Cystoprostatectomy – Transitional Cell Carcinoma
A. Specimen is received fresh labeled “bladder prostate and seminal vesicles” and consists of a 240 g radical cystectomy specimen including bladder (13.5 x 10.5 x 4.5), prostate (4.3 x 3.3 x 2.5 cm), right seminal vesicle (3.5 x 1.0 x 1.0 cm), left seminal vesicle (2.5 x 1.0 x 1.0 cm), left vas deferens (13.9 cm in length x 0.5 cm in diameter), and right vas deferens (6.5 cm in length x 0.6 cm in diameter). There is an inserted catheter that measures 32.0 cm in length and 0.5 cm in diameter. The left and right ureters are identified and patent. The anterior surface of the entire specimen is inked in yellow, posterior in black, right lateral in red, and left lateral in green.
The specimen is sectioned to reveal a 1.0 x 0.6 x 0.5 cm, soft, red-tan, friable mass on the anterior wall located 0.3 cm from the left ureteral orifice and 0.7 cm from nearest anterior surface. Sectioning reveals that the lesion grossly appears to be confined to the mucosa. The remainder of the bladder mucosa is edematous, congested and displays a 2.5 x 2.3 cm maroon-red ulcer located 1.2 cm superior to the previously described lesion. Sectioning reveals that the ulcer extends 0.1 cm from the mucosa and is located 2.0 cm from the nearest posterior margin.
Sectioning through the prostate reveals a firm, tan-white, well-circumscribed area around the prostatic urethra that measures 0.7 cm in greatest dimension.The remainder of the prostatic parenchyma is tan-white, diffusely nodular, and finely trabeculated. The seminal vesicles and vas deferens are unremarkable. Representative sections are submitted in A1-A37.
Radical Nephrectomy- Renal Cell Carcinoma
The specimen is received in formalin labeled “right kidney and right adrenal gland” and consists of a 464 g right nephrectomy specimen including kidney (13.5 x 10.5 x 5.5 cm) and detached adrenal gland (5.3 x 2.7 x 2.0 cm). The surrounding perirenal fat is tan-yellow, lobular, hemorrhagic and ranges from 1.3 to 5.0 cm in thickness and is surrounded by tan-brown to red-brown glistening Gerota’s fascia. The external segments of ureter (1.3 cm in length x 0.3 cm in diameter), renal vein (1.1 cm in length x 0.3 cm diameter), and renal artery (0.9 cm length x 0.2 cm diameter) are identified and appear to be patent and free of obstruction.
Bivalving the specimen reveals a 7.5 x 6.5 x 5.5 cm single well circumscribed tan-yellow to orange-yellow, tumor within the mid to inferior pole of the kidney. The tumor is rubbery to firm, focally hemorrhagic, bulges from the lateral border of the right kidney and has a multinodular appearance with diffuse tan-white fibrous septation between the nodules. The renal pelvis at the hilum adjacent to the tumor is moderately dilated and the mucosa is tan-white smooth and glistening. There are some areas of focal granularity within the uninvolved renal cortex surrounding the tumor mass. The margin of resection consisting of Gerota’s fascia and fibroadipose tissue overlying the tumor is inked in black. Sectioning reveals extension of the tumor to within 0.1 cm of the nearest renal capsule surface with 0.1 cm approximation to the overlying Gerota’s fascia. The tumor upon further sectioning varies in color from yellow-pink to bright red and exhibits scattered areas of necrosis hemorrhage and calcification.
The remainder of the renal parenchyma is tan-brown with a fairly well delineated corticomedullary junction and upon sectioning is determined to be unremarkable. Sectioning through the perirenal fat reveals no grossly identifiable lymph nodes. Representative sections are submitted in A1-A15.
Radical Nephrectomy – Transitional Cell Carcinoma
The specimen is received in formalin labeled “right kidney, ureter and bladder cuff”and consists of a 542 g, 11.8 x 6.5 x 4.0 cm, right nephrectomy specimen with a segment of ureter (29.5 cm in length x 0.6 cm in average diameter). At the distal end of the ureter is an attached 3.0 x 2.0 x 1.3 cm bladder cuff. The kidney is covered by tan-yellow to tan-brown diffusely hemorrhagic lobular perirenal fat that ranges from 1.5 to 9.0 cm in thickness which is covered in part by tan-pink glistening Gerota’s fascia. The renal capsule is tan-pink to tan-brown glistening and has been partially stripped.
Examining the renal hilum reveals 2 renal arteries (2.0 cm in length x 0.5 cm in diameter and 2.5 cm in length x 0.4 cm in diameter) and a renal vein (0.7 cm in length 0.8 cm in diameter). The arteries are calcified and firm upon sectioning. The renal vein appears to be free of obstruction or mass lesions. Bivalving the specimen reveals a 3.0 x 2.8 x 2.0 cm tan-pink to tan-brown necrotic papillary friable poorly delineated soft lesion in the mid to inferior portion of the collecting system and pelvis. Sectioning reveals no definite invasion, with the mass approaching to within 0.1 cm of the nearest sinus fat. The remaining collecting system mucosa is tan-yellow slightly edematous but otherwise unremarkable. There is a 2.5 x 2.0 cm tan-white stellate apparent fibrous scar in the renal sinus fat around the mid upper pole calyx. The remainder of the soft tan-brown to red-brown renal parenchyma exhibits blunted pyramids, a 0.8 cm in thickness renal cortex, and a fairly well delineated corticomedullary junction.
The external surface of the ureter is inked in orange and cross sectioned to reveal a patent lumen, free of obstruction or other mass lesions. The bladder cuff is tan-brown to red-brown shaggy and contains a 0.2 x 0.1 cm ureteral orifice. The bladder cuff margin is inked in black and sectioning along the perpendicular axis reveals an unremarkable tan-pink trabeculated muscular layer which does not appear to contain any mass lesions. No lymph nodes found within the perirenal fat. Representative sections are submitted in A1-A30.
Prostatectomy – Carcinoma
The specimen is received in formalin labeled “prostate” and consists of a 47.0 g radical prostatectomy specimen including prostate, bilateral seminal vesicles, and bilateral vas deferens. The prostate measures 4.2 cm (right to left) x 4.0 cm (superior to inferior) x 3.5 cm (anterior to posterior). The right seminal vesicle (3.5 x 1.7 x 1.0 cm) and left seminal vesicle (3.5 x 1.9 x 0.8 cm) are unremarkable. The right vas deferens (4.0 cm in length and 0.5 cm in diameter) and left vas deferens (5.3 cm in length and 0.5 cm in diameter) are unremarkable.
The external surface of the prostate is tan-brown to tan-gray and shaggy. There is a staple line along the anterior midline which is removed. The right half of the entire specimen is inked in blue and the left half is inked in green. The prostatic urethra is identified and determined to be probe-patent. Serial sectioning reveals a poorly delineated, tan-gray to tan-white, firm, 3.0 x 1.5 x 0.5 cm mass along the postero-lateral aspect of the mid to inferior prostate involving primarily the right side but extending across the midline to the left side. It is within 0.1 cm of the right and left posterior margins. The remainder of the prostate parenchyma is tan-white to tan-pink and exhibits diffuse, well circumscribed, tan-white nodularity ranging from 0.4-0.6 cm in greatest dimension. Representative sections are taken and submitted in cassettes C1-C27 according to standard diagram.
Right Radical Orchiectomy – Seminoma
The specimen is received in formalin labeled ” right radical orchiectomy” and consists of a 47 g orchiectomy specimen including testis (5.5 x 4.0 x 2.5 cm) and spermatic cord (9.0 cm length x 1.5 cm diameter). The tunica vaginalis is tan-pink, slightly congested, is inked in black and when incised reveals a tan-pink to tan-white congested smooth and intact tunica albuginea. The epididymis (5.3 x 3.5 x 2.0 cm) is tan-pink to tan-white focally congested and unremarkable. Sectioning reveals a 1.3 x 1.0 x 0.3 cm tan-white fleshy nodule with focal hemorrhage located in the mid–inferior pole that is approximately 2.5 cm from the head of the epididymis, 0.7 cm from the rete testis, and 0.3 cm from the nearest tunica albuginea. The tan-yellow lobular fat overlying the testis is markedly hemorrhagic.
Sectioning through the spermatic cord reveals no discrete mass lesions. The remainder of the testicular parenchyma is tan-pink to tan-yellow soft and strings with ease. Representative sections, including entire tumor, are submitted in cassettes A1-A9 as follows:
- A1: Spermatic cord margin
- A2-A5: Epididymis, rete testis in relation to tumor
- A6: Epididymis, rete testis in relation to uninvolved testicular parenchyma
- A6-A9: Remainder of tumor, entirely submitted, with adjacent testicular parenchyma
Partial Penectomy- Squamous Cell Carcinoma
The specimen is received fresh labeled “fresh penile and foreskin mass”and consists of a 6.0 x 3.5 x 3.5 cm partial penectomy specimen with attached tan-gray wrinkled foreskin. There is an orienting suture designating the 12 o’clock dorsal margin. The proximal deep margin is inked in black and the 6 o’clock margin is inked in orange. The specimen is sectioned in the sagittal plane to reveal a 4.5 x 2.5 x 1.5 cm tan-white hemorrhagic mass with irregular borders which is located 0.3 cm from the deep margin, 2.5 cm from the 12 o’clock skin margin, 0.7 cm from the 3 o’clock margin, 0.2 cm from the 6 o’clock margin, and 1.5 cm from the 9:00 margin. Representative sections are submitted in A1-A9 as follows:
- A1: Deep margin, perpendicular
- A2: 12 o’clock margin, perpendicular
- A3: 3 o’clock margin, perpendicular
- A4: 6 o’clock margin, perpendicular
- A5: 9 o’clock margin, perpendicular
- A6-E7: tumor
- A8: 5 o’clock margin, perpendicular
- A9: 9 o’clock margin, perpendicular
ALINA MAYSTERCHUK 