Cystoprostatectomy grossing

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This article deals with cystoprostatectomy grossing, also cystoprostatectomy cut-up.

Introduction

Cystoprostatectomies are done for bladder cancer. Granular areas of the bladder often correlate with carcinoma in situ.

Lack of a tumour is common in muscle invasive cases that had neoadjuvant therapy; approximately 15% of cases are ypT0.[1]

Specimen opening

  • Orientation:
    • Posterior - typically has serosa (shiny).
    • Seminal vesicles - should be identified on the posterior.
  • Inking:
    • Anterior midline of prostate - green stripe.
    • Anterior urinary bladder site of openning.
      • Line 1: anterior bladder base toward upper left.
      • Line 2: anterior bladder base toward upper right.
    • Right prostate - blue.
    • Left prostate - black.
  • Opening:
    • Cut along urethra through anterior prostate (bisect green stripe painted on anterior prostate).
    • Continue cut through urethra upward to left and upward to right - such that anterior bladder wall can be flipped upward.
    • Should be pinned open on a large block of paraffin wax.
      • A paper towel should be placed behind the specimen - between the specimen and paraffinx wax.
  • Place specimen(s) in formalin.

Protocol

Specimen:

  • Type: cystoprostatecomy.
  • Specimen weight: ___ grams.
  • Specimen dimensions (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
  • Prostate dimensions (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
  • Left seminal vesicle: ___ x ___ x ___ cm.
  • Right seminal vesicle: ___ x ___ x ___ cm.
  • Inking: green - anterior prostate, blue - right prostate, black - left prostate, green - urinary bladder openning.

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].

Representative sections:

  • Urethral resection margin/apex of prostate on edge. §
  • Ureteral surgical (or specimen) margins - left and right ‡ (en face).
  • Sagittal section of posterior prostate, posterior bladder neck and posterior-inferior bladder divided into multiple blocks.
  • Left prostate - mid part of gland.
  • Right prostate - mid part of gland.
  • Left parasagittal section † of the bladder neck and prostate gland.
  • Right parasagittal section † of the bladder neck and prostate gland.
  • Bladder tumour - 1 section/cm.
    • Section with deepest invasion.
    • One section if fat invasion obvious, three sections if it is suspicious.
  • Suspicious granular areas.
  • Left bladder wall.
  • Right bladder wall.
  • Anterior bladder wall.
  • Posterior bladder wall.
  • Dome of bladder.
  • Trigone of bladder.

Protocol notes

  • § This is how it is done in prostatectomies.
  • † The parasagittal sections of the bladder and prostate are important for staging.
    • Invasion into the prostatic stroma is pT4.
  • ‡ Should be in separate blocks or inked with different colours (such that they can be separated at time of microscopy).

Alternate approaches

See also

Related protocols

References

  1. D'Souza, AM.; Pohar, KS.; Arif, T.; Geyer, S.; Zynger, DL. (Oct 2012). "Retrospective analysis of survival in muscle-invasive bladder cancer: impact of pT classification, node status, lymphovascular invasion, and neoadjuvant chemotherapy.". Virchows Arch 461 (4): 467-74. doi:10.1007/s00428-012-1249-4. PMID 22915241.