Difference between revisions of "Orchiectomy grossing"

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[[Image:Seminoma_of_the_Testis.jpg|thumb|150px|Orchiectomy specimen showing testis replaced by tumour (proven to be [[seminoma]]). (WC/Ed Uthman)]]
[[Image:Seminoma_of_the_Testis.jpg|thumb|150px|Orchiectomy specimen showing testis replaced by tumour (proven to be [[seminoma]]). (WC/Ed Uthman)]]  
This article deals with '''orchiectomy grossing'''.  
This article deals with '''orchiectomy grossing'''.  


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Orchiectomies are typically done for [[testicular tumours]].
Orchiectomies are typically done for [[testicular tumours]].


They may be done for chronic pain or to control [[prostate cancer]].
They may be done for chronic pain<ref name=pmid23929499>{{Cite journal  | last1 = Rönkä | first1 = K. | last2 = Vironen | first2 = J. | last3 = Kokki | first3 = H. | last4 = Liukkonen | first4 = T. | last5 = Paajanen | first5 = H. | title = Role of orchiectomy in severe testicular pain after inguinal hernia surgery: audit of the Finnish Patient Insurance Centre. | journal = Hernia | volume = 19 | issue = 1 | pages = 53-9 | month = Feb | year = 2015 | doi = 10.1007/s10029-013-1150-3 | PMID = 23929499 }}</ref> or to control [[prostate cancer]]. Occasionally done in the context of a [[hernia repair]].<ref name=pmid3425809>{{cite journal |authors=Curtsinger LJ, Page CP, Aust JB |title=Orchiectomy during herniorrhaphy: what should we tell the patient? |journal=Am J Surg |volume=154 |issue=6 |pages=636–9 |date=December 1987 |pmid=3425809 |doi=10.1016/0002-9610(87)90232-7 |url=}}</ref>


==Specimen opening==
==Specimen opening==
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**Do not cut through.
**Do not cut through.
**If tumour is a large do additional cuts parallel to the first cut to ensure proper [[fixation]].
**If tumour is a large do additional cuts parallel to the first cut to ensure proper [[fixation]].
*Place specimen(s) in [[formalin]].


Note:
Note:
*Cutting easier if blade wet before cutting.
*Cutting easier if blade wet before cutting.
*[[Marking ink|Inking]] the cord at the margin and mid section of the cord in different colours allows one to reconstruct the location if one has to go back to the gross.


==Protocol==
==Protocol==
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====Staging====
====Staging====
{{Main|Testicular cancer staging}}
Based on AJCC 7th Edition:<ref>URL: [https://en.wikibooks.org/wiki/Radiation_Oncology/Testis/Staging https://en.wikibooks.org/wiki/Radiation_Oncology/Testis/Staging]. Accessed on: 15 December 2014.</ref><ref name=cancer_org>URL: [http://www.cancer.org/cancer/testicularcancer/detailedguide/testicular-cancer-staging http://www.cancer.org/cancer/testicularcancer/detailedguide/testicular-cancer-staging]. Accessed on: 15 December 2014.</ref>
Based on AJCC 7th Edition:<ref>URL: [https://en.wikibooks.org/wiki/Radiation_Oncology/Testis/Staging https://en.wikibooks.org/wiki/Radiation_Oncology/Testis/Staging]. Accessed on: 15 December 2014.</ref><ref name=cancer_org>URL: [http://www.cancer.org/cancer/testicularcancer/detailedguide/testicular-cancer-staging http://www.cancer.org/cancer/testicularcancer/detailedguide/testicular-cancer-staging]. Accessed on: 15 December 2014.</ref>
*pT1 - confined to the testis or epididymis, no [[lymphovascular invasion]].
*pT1 - confined to the testis or epididymis, no [[lymphovascular invasion]].
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*pT3 - into [[spermatic cord]].
*pT3 - into [[spermatic cord]].
*pT4 - into the [[scrotum]].
*pT4 - into the [[scrotum]].
Notes:
*Invasion into the [[epididymis]] and/or tunica albuginea does not change the [[cancer staging|stage]].<ref name=cancer_org/>
*[[Rete testis]] involvement and testicular hilum involvement may be seen or suspected at the time of [[cut-up]]. Both of these are poor prognosticators;<ref>{{Cite journal  | last1 = Yilmaz | first1 = A. | last2 = Cheng | first2 = T. | last3 = Zhang | first3 = J. | last4 = Trpkov | first4 = K. | title = Testicular hilum and vascular invasion predict advanced clinical stage in nonseminomatous germ cell tumors. | journal = Mod Pathol | volume = 26 | issue = 4 | pages = 579-86 | month = Apr | year = 2013 | doi = 10.1038/modpathol.2012.189 | PMID = 23238629 }}</ref> however, they to do not affect the (AJCC 7th Edition) stage.
**Involvement of the testicular hilum is not specifically addressed in the AJCC 7th Edition. Based on the current evidence, tt is probably best classified as pT1 (if there is no [[LVI]] and the tumour is otherwise confined to the testis/epididymis).


===Alternate approaches===
===Alternate approaches===


==See also==
==See also==
*[[Testicular cancer staging]].
===Related protocols===
===Related protocols===
==References==
==References==
{{Reflist|1}}
{{Reflist|1}}

Latest revision as of 18:04, 27 September 2024

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. Occasionally done in the context of a hernia repair.[2]

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.
  • Inking the cord at the margin and mid section of the cord in different colours allows one to reconstruct the location if one has to go back to the gross.

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.[3]

Staging

Main article: Testicular cancer staging

Based on AJCC 7th Edition:[4][5]

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. ↑ Curtsinger LJ, Page CP, Aust JB (December 1987). "Orchiectomy during herniorrhaphy: what should we tell the patient?". Am J Surg 154 (6): 636–9. doi:10.1016/0002-9610(87)90232-7. PMID 3425809.
  3. ↑ Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 409. ISBN 978-0443066450.
  4. ↑ URL: https://en.wikibooks.org/wiki/Radiation_Oncology/Testis/Staging. Accessed on: 15 December 2014.
  5. ↑ URL: http://www.cancer.org/cancer/testicularcancer/detailedguide/testicular-cancer-staging. Accessed on: 15 December 2014.
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