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Kidney tumor - adult malignancies

Adult malignancies - Miscellaneous

Grossing

Reviewers: Sean Williamson, M.D. (see Reviewers page)
Revised: 13 July 2012, last major update July 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Ink surface opposite tumor before sectioning, which causes capsular retraction
● Measure and weigh kidney (important for some clinical trials)
● Check renal vein for thrombus (submit in separate block)
● Suggested to open through venous system to avoid misinterpretating retrograde venous invasion (within the kidney) as tumor multifocality or larger overall tumor size (Mod Pathol 2011;24:1578)
● Bivalve kidney
● In adults only, remove perirenal fat (Gerota's fascia) by blunt dissection, except over tumor or areas of adherence
● Submit fresh tissue for special studies (cytogenetics, flow cytometry, EM)

Optional:
● Weigh kidney without perirenal fat (generally of greater significance than weight including perirenal fat, although preservation of the tumor-fat interface may be helpful if involvement is uncertain)
● Make parallel cuts in sagittal plane; refrigerated fixation is recommended for better sections

Sections:
● 1 of tumor per cm of tumor diameter, include all areas with different colors, especially white/grey
● Sample all tumor nodules
● Also tumor and adjacent kidney, capsule, Gerota’s fascia, renal sinus (Am J Surg Pathol 2007;31:1089, Am J Surg Pathol 2004;28:1594), other adjacent tissue, surgical margins
● Tumor thrombi, other kidney lesions, normal kidney, renal pelvis, renal artery and vein, ureter margin, lymph nodes, adrenal gland

● For Wilms tumor of childhood, take sections through renal pelvis/sinus and include medial sinus margin (medial end of soft tissues surrounding renal artery and vein), junction between normal kidney and tumor, tumor capsule and uninvolved kidney
● Document where sections are taken on a diagram; snap freeze tumor and normal kidney for molecular studies

Kidney morcellation:
● Fragmentation of kidney and associated tumors due to laparoscopic nephrectomy
● Suggested sampling is influenced by radiologic features, probably should sample 5% of specimen including grossly visible tumor; staging is severely limited (Am J Surg Pathol 2001;25:1158)

End of Kidney tumor > Adult malignancies - Miscellaneous > Grossing

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