Bladder, ureter & renal pelvis

Topic Completed: 1 March 2011

Minor changes: 11 June 2020

Copyright: 2002-2020,, Inc.

PubMed Search: Grossing

Turki Al-Hussain, M.D.
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Page views in 2020 to date: 982
Table of Contents
Definition / general
Cite this page: Al-Hussain T, Levy G Grossing. website. Accessed September 30th, 2020.
Definition / general
  • TURBT (transurethral resection of bladder tumor): weigh fragments together and measure largest fragment in one dimension; submit all specimen fragments if possible
  • Cystectomy: ink entire external surface; either open with Y shaped incision through anterior wall, pin and fix overnight or fill with formalin, fix overnight, and divide into anterior and posterior halves

Gross inspection of cystectomy specimen:
  • Document and measure all organs received
  • Document number and location of lesions
  • Examine ureters carefully
  • Document gross tumor extension into surrounding soft tissues (for substaging of pT3 disease)
  • Evaluate surgical margins

Distal urethral margins:
  • Women: usually taken en face
  • Men: prostatic urethra at apex may be taken en face or as apical cone (perpendicular)
  • Apical margin in men may be involved by incidental prostate cancer

Soft tissue:
  • Careful gross examination will identify deepest point of invasion that should be sampled
  • Sections usually taken perpendicular to inked outer surface

Lymph node identification in both cystectomy and separately submitted specimen:
  • At least 10 to 14 nodes should be retrieved, although node numbers vary widely according to individual patient circumstances (J Urol 2004;171:1823)
  • Clearly report anatomic node groups sampled, if possible (e.g. paraaortic)
  • Submit 1 section from each grossly positive lymph node
  • Submit all possible nodal tissue if it can be done in 5 or fewer cassettes
  • All other lymph nodes should be entirely submitted, as presence of nodal disease may be used as an indication for adjuvant therapy
  • Lymph nodes may be grossly or microscopically detected in the perivesical fat (See CAP Cancer Protocols and Checklists, 2011)
  • Submit grossly normal fat for small (< 1 cm) lymph nodes

Ureters and urethra:
  • Examination is usually for carcinoma in situ
  • Invasion may rarely be seen in surrounding soft tissue

Sections to submit:
  • Tumor, representative, 1 per cm of tumor diameter (up to 10 cassettes); if initial sampling shows only noninvasive or non-muscle invasive tumor, submit additional sections as necessary to rule out invasion or muscle invasion
  • Tumor, deepest penetration into wall (multiple sections)
  • Tumor and adjacent normal bladder wall
  • Bladder neck
  • Bladder trigone (two sections)
  • Anterior and posterior wall (two sections each)
  • Left lateral and right lateral wall
  • Dome (two sections)
  • Ureteral orifices, including intramural portion
  • Ureteral margin, possibly additional sections if long segment is present
  • Urethral margin
  • Prostatic urethral margin (if present)
  • Margins of resection
  • Other grossly abnormal areas in bladder, ureters, urethra or other tissue
  • Prostate (peripheral zone, central zone, seminal vesicles, grossly suspicious areas)
  • Lymph nodes
  • Pelvic wall
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