Cystoprostatectomy grossing

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.

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).

See also

Related protocols

• Radical prostatectomy.
• Radical cystectomy.