Orchiectomy grossing

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Orchiectomy specimen showing testis replaced by tumour (proven to be seminoma). (WC/Ed Uthman)

This article deals with orchiectomy grossing.

Introduction

Orchiectomies are typically done for testicular tumours.

They may be done for chronic pain[1] or to control prostate cancer.

Specimen opening

  • Orient the specimen.
  • Bisect the testis with one cut toward the hilum.
    • Do not cut through.
    • If tumour is a large do additional cuts parallel to the first cut to ensure proper fixation.
  • Place specimen(s) in formalin.

Note:

  • Cutting easier if blade wet before cutting.

Protocol

Dimensions and weight:

  • Laterality: [ left / right ].
  • Weight: ___ grams.
  • Testis: ___ x ___ x ___ cm.
  • Epididymis: ___ x ___ x ___ cm.
  • Spermatic cord - length: __ cm, diameter: ___ cm.
  • Inking: [colour].

Tumour:

  • Size: ___ x ___ x ___ cm.
  • Colour: [ tan / white / variable ].
  • Firmness: [ firm / soft ].
  • Morphology: [solid / cystic / solid and cystic - with ___ % cystic].
  • Circumscription: [circumscribed / infiltrative border ].
  • Hemorrhage: [ absent / present ].
  • Necrosis: [ absent / present ].
  • Extension into tunica albuginea: [ not identified / indeterminate / present ].
  • Extension into the epididymis: [ not identified / indeterminate / present ].

Other - after sectioning:

  • Testicular parenchyma: [ brown-tan, unremarkable / ___ ].
  • Spermatic cord: [ unremarkable / ___ ].

Representative sections are submitted as follow:

  • Spermatic cord resection margin, en face.
  • Spermatic cord mid-section, cross section.
  • Spermatic cord close to testis.
  • Tumour in relation to epididymis.
  • Tumour and rete testis.
  • Tumour with testicular coverings.
  • Additional tumour sections.
  • Testis distant from the tumour.

Protocol notes

  • The tumour should be submitted in total if this can be done in less than 10 cassettes.
  • Lester's book (2nd Ed.) recommends 1 cassette per cm of maximal tumour dimension.[2]

Staging

Based on AJCC 7th Edition:[3][4]

Alternate approaches

See also

Related protocols

References

  1. Rönkä, K.; Vironen, J.; Kokki, H.; Liukkonen, T.; Paajanen, H. (Feb 2015). "Role of orchiectomy in severe testicular pain after inguinal hernia surgery: audit of the Finnish Patient Insurance Centre.". Hernia 19 (1): 53-9. doi:10.1007/s10029-013-1150-3. PMID 23929499.
  2. Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 409. ISBN 978-0443066450.
  3. URL: https://en.wikibooks.org/wiki/Radiation_Oncology/Testis/Staging. Accessed on: 15 December 2014.
  4. URL: http://www.cancer.org/cancer/testicularcancer/detailedguide/testicular-cancer-staging. Accessed on: 15 December 2014.