Partial nephrectomy grossing

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Schematic showing the before and after for a partial nephrectomy. (WC/CRUK)

This article deals with the cut-up of partial nephrectomy for tumour specimens.

Total nephrectomy for tumour specimens are dealt with in the total nephrectomy for tumour article.

Introduction

Partial nephrectomies are done for kidney tumours (specifically renal cell carcinoma) and may be done on large tumours (>4 cm) with good outcomes.[1]

They do not have have any (large) vessels or the any significant part of the collecting system.

Frozen section evaluations in partial nephrectomies are of questionable value.[2][3]

Protocol

Dimensions, weight and inking:

  • Type: partial nephrectomy.
  • Laterality: [left / right].
  • Weight: ___ grams.
  • Size of specimen (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
  • Adrenal gland: [___ x ___ x ___ cm / not identified].
  • Inking of renal parenchymal margin: [colour].
  • Inking other margin: [another 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 / mid / lower pole].
  • Colour: [yellow / tan / white].
  • 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].

Other:

  • Non-tumour parenchyma: [cannot access / cortex unremarkable / thinned].
  • Lymph nodes: [number of lymph nodes with [unremarkable cut surface / tumour] / not identified].

Representative sections are submitted:

  • Tumour with nearest margin.
  • Tumour and perinephric fat.
  • Normal kidney.
  • Adrenal gland.

Protocol notes

  • Tumour stage size cut points: <=4 cm, <=7 cm.

Alternate approaches

See also

Related protocols

References

  1. El-Ghazaly, TH.; Mason, RJ.; Rendon, RA. (Jan 2014). "Oncological outcomes of partial nephrectomy for tumours larger than 4 cm: A systematic review.". Can Urol Assoc J 8 (1-2): 61-6. doi:10.5489/cuaj.1682. PMID 24578747.
  2. Yossepowitch, O.; Thompson, RH.; Leibovich, BC.; Eggener, SE.; Pettus, JA.; Kwon, ED.; Herr, HW.; Blute, ML. et al. (Jun 2008). "Positive surgical margins at partial nephrectomy: predictors and oncological outcomes.". J Urol 179 (6): 2158-63. doi:10.1016/j.juro.2008.01.100. PMID 18423758.
  3. Gordetsky, J.; Gorin, MA.; Canner, J.; Ball, MW.; Pierorazio, PM.; Allaf, ME.; Epstein, JI. (Dec 2014). "Frozen Section During Partial Nephrectomy: Does it Predict Positive Margins?". BJU Int.. doi:10.1111/bju.13011.