Radical cystectomy grossing
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This article deals with radical cystectomy grossing, also radical cystectomy cut-up.
A cystectomy is removal of the urinary bladder; however, it may refer to the removal of a cyst, e.g. ovarian cystectomy.
Introduction
It is done for bladder cancer (urothelial carcinoma).
In men, the urinary bladder is usually removed along with the prostate gland (see cystoprostatectomy).
The ureters in these cases are often are assessed intraoperatively. The occurrence of CIS is strongly associated with CIS in the urinary bladder.[1]
Specimen opening
- Orientation:
- Posterior - typically has serosa (shiny).
- Uterus, uterine tubes and ovaries posterior to bladder.
- Inking:
- 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.
- Opening:
- 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.
Protocol
Specimen:
- Type: cystectomy [with vagina / uterus / uterine tubes / ovaries].
- Specimen weight: ___ grams.
- Specimen dimensions (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
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].
Other:
- [None / granular areas / hemorraghic areas / polypoid areas / polyps].
Representative sections:
- 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):
- Ovaries.
- Uterine tubes - esp. fibriated ends.
- Vagina - esp. in relation to tumour.
- Uterus:
- Cervix.
- Corpus - anterior & posterior walls.