48,466
edits
Difference between revisions of "Total nephrectomy for tumour grossing"
Jump to navigation
Jump to search
Total nephrectomy for tumour grossing (view source)
Revision as of 16:21, 6 July 2017
, 16:21, 6 July 2017→Protocol notes
| (12 intermediate revisions by the same user not shown) | |||
| Line 2: | Line 2: | ||
This article deals with the [[cut-up]] of '''total nephrectomy for tumour''' specimens. It also includes '''radical nephrectomy''' with or without an adrenal gland. | This article deals with the [[cut-up]] of '''total nephrectomy for tumour''' specimens. It also includes '''radical nephrectomy''' with or without an adrenal gland. | ||
''Partial nephrectomy'' specimens are dealt with separately. | ''[[Partial nephrectomy]]'' specimens and ''[[nephroureterectomy]]'' specimens are dealt with separately. | ||
==Introduction== | ==Introduction== | ||
| Line 11: | Line 11: | ||
*Total nephrectomy. | *Total nephrectomy. | ||
*Radical nephrectomy - includes Gerota's fascia. | *Radical nephrectomy - includes Gerota's fascia. | ||
**Gerota's fascia is the fascia overlying the perinephric fat | **Gerota's fascia is the fascia overlying the perinephric fat. | ||
**''Radical nephrectomy'' by definition does ''not'' require removal of the [[adrenal gland]].<ref name=pmid26425218>{{Cite journal | last1 = Nason | first1 = GJ. | last2 = Walsh | first2 = LG. | last3 = Redmond | first3 = CE. | last4 = Kelly | first4 = NP. | last5 = McGuire | first5 = BB. | last6 = Sharma | first6 = V. | last7 = Kelly | first7 = ME. | last8 = Galvin | first8 = DJ. | last9 = Mulvin | first9 = DW. | title = Comparative effectiveness of adrenal sparing radical nephrectomy and non-adrenal sparing radical nephrectomy in clear cell renal cell carcinoma: Observational study of survival outcomes. | journal = Can Urol Assoc J | volume = 9 | issue = 9-10 | pages = E583-8 | month = | year = | doi = 10.5489/cuaj.2842 | PMID = 26425218 }}</ref><ref name=pmid23039377>{{Cite journal | last1 = Yap | first1 = SA. | last2 = Alibhai | first2 = SM. | last3 = Abouassaly | first3 = R. | last4 = Timilshina | first4 = N. | last5 = Margel | first5 = D. | last6 = Finelli | first6 = A. | title = Ipsilateral adrenalectomy at the time of radical nephrectomy impacts overall survival. | journal = BJU Int | volume = 111 | issue = 3 Pt B | pages = E54-8 | month = Mar | year = 2013 | doi = 10.1111/j.1464-410X.2012.11435.x | PMID = 23039377 }}</ref> | |||
Resections for tumours generally are ''radical nephrectomies'' or ''partial nephrectomies''. | Resections for tumours generally are ''radical nephrectomies'' or ''partial nephrectomies''. | ||
| Line 25: | Line 26: | ||
===Opening notes=== | ===Opening notes=== | ||
*It is reasonable to skip the inking step as if the tumour is at the surface it is usually obvious. | *It is reasonable to skip the [[inking]] step as if the tumour is at the surface it is usually obvious. | ||
==Protocol== | ==Protocol== | ||
| Line 71: | Line 72: | ||
===Protocol notes=== | ===Protocol notes=== | ||
* | *[[Kidney cancer staging|Kidney tumour stage]] size cut points: <=4 cm, <=7 cm. | ||
*‡ It is important to sample the renal vein wall if tumour thrombus projecting out of the renal vein, as a positive margin is called based on microscopic involvement of | **The 7th edition of the [[TNM staging system]] divides pT2 into pT2a (>7 cm and <=10 cm) and pT2b (>10 cm); however, evidence does not support this subdivision.<ref name=pmid21030143>{{Cite journal | last1 = Waalkes | first1 = S. | last2 = Becker | first2 = F. | last3 = Schrader | first3 = AJ. | last4 = Janssen | first4 = M. | last5 = Wegener | first5 = G. | last6 = Merseburger | first6 = AS. | last7 = Schrader | first7 = M. | last8 = Hofmann | first8 = R. | last9 = Stöckle | first9 = M. | title = Is there a need to further subclassify pT2 renal cell cancers as implemented by the revised 7th TNM version? | journal = Eur Urol | volume = 59 | issue = 2 | pages = 258-63 | month = Feb | year = 2011 | doi = 10.1016/j.eururo.2010.10.005 | PMID = 21030143 }}</ref> | ||
*‡ It is important to sample the renal vein wall if tumour thrombus is projecting out of the renal vein, as a positive margin is called based on microscopic involvement of the vein or tumour adherence to the vein wall at microscopy.<ref name=pmid24025521>{{Cite journal | last1 = Trpkov | first1 = K. | last2 = Grignon | first2 = DJ. | last3 = Bonsib | first3 = SM. | last4 = Amin | first4 = MB. | last5 = Billis | first5 = A. | last6 = Lopez-Beltran | first6 = A. | last7 = Samaratunga | first7 = H. | last8 = Tamboli | first8 = P. | last9 = Delahunt | first9 = B. | title = Handling and staging of renal cell carcinoma: the International Society of Urological Pathology Consensus (ISUP) conference recommendations. | journal = Am J Surg Pathol | volume = 37 | issue = 10 | pages = 1505-17 | month = Oct | year = 2013 | doi = 10.1097/PAS.0b013e31829a85d0 | PMID = 24025521 }}</ref> | |||
**Tumour projecting out of the vein (i.e. at the surface of specimen), at the time of grossing, is presumed to be due to retraction of the vein after it is cut. | **Tumour projecting out of the vein (i.e. at the surface of specimen), at the time of grossing, is presumed to be due to retraction of the vein after it is cut. | ||
*† If fat invasion obvious = 1 section. | *† If fat invasion obvious = 1 section. | ||
**Suspicion of fat invasion = 3 sections. | **Suspicion of fat invasion = 3 sections. | ||
***It should be noted that as per Trpkov ''et al.''<ref name=pmid24025521/>: "<nowiki>[A]</nowiki> circumscribed, pushing ... border, even if extending well beyond the normal outline of the renal cortex, is '''not''' <nowiki>[emphasis added]</nowiki> diagnostic of perinephric fat invasion." | |||
===Alternate approaches=== | ===Alternate approaches=== | ||
*Ink only the areas that are suspicious for tumour. | |||
==See also== | ==See also== | ||
*[[Kidney cancer staging]]. | |||
*[[Marking ink]]. | |||
===Related protocols=== | ===Related protocols=== | ||
*[[Partial nephrectomy]]. | *[[Partial nephrectomy]]. | ||
*[[Nephroureterectomy]]. | |||
==References== | ==References== | ||
{{Reflist|1}} | {{Reflist|1}} | ||