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Radical cystectomy grossing (view source)
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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== | ||
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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]]. | ||