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Difference between revisions of "Radical cystectomy grossing"
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Radical cystectomy grossing (view source)
Revision as of 03:13, 11 October 2016
, 03:13, 11 October 2016no edit summary
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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 | 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== | ||
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*Appearance: [tan/brown / white], [firm / friable]. | *Appearance: [tan/brown / white], [firm / friable]. | ||
*Extension into perivescicular adipose tissue: [not identified, present]. | *Extension into perivescicular adipose tissue: [not identified, present]. | ||
Other: | |||
*[None / granular areas / hemorraghic areas / polypoid areas / polyps]. | |||
Representative sections: | Representative sections: | ||
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*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 at site of ureteric oriface. | *Left bladder wall at site of ureteric oriface. | ||
*Right bladder wall at site of ureteric oriface. | *Right bladder wall at site of ureteric oriface. | ||