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    Genitourinary small biopsies

    Background

    A range of biopsies are taken to investigate benign and malignant lesions of the genitourinary tract including endoscopic biopsies of bladder, urethra, needle biopsies of testis, prostate and penis and transurethral resections of bladder and prostate.1-5


    Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

    Testis biopsies

    A fixative such as Bouin’s or acetic acid–zinc formalin rather than routine buffered formalin is recommended to prevent shrinkage of tissue in non-neoplastic testis biopsies.2

    See general information for more detail on specimen handling procedures.

    Inspect the specimen and dictate a macroscopic description.


    External Inspection

    Record the following features of the specimen.1,5

    Transurethral resection of prostate (TURP)

    • Weight (g)

    Prostate core biopsies

    • Number of cores/pieces
    • Length of each piece (mm)

    Urinary tract (including penis) -small biopsies

    The specimen usually consists of tiny pieces of tissue.

    Orientate and identify mucosal surfaces if applicable.

    • Number of pieces
    • Size (mm) of each piece in three dimensions
      • Where multiple fragments are present, the range of maximum sizes may be appropriate*

    *“Multiple” should only be used to describe specimens where biopsies are too numerous to count

    Urinary tract -large specimens

    e.g. Transurethral resection of bladder tumour (TURBT)

    As for other small biopsies of urinary tract.
    In addition:

    • Weight (g)

    Testis biopsies (neoplastic and non-neoplastic)

    • Number of pieces
    • Size (mm) of each piece in three dimensions

    Dissection

    No dissection required.


    Internal Inspection

    Not required.


    Processing

    Submit all tissue. Transfer directly into cassettes for processing. Biopsy pads, lens paper or similar are required to prevent loss of tissue during processing.

    Various sampling methods are recommended.

    • A minimum recommendation is to submit the first 12g (6 cassettes) of tissue plus one cassette for every additional 5g.3
    • Alternatively submit the first 16g (8 cassettes). If the patient is <65 years of age and there is more tissue, all tissue should be submitted. If the patient is >65 years of age, embed the remainder only if pT1c cancer is found in the initial 8 blocks.4

    Transfer directly into cassettes for processing. Biopsy pads, lens paper or similar are required to prevent loss of tissue during processing.

    The entire specimen is usually submitted to assess response to therapy.

    Submit all tissue. Transfer directly into cassettes for processing. Biopsy pads, lens paper or similar are required to prevent loss of tissue during processing.

    Submit the first 20g (10 cassettes) of tissue plus one cassette for every additional 5g.1,4 Transfer into cassettes for processing ensuring biopsy pads, lens paper or similar are present to prevent tissue loss during processing.

    Submit all tissue. Transfer directly into cassettes for processing. Biopsy pads, lens paper or similar are required to prevent loss of tissue during processing.

    Record details of each cassette.

    An illustrated block key similar to the one provided may be useful.

    Block allocation key

    Cassette id
    Site
    No. of pieces
    A
    Testis
     

     

    Acknowledgements

    A/Prof Hemamali Samaratunga for her contribution in reviewing and editing this protocol.


    References

    1. O’Rourke D, Turner G and Allen D. Tissue Pathways for Urological Pathology, The Royal College of Pathologists, London, 2010.
    2. Cerilli LA, Kuang W and Rogers D. A practical approach to testicular biopsy interpretation for male infertility. Arch Pathol Lab Med2010;134(8):1197-1204.
    3. Trpkov K, Thompson J, Kulaga A and Yilmaz A. How much tissue sampling is required when unsuspected minimal prostate carcinoma is identified on transurethral resection? Arch Pathol Lab Med 2008;132(8):1313-1316.
    4. McDowell PR, Fox WM, Epstein JI. Is submission of remaining tissue necessary when incidental carcinoma of the prostate is found on transurethral resection? Human pathology. 1994;25(5):493-7.
    5. Shanks JH, Chandra A, McWilliam L and Varma M. Dataset for tumours of the urinary collecting system (renal pelvis, ureter, bladder and urethra), The Royal College of Pathologists, London, 2013.

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      GU small biopsy 2

      Prostate core biopsy

      TURP 1

      TURP for processing

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      25-Mar-2019
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