ovarian cystectomy.
Introduction
It is done for bladder cancer (urothelial carcinoma).
In men, the urinary bladder is usually removed along with the prostate gland (see cystoprostatectomy).
The ureters in these cases are often are assessed intraoperatively. The occurrence of CIS is strongly associated with CIS in the urinary bladder.[1]
Specimen opening
- Orientation:
- Posterior - typically has serosa (shiny).
- Uterus, uterine tubes and ovaries posterior to bladder.
- Inking:
- Urethra margin - green ink.
- Anterior urinary bladder site of opening (blue ink):
- Line 1: anterior bladder base toward upper left.
- Line 2: anterior bladder base toward upper right.
- If total hysterectomy - soft tissue margin - black ink.
- Opening:
- Open anteriorly through the urethra and follow the ink upward to left and upward to right - such that anterior bladder wall can be flipped upward.
- Open the uterus - if present - with scissors through the external os with cuts on the lateral walls.
- Specimen should be pinned open on a large block of paraffin wax.
- A paper towel should be placed behind the specimen - between the specimen and paraffin wax.
- Place specimen(s) in formalin.
Protocol
Specimen:
- Type: cystectomy [with vagina / uterus / uterine tubes / ovaries].
- Specimen weight: ___ grams.
- Specimen dimensions (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
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].
Other:
- [None / granular areas / hemorraghic areas / polypoid areas / polyps].
Representative sections:
- Urethral resection margin on edge.
- Ureteral surgical (or specimen) margins (left and right).
- Bladder tumour - 1 section/cm.
- Section with deepest invasion.
- One section if fat invasion obvious, three sections if it is suspicious.
- Suspicious granular areas and polyps.
- Left bladder wall at site of ureteric oriface.
- Right bladder wall at site of ureteric oriface.
- Anterior bladder wall.
- Posterior bladder wall.
- Dome of bladder.
- Trigone of bladder.
Sections of additional structures (if applicable):
- Ovaries.
- Uterine tubes - esp. fibriated ends.
- Vagina - esp. in relation to tumour.
- Uterus:
- Cervix.
- Corpus - anterior & posterior walls.