Radical cystectomy grossing
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This article deals with radical cystectomy grossing, also radical cystectomy cut-up.
- Posterior - typically has serosa (shiny).
- Uterus, uterine tubes and ovaries posterior to bladder.
- Urethra margin - green ink.
- Anterior urinary bladder site of opening (blue ink):
- Line 1: anterior bladder base toward upper left.
- Line 2: anterior bladder base toward upper right.
- If total hysterectomy - soft tissue margin - black ink.
- Open anteriorly through the urethra and follow the ink upward to left and upward to right - such that anterior bladder wall can be flipped upward.
- Open the uterus - if present - with scissors through the external os with cuts on the lateral walls.
- Specimen should be pinned open on a large block of paraffin wax.
- A paper towel should be placed behind the specimen - between the specimen and paraffin wax.
- Place specimen(s) in formalin.
- Type: cystectomy [with vagina / uterus / uterine tubes / ovaries].
- Specimen weight: ___ grams.
- Specimen dimensions (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
- 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].
- [None / granular areas / hemorraghic areas / polypoid areas / polyps].
- Urethral resection margin on edge.
- Ureteral surgical (or specimen) margins (left and right).
- Bladder tumour - 1 section/cm.
- Section with deepest invasion.
- One section if fat invasion obvious, three sections if it is suspicious.
- Suspicious granular areas and polyps.
- Left bladder wall at site of ureteric oriface.
- Right bladder wall at site of ureteric oriface.
- Anterior bladder wall.
- Posterior bladder wall.
- Dome of bladder.
- Trigone of bladder.
Sections of additional structures (if applicable):
- Uterine tubes - esp. fibriated ends.
- Vagina - esp. in relation to tumour.
- Corpus - anterior & posterior walls.