pathology.ucla.edupathology.ucla.edu/.../Education/Genitourinary_2018v2.docx · Web viewLP = lamina propria CS = coronal sulcus ALB = tunica albuginea CC = corpus cavernosum U = ventral

Genitourinary Grossing GuidelinesADRENALSpecimen Type: ADRENALECTOMY (morcellated or intact resection)

Gross Template:

Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a *** gram, *** x *** x *** cm [intact, disrupted, morcellated] adrenalectomy. [Weigh and measure the gland after removing this excess adipose tissue].

Sectioning reveals [describe any lesion present – size, capsule, color]. The unremarkable cortex is [color, uniformity, and presence of nodules] and measures *** cm in thickness. The medulla is [thickness, color, uniformity, and presence of nodules]. [Describe number/size of lymph nodes identified]. Representative sections are submitted [describe cassette submission].

Note: For laparoscopically-removed adrenal glands that have been morcellated, examine the fragments of tissue to see if there is any excess adipose tissue. Remove the excess adipose tissue, then weigh and measure the aggregate amount of adrenal tissue fragments. Submit 4-5 blocks of tissue, focusing on areas of nodularity.

Cassette Submission:

Gland with no discrete lesion: One cassette including medulla and cortexGlad with primary tumor:

One cassette per 1 cm of lesion Show relationship to closest inked margin Show relationship to uninvolved gland Show relationship to peri-adrenal tissues One cassette of hilar blood vessels One cassette of unremarkable gland Submit all lymph nodes identified

Gland with known metastatic tumor: 1-2 cassettes of tumor

KIDNEYSpecimen Type: NEPHRECTOMY (non tumor) –pylonephritis, hydronephrosis, polycysticProcedure:

1. Examine the specimen and describe the following three compartments:a. Kidney- renal capsule, cortex, medulla, collecting systemb. Hilum- ureter, vessels, sinus fatc. Perinephric fat

2. Submit sections to include each of the three compartmentsa. One section of normal cortical tissue will have a “Kidney-exp” protocol

i. Kidney-exp: 1 masson trichrome, 1 PAS, 1 Jones methenamine3. Submit normal cortex for IF (Zeus) and 3-4 pieces of cortical tissue for EM

(glutaraldehyde)- only if instructed to do so by attendinga. Submit IF and hold EM in back refrigerator

4. Cystic kidneys are grossed in the same mannera. Document location of cysts (cortex vs medulla)b. Document size and contents of cystsc. Carefully examine cysts for solid areas, including thickened walls, or

papillary areas. These may contain areas of neoplasia. If there is concern for neoplasia, process per neoplastic nephrectomy grossing guidelines.

Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a [right,left] *** gram, *** x *** x *** cm total nephrectomy. The kidney alone measures *** x *** x *** cm . The ureter measures *** cm in length x *** cm in diameter. The renal artery measures *** cm in length x *** cm in diameter. The renal vein measures *** cm in length x *** cm in diameter. [Describe adrenal gland if present- weigh and measure].

The capsule is remarkable for [describe defects, adhesions, fibrosis, granular, etc.] The cortex [describe thickness, distinct/indistinct CMJ, cysts, other]. The medulla [describe color and shape of pyramids, cysts]. The pelvicalyceal system [is/ is not] dilated. The sinus adipose tissue [is/ is not] decreased. Calculi [are/ are not] present [describe obstruction and dilation of calyces if present]. The mucosa of the collecting system is [smooth, roughened, granular, thickened, other.] The ureter [describe stenosis, dilation, lesions present]. The vessels are remarkable for [plaque, thrombus, other, unremarkable].

No lesions or masses are identified. A portion of tissue is held in glutaraldehyde for possible future electron microscopy studies. Representative sections are submitted [describe cassette summary]. Gross photographs are taken.

Cassette Submission: 5-6 cassettes- Include sections of normal kidney (place in first cassette)- Include sections of scarred areas (including cortical surface,

collecting system, ureter, and blood vessels – at least 2 sections)- Include sections of incidental lesions

Specimen Type: PARTIAL NEPHRECTOMY Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a(n) [intact, disrupted, previously incised] *** gram, *** x *** x *** cm partial nephrectomy.

Sectioning reveals a [describe mass- size, focality, color, consistency, circumscription, encapsulation, necrosis, hemorrhage]. The mass measures *** cm from the parenchymal margin and *** cm from the [capsule/perinephric fat/Gerota’s fascia.]

The remaining cut surface is [unremarkable or describe additional pathology]. No additional lesions or masses are identified. A portion of tissue is held in glutaraldehyde for possible future electron microscopy studies. A portion of tissue is placed in RPMI and sent for cytogenetics studies. Representative sections are submitted [describe cassette summary]. Gross photographs are taken.

Ink key: Parenchymal margin: blueCapsule/perinephric fat margin: black

Cassette Submission: 5-6 cassettes- Two cassettes of tumor with cloest parenchymal margin of

resection- Two cassette of tumor with closest capsular resection margin- Two cassettes of renal sinus in relationship to tumor (if present)- A total of one section per cm of tumor- If the tumor is 3 cm of less – submit it entirely

Specimen Type: NEPHRECTOMY (TUMOR- adult)Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a [right,left] ***g, *** x *** x *** cm total nephrectomy. The

kidney alone measures *** x *** x *** cm . The ureter measures *** cm in length x *** cm in diameter. The renal artery measures *** cm in length x *** cm in diameter. The renal vein measures *** cm in length x *** cm in diameter. [Describe adrenal gland if present- weigh and measure].

Sectioning reveals a [describe mass- size, focality, color, consistency, circumscription, encapsulation, necrosis, hemorrhage] located in the [upper, lower pole or centrally]. The mass extends [into the perinephric fat, to Gerota’s fascia, into the pelvicalyceal system, into the renal artery and/or vein, adrenal gland, other]. The mass [does/ does not] extend into the renal sinus adipose tissue. [Describe satellite nodules]. The mass measures *** cm from Gerota’s fascia/perinephric fat margin, *** cm from the renal vein margin, and *** cm from the ureteral margin.

The remaining parenchyma is [unremarkable, or describe additional pathology]. The corticomedullary junction is [distinct/ poorly defined]. The pelvicalyceal system [is/ is not] dilated. Calculi [are/ are not] present [describe obstruction and dilation of calyces if present]. The mucosa of the collecting system is [smooth, roughened, granular, thickened, other.] The ureter [describe stenosis, dilation, lesions present]. The vessels are remarkable for [plaque, thrombus, other, unremarkable].

No additional lesions or masses are identified. A portion of tissue is held in glutaraldehyde for possible future electron microscopy studies. A portion of tissue is submitted in RPMI for cytogenetics studies. Representative sections are submitted [describe cassette summary]. Gross photographs are taken.

Ink key: Capsule/Gerota’s fascia/perinephric fat: black

Cassette Submission: 8-10 cassettes- One cassette of vascular and ureteral margins, shave- Tumor sections: 1 section per 1 cm of the greatest dimension of

tumoro Sections to demonstrate the perinephric fat invasion o Sections to demonstrate sinus fat involvemento Sections to demonstrate vascular invasiono Sampling areas of different color and consistency.

- Additional sections should be taken as needed o Sections of satellite nodules

- One cassette of non-neoplastic parenchyma (at least 2 cm away from tumor)

- One cassette of adrenal gland (if present)- Submit all hilar lymph nodes (if present)

- WILM’S TUMORo 1 section per 1 cm of tumor, up to 8 cassetteso Note: Any small foci beneath the capsule or adjacent to the

pyramids may represent nodular renal blastema and representative sections should be obtained of these areas. As a guide, there should be one section per cm. of maximum dimension of the tumor up to 8 cm. A map of the tumor labelling the exact site of the sections taken must be included with the gross.

Specimen Type: PENECTOMYGross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a [partial/total] penectomy measuring [***x***x*** cm] including the glans penis *** x *** x *** cm , shaft of penis *** x *** x *** cm and penile foreskin *** x *** x *** cm .

There is a *** x *** x *** cm lesion located on [ventral/dorsal/lateral] aspect of the glans penis/penile shaft/urethral meatus. The lesion is [exophytic/papillary/verrucoid/ulcerated] and has a [describe cut surface]. The lesion involves the [corpus spongiosum/corpora cavernosum/urethra/penile foreskin]. The mass has a *** cm maximum depth of invasion and invades into the [corpus spongiosum/corpora cavernosum/urethra].

The remainder of the glans penis/skin of shaft penis/penile foreskin are [unremarkable or describe additional pathology]. The corpus spongiosum/corpora cavernosum/urethra are [unremarkable or describe additional pathology]. No additional lesions or masses are grossly identified. Gross photographs and taken. Representative sections are submitted.

Cassette Submission: 15-20 cassettes- Proximal resection margin (en face)

o Submit perpendicular section if in relationship to lesiono Include skin, corpora, and urethra

- One cassette of foreskin- Tumor

o 1 cassette per 1 cm of tumor sizeo Demonstrate deepest extent of invasiono Demonstrate relationship to adjacent structures (surface

epithelium, corpus spongiosum, corpora cavernosa, and urethra)

PF = Buck’s penile fascia

COS = coronal sulcus

F = foreskin

DT = Dartos

E = epithelium

GL = glans

MU = urethral meatus

LP = lamina propria

CS = coronal sulcus

ALB = tunica albuginea

CC = corpus cavernosum

U = ventral urethra

PROSTATESpecimen Type: NEEDLE CORE BIOPSYGross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] are [number] of [color] core biopsies measuring *** cm in length x *** cm in diameter. The specimen is entirely submitted in cassette [describe cassette submission]. Cassette Submission: Submit all tissue

Specimen Type: TRANSURETHRAL RESECTION OF PROSTATE (TURP)Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a *** gram]*** x *** x *** cm aggregate of semi-firm, pink-tan portions of tissue. The portions range from *** to *** cm in greatest dimension. All portions appear homogeneous in color and texture. There [are/are no] areas of hemorrhage, degeneration, or calfication. Representative sections are submitted (totallying approximately ***%) of the specimen in cassette [describe cassette submission].

Cassette Submission: Submit cassettes based on below:

- Less than or equal to 12 grams - submit the entire specimen (usually will fit into 6-8 cassettes)

- Greater than 12 grams –8 cassettes for first 12 grams and one cassette for every additional 5 grams

- Note: Do not overfill cassettes to the point where entire pieces are overlapping one another

Specimen Type: SUPRAPUBIC or RETROPUBIC PROSTATECTOMY (for BPH)Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a *** gram, *** x *** x *** cm aggregate of semi-firm, pink-tan portions of tissue. The portions range from *** to *** cm in greatest dimension. Sectioning reveals [describe cut surface- hemorrhage, degeneration, or calfication, and presence of nodules]. Representative sections are submitted (totallying approximately ***%) of the specimen in cassette [describe cassette submission].

Cassette Submission: 8-10 cassettes

- Sections of lateral and posterior lobes (if possible)- Sections of suspicious areas- If carcinoma is present, submit distal urethral and bladder neck

margins (if possible)- Submit majority of remainder of tissue to TPCL

Specimen Type: RADICAL PROSTATECTOMY Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a *** gram intact radical prostatectomy (to exclude bilateral adnexa). The prostate measures *** cm (lateral left - lateral right) x *** cm (apex - base) x *** cm (anterior - posterior). The external capsule is smooth and grossly intact with focal areas of cautery artifact at the bladder neck margin. The prostatic urethra is patent and measures *** cm in length x *** cm in average diameter. The grossly unremarkable bilateral seminal vesicles and vasa deferentia weigh *** gm in aggregate. The right seminal vesicle measures *** x *** x *** cm and the left seminal vesicle measures *** x *** x *** cm. The bilateral vasa deferentia are grossly unremarkable. The right vas deferens measures *** cm in length x *** cm in diameter and the left vas deferens measures *** cm in length x *** cm in diameter. The prostate is serially sectioned from base - apex into *** transverse levels to reveal [diffuse periurethral nodularity, prominent nodues, fibrosis, lesion]. The [prominent nodule/lesion] area is located in the [left/right, anterior/posterior, central/peripheral] aspect and measures *** cm from the capsule. The apex and bladder neck margins are shaved, serially sectioned and entirely submitted. Representative sections (totaling approximately ***% of the prostate) are submitted for permanent sections. Ink key: Black right Blue left

Yellow midline anterior Red midline posterior

Cassette Submission: A1- right prostatic base margin, perpendicularA2- left prostatic base margin, perpendicular A3- right apex margin, perpendicular A4- left apex margin, perpendicular A5- cross-section of right seminal vesicle base A6- cross-section of left seminal vesicle base A7- right and left vas deferens margins, en faceA8- level __, whole mount sectionA9- level __, whole mount sectionA10- level __, whole mount section

TESTISSpecimen Type: BIOPSY Comment: These are performed either for tumor or for analysis of spermatogenesis. They may be processed identically. It is important to treat these biopsies GENTLY, as testicular parenchyma is very delicate.

Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a [number] [color, texture] core biopsies measuring *** cm in length x *** cm in diameter. The specimen is entirely submitted [describe cassette submission].

Cassette Submission: All tissue submitted

Specimen Type: ORCHIECTOMY (non-neoplastic)Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a(n) ***gram, *** x *** x *** cm [intact/disrupted] orchiectomy. The spermatic cord measures *** cm in length x *** cm in diameter. The tunica vaginalis is [present/absent].

Sectioning reveals [describe cut surface, fibrosis, necrosis, lesisons]. Representative sections are submitted [describe cassette submission].


- Include sections of spermatic cord (including en face margin)- Sample all lesions (periphery and center)

o Sample lesion with relationship to rete testis, tunica albuginea, and epididymis

- If no lesions are identified – submit two cassettes of testicular parenchyma

Specimen Type: ORCHIECTOMY (for TUMOR)Note: Prior to sectioning the testis, it is best to obtain sections of the spermatic cord to avoid contamination by testicular tumor, which is often loose and friable. Serially section the spermatic cord along its length and submit shave of cord margin and representative cross-sections of proximal, middle, and distal cord (be clear in cassette summary as to the designation of location on cord, such as “base of cord [nearest testis proper]”).

Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a(n) *** gram, *** x *** x *** cm [intact/disrupted] orchiectomy. The spermatic cord measures *** cm in length x *** cm in diameter. The tunica vaginalis is [disrupted/intact/partial/etc.].

Sectioning reveals *** x *** x *** cm lesion. The lesion has a [describe cut surface, circumscription, necrosis, hemorrhage, focality]. The lesion [is confined to the testicular parenchyma, invades hilar soft tissue, invades the tunica albuginea, invades the tunica vaginalis, invades rete testis, invades epididymis].

The remaining parnechyma is [tan-brown and unremarkable, fibrotic or describe additional lesions]. No additional lesions are grossly identified. Gross photographs are taken. Representative sections are submitted [describe cassette submission].


- Include sections of spermatic cord (including en face margin)- Include one section per cm of maximum tumor diameter

o Sample hemorrhagic and necrotic areaso Sample solid/fleshy/cystic areaso Sample lesion with relationship to rete testis, tunica

albuginea, epididymis, mediastinum testis, and uninvolved testis

- Include sections of epididymis and uninvolved testis

Specimen Type: RETROPERITONEAL LYMPH NODE DISSECTIONComment : These specimens are usually seen in patients with residual masses following chemotherapy. Pay particular attention to the number of lymph nodes included in the specimen and the size of the largest lymph node. If it is difficult to individually dissect out the lymph nodes, clearly mention that there is a matted lymph node mass and give the dimension of the mass. Evaluate the cut surface of the mass and indicate if it is entirely solid or has cystic areas.

Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a *** x *** x *** cm portion of [oriented/unoriented] fibroadipose tissue. [Indicate orientation provided]. [***] lymph nodes are found within the fibroadipose tissue, which range from *** to *** cm in maximum dimension. The lymph nodes are sectioned to reveal [describe cut surface, indicate if grossly evident metastatic tumor present and provide maximum dimension]. Representative sections of the grossly positive lymph nodes and all remaining identified lymph nodes and fibroadipose tissue are entirely submitted.


- Submit all grossly involved lymph nodes- Note: Consult pathologist with any questions – these are difficult

specimens to gross!

URETERSpecimen Type: URETERECTOMY (resection)Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a segment of ureter with adherent soft tissue measuring *** cm in length x *** cm in diameter.

The adventitial surface is [describe abnormalities, defects, lesions]. Sectioning reveals [describe lesion- size, shape, color, consistency]. The mucosa is [pink-tan, unremarkable]. The mass has a *** cm maximum thickness and [is grossly superficial, extends into the wall, extends to OR measures __cm from the adventitial surface]. The lesion measures *** cm from the proximal margin and *** cm from the distal margin.

The uninvolved wall is tan-white and has a *** cm average thickness. The lumen ranges from *** to *** cm in diameter. *** lymph nodes are identified ranging from *** to *** cm in greatest dimension. Representative sections are submitted [describe cassette submission].

Cassette Submission: - Incidental removal – one cassette of representative cross sections- Stenotic lesions

o Cross sections of stenotic zoneo Cross sections of proximal and distal areas

- Neoplastico Proximal resection margin (en face)o Distal resection margin (en face)o One section per cm of tumor

Show relationship to lumen and depth of invasion

URINARY BLADDERSpecimen Type: TRANSURETHRAL RESECTION OF BLADDER TUMOR (TURBT)Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a *** gram,*** x *** x *** cm aggregate of semi-firm, pink-tan portions of tissue. The portions range from *** to *** cm in greatest dimension. All portions appear homogeneous in color and texture. There [are/are no] areas of hemorrhage, degeneration, or calcification. The specimen is entirely submitted [describe cassette submission]. Cassette Submission: All tissue submitted

Specimen Type: CYSTECTOMY (Total or Partial)Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a(n) [intact/disrupted/previously incised] cystectomy measuring *** x *** x *** cm in greatest overall dimensions. The bladder measures *** x *** x *** cm . The right ureter measures *** cm in length x *** cm in diameter. The left ureter measures *** cm in length x *** cm in diameter.

The bladder is opened along the anterior aspect to reveal a *** x *** cm] [mass-(papillary, solid, flat), ulcer, area of fibrosis] located in the [trigone, dome, right/left lateral wall, anterior wall]. The mass [involves/ does not involve] the [right and/or left] ureteral orifices. Sectioning reveals the mass has a [describe cut surface-hemorrhage, necrosis] and a *** cm maximum thickness. The mass [is grossly superficial, extends into the bladder wall, extends into the pericystic fibroadipose tissue] and measures *** cm from the inked soft tissue margin and *** cm from the urethral margin.

The remaining bladder mucosa is (unremarkable, edematous). [Number] lymph nodes are identified ranging from *** to *** cm in greatest dimension. All identified lymph

nodes and representative sections of the remaining specimen are submitted [describe cassette submission].

Ink Key:Right-blackLeft- blue


- Ureteral resection margins (en face)- Urethral resection margin (en face)- Lesion

o Lesion with relationship to ureteral orifices and adjacent bladder mucosa

o Full-thickness sections of lesion(s) at maximum depth of invasion – in relation to nearest soft tissue margin

- Two representative sections each of uninvolved mucosa (two sections in one cassette if possible)

o Anterior wallo Posterior wallo Trigoneo Domeo Left lateral wallo Right lateral wallo Longitudinal section of each ureteral orifice

- Representative cross sections of ureters- All lymph nodes

Specimen Type: CYSTECTOMY/PELVIC EXENTERATION (FEMALES)Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a(n) [intact/disrupted/previously incised] cystohysterectomy with [attached/separately received] [total/supracervical] hysterectomy measuring *** x *** x *** cm in greatest overall dimensions. The bladder measures *** x *** x *** cm. The right ureter measures *** cm in length x *** cm in diameter. The left ureter measures *** cm in length x *** cm in diameter. The uterus weighs *** grams and measures[*** cm (cornu-cornu) x *** cm (fundus-lower uterine segment) x *** cm (anterior - posterior)]. The cervix measures *** cm in length x *** cm in diameter. The endometrial cavity measures *** cm in length, up to *** cm wide. The endometrium measures *** cm in average thickness. The myometrium ranges from *** to *** cm in thickness. The right ovary measures *** x *** x *** cm. The left ovary measures *** x *** x *** cm. The right fallopian tube measures *** cm in length [with/with

out] fimbriae x *** cm in diameter, with a *** cm average luminal diameter. The left fallopian tube measures *** cm in length [with/with out] fimbriae x *** cm in diameter, with a *** cm average luminal diameter. The anterior vaginal wall measures *** x *** x *** cm.

The bladder is opened along the anterior aspect to reveal a [***x***cm] [mass-(papillary, solid, flat), ulcer, area of fibrosis] located in the [trigone, dome, right/left lateral wall, anterior wall]. The mass [involves/ does not involve] the [right and/or left] ureteral orifices. Sectioning reveals the mass has a [describe cut surface-hemorrhage, necrosis] and a *** cm maximum thickness. The mass [is grossly superficial, extends into the bladder wall, extends into the pericystic fibroadipose tissue, extends into the uterus, anterior vaginal wall] and measures *** cm from the inked soft tissue margin and *** cm.

The remaining bladder mucosa is (unremarkable, edematous). The anterior vaginal wall is [pink-tan, and unremarkable, describe presence of lesions]. The endometrium is [tan-red, unremarkable, describe presence of lesions]. The myometrium is [tan, yellow, and unremarkable, remarkable for-describe leiyomyomas/cysts/etc]. The right and left fallopian tubes are [grossly unremarkable, remarkable for adhesions, show evidence of prior tubal ligation, etc]. The myometrium is [tan-pink, unremarkable, describe presence of lesions]. The cervix is [grossly unremarkable, presence of Nabothian cysts, lesions]. The right and left ovary are [unremarkable, show atrophic changes, describe presence of lesions]. [Number] lymph nodes are identified. Representative sections are submitted [describe cassette submission]. Gross photographs are taken.

Ink key: Black right soft tissue marginBlue left soft tissue margin




o Full-thickness sections of lesions at maximal depth of invasion – in relation to nearest soft tissue margin


o Anterior wallo Posterior wallo Trigoneo Domeo Left lateral wall

o Right lateral wallo Longitudinal section of each ureteral orifice

- Representative cross sections of ureters- All lymph nodes- Anterior cervix- Posterior cervix- Anterior uterine full thickness- Posterior uterine full thickness- Anterior/posterior endyometrium- Right fallopian tube and right ovary - Left fallopian tube and left ovary - Vaginal wall (if present)

Specimen Type: CYSTOPROSTATECTOMYComment: The non-serosal surface of the bladder should be inked black, right of the prostate gland inked blue, and left of the prostate gland inked yellow. Then, a vertical incision should be made anteriorly from the dome of the bladder to just above the prostate. The bladder is inspected and photographed if an interesting lesion is present. If sufficient amount of lesion is present, then the tissue procurement team should be contacted. After procurement (or if there is no mass lesion present), the specimen should be fixed in formalin overnight .The urinary bladder and prostate should be processed at the same time.

Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] is a(n) [intact/disrupted/previously incised] cystoprostatectomy measuring *** x *** x *** cm in greatest overall dimensions. The bladder measures *** x *** x *** cm. The right ureter measures *** cm in length x *** cm in diameter. The left ureter measures *** cm in length x *** cm in diameter. The prostate weighs *** grams and measures *** cm (lateral left - lateral right) x *** cm (apex - base) x *** cm (anterior - posterior)]. The prostatic urethra is patent and measures *** cm in length x *** cm in average diameter. The right seminal vesicle measures *** x *** x *** cm . The left seminal vesicle measures *** x *** x *** cm. The right vas deferens measures *** cm in length x *** cm in diameter and the left vas deferens measures *** cm in length x *** cm in diameter.

The bladder is opened along the anterior aspect to reveal a *** x *** cm [mass-(papillary, solid, flat), ulcer, area of fibrosis] located in the [trigone, dome, right/left lateral wall, anterior wall]. The mass [involves/ does not involve] the [right and/or left] ureteral orifices. Sectioning reveals the mass has a [describe cut surface-hemorrhage, necrosis] and a *** cm maximum thickness. The mass [is grossly superficial, extends into the bladder wall, extends into the pericystic fibroadipose tissue, extends into the

prostatic parenchyma] and measures *** cm from the inked soft tissue margin and *** cm from the prostatic urethral margin.

The remaining bladder mucosa is (unremarkable, edematous). The prostate is serially sectioned from base - apex into *** transverse levels to reveal [diffuse periurethral nodularity, prominent nodues, fibrosis, lesion, extension of bladder mass]. The [prominent nodule/lesion] area is located in the [left/right, anterior/posterior, central/peripheral] aspect and measures *** cm from the capsule. The seminal vesicles and vasa deferentia are grossly unremarkable. [Number] lymph nodes are identified ranging from *** - *** cm in maximum dimension. Representative sections are submitted [describe cassette submission]. Gross photographs are taken.

Ink key: Black right Blue left Yellow midline anterior prostateRed midline posterior prostate




o Full-thickness sections of lesions at maximal depth of invasion – in relation to nearest soft tissue margin


o Anterior wallo Posterior wallo Trigoneo Domeo Left lateral wallo Right lateral wallo Longitudinal section of each ureteral orifice

- Representative cross sections of ureters- All lymph nodes- Prostate

o Apical margin (perpendicular sections)o Bladder neck area (not true margin)o 4 cassettes of posterior quadrants (level 2 + level 4)o 2 cassettes of anterior quadrants (level 3)o Include sections to contain prostatic urethra

- Note: If other adjacent organs, such as rectum, are present, submit sections showing relationship of tumor to these structures. Otherwise, one to two representative sections of these structures is enough.

Specimen Type: CALCULIGross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received [fresh/in formalin] are [number] of [color, shape] calculi measuring *** x *** x *** cm in aggregate ranging from *** cm to *** cm in greatest dimension. A photograph is taken. The specimen is sent for chemical analysis.Cassette Submission: Tissue submitted for chemical analysis (if requested).

Specimen Type: GENITOURINARY (GU) HARDWAREComment: If tissue is attached to hardware received by the GU service, do not submit the tissue for microscopic exam. These cases are gross only. An exception can be made if there is a specific request from the ordering clinician or a pathologist. In the case of transplant catheters, the attached tissue can only be submitted if requested by the clinician or approved by Dr. Said.

Examples of GU hardware are the following: • peritoneal dialysis catheter • old permacatheter • PD catheter• ureteral stent • explanted ureteral stent • any other GU hardware.

Gross Template: Labeled with the patient’s name (***), medical record number (***), designated “***”, and received unfixed is [describe hardware] measuring *** x *** x *** cm. There is the following medical inscription: “***”. A photograph is taken. The specimen is for gross examination only.

Cassette Submission: Gross only – no cassettes submitted

Documents

pathology.ucla.edupathology.ucla.edu/.../Education/Genitourinary_2018v2.docx · Web viewLP = lamina propria CS = coronal sulcus ALB = tunica albuginea CC = corpus cavernosum U = ventral