Nephroureterectomy grossing

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This article deals with the nephroureterectomy grossing, also the cut-up of nephroureterectomy specimens. These specimens include both a kidney, a ureter and a urinary bladder cuff.

Total nephrectomy specimens (without the ureter) and partial nephrectomy specimens are dealt with separately.

Introduction

Nephroureterectomies are done for urothelial carcinoma of the ureter and/or renal pelvis.

The false positive/negative for tumour rate is reported as high as 2.9%.[1]

Specimen opening

  1. Paint surface of specimen (optional).
  2. Take the vascular margins - renal artery and renal vein (both en face) and place in one tissue cassette.
  3. Open the kidney in the frontal plane (from lateral to medial).
    • The cut should go through the renal pelvis.
  4. Place specimen(s) in formalin.

Protocol

Dimensions, weight and inking:

  • Type: nephroureterectomy.
  • Laterality: [left / right].
  • Weight: ___ grams.
  • Size of specimen (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
  • Ureter (length x diameter): ___ x ___ cm.
  • Size of bladder cuff: ___ x ___ cm.
  • Renal vein (length x diameter): ___ x ___ cm.
  • Renal artery (length x diameter): ___ x ___ cm.
  • Adrenal gland: [___ x ___ x ___ cm / not identified].
  • Inking of surface: [colour].
  • Inking of bladder cuff/resection margin: [colour].
  • Size of kidney (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
  • Perinephric fat (maximal dimension): ___ cm.

Tumour:

  • Dimensions (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
  • Location: [upper pole / lower pole / renal pelvis / ureter].
  • Colour: [white / tan / yellow].
  • Morphology: [solid / cystic / solid and cystic - with ___ % cystic].
  • Friability: [friable / not friable].
  • Circumscription: [well circumscribed / indeterminate / infiltrative border].
  • Hemorrhage: [present / absent].
  • Necrosis: [present / absent].
  • Margin: [nearest margin ___, distance ___ cm / positive margin, location ___].
  • Extension into perinephric fat: [absent / not identified-pushing border / suspicious / present].
  • Extension into the renal parenchyma: [absent / suspicious / present].
  • Extension into renal hilar fat: [absent / not identified-pushing border / suspicious / present].
  • Extension into renal vein: [absent / suspicious / present].

Other:

  • Non-tumour renal parenchyma: [cortex unremarkable / thinned].
  • Non-tumour collecting system mucosa: [smooth and regular / granular / irregular / dilated].
  • Lymph nodes: [number of lymph nodes with [unremarkable cut surface / tumour] / not identified].

Representative sections are submitted:

  • Renal vein margin and renal artery margin (en face).
  • Urinary bladder cuff margin (on edge). §
  • Urinary bladder cuff.
  • Ureter - representative sections. ¶
  • Tumour with nearest margin.
  • Tumour in relation to perinephric fat. †
  • Tumour in relation to renal parenchyma. ††
  • Tumour and sinus fat.
  • Normal kidney.
  • Adrenal gland.

Protocol notes

  • § Bladder cuff margin may be done en face.
  • ¶ Should be cross sections - not longitudinal sections.
  • † This typically upstages to pT4. It is uncommon that the tumour goes through the kidney and into the perinephric fat.
  • †† Invasion into the renal parenchyma typically upstages to pT3. This can be difficult to judge on cut-up. If renal parenchymal invasion is not seen grossly at least three sections should be taken. Small tumours are usually submitted in toto.

Alternate approaches

See also

Related protocols

References

  1. Hong, S.; Kwon, T.; You, D.; Jeong, IG.; Hong, B.; Hong, JH.; Ahn, H.; Kim, CS. (Oct 2014). "Incidence of benign results after laparoscopic radical nephroureterectomy.". JSLS 18 (4). doi:10.4293/JSLS.2014.00335. PMID 25408605.