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Bladder

Miscellaneous

Grossing of bladder tumors


Reviewers: Turki Al-Hussain, M.D., Johns Hopkins Medical Centers, Gillian Levy, M.D., Yale Medical Center (see Reviewers page)
Revised: 16 May 2011, last major update March 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Procedure
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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

Diagrams
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Cystoprostatectomy

Sections to submit
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● 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

End of Bladder > Miscellaneous > Grossing of bladder tumors


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