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    Urethra

    Background

    Urethral specimens are usually received with bladder from cystectomy procedures. However occasional urethrectomy resections occur for primary malignant tumours or bladder cancer extension. Resection may also be required to treat urethral stricture.1,2


    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.

    • No
      • Non-routine fixation (not formalin), describe.
    • Yes
      • Special studies required, describe.
      • Ensure samples are taken prior to fixation.
    • Not performed
    • Performed, describe type and result
      • Frozen section
      • Imprints
      • Other, describe

    See general information for more detail on specimen handling procedures.

    Inspect the specimen and dictate a macroscopic description.


    External Inspection

    Orientate and identify the anatomical features of the specimen.

    Record additional orientation or designation provided by operating clinician:

    • Absent
    • Present
      • Method of designation (e.g. suture, incision)
      • Featured denoted

    Photograph the intact specimen if required.

    Describe the following features of the specimen:

    Procedure

    Record as stated by the clinician.

    • Urethrectomy
      • Partial
      • Total
    • Other, describe

    Specimen integrity

    • Intact
    • Disrupted, describe
      • Number of fragments

    Specimen size (mm)

    • Each fragment
      • Length
      • Diameter

    If additional anatomical components are included, specify and measure according to relevant tissue protocol.


    Dissection

    Paint the circumferential resection margin (adventitial connective tissue) with ink and record the colours applied.

    Serially section transversely at 3mm intervals maintaining sequential order from proximal to distal.

    Lay the sections out sequentially and photograph to record a block key.


    Internal Inspection

    Describe the internal or cut surface appearance including the following items:

    Tumour

    • Absent
    • Present
      • Number; if more than one tumour, designate and describe each tumour separately

    Tumour size (mm)

    • Maximum dimension
    • Other dimensions

    Tumour description

    • Plaque/thickening
    • Ulcer
    • Stricture
    • Nodule
    • Papillary

    Tumour site;

    (more than one may apply)

    Male

    • Penile
    • Bulbomembranous
    • Prostatic
    • Undetermined

    Female

    • Anterior
    • Posterior
    • Undetermined

    Tumour invasion

    • Absent
    • Present
      • Urethral wall
      • Peri-urethral tissues
    • Depth (mm)

    Distance to margins (mm)

    • Distance of tumour to closest "cut-end" margin
      • Specify margin if orientated (proximal/distal)
    • Distance of tumour to circumferential margin

    Retrieved from resection specimen

    • Describe site(s)
    • Number retrieved

    Separately submitted

    • For each specimen container, record specimen number and designation
    • Collective size of tissue in three dimensions (mm)
    • Number of grossly identified lymph nodes submitted
    • Maximum diameter of each (mm)

    Processing

    Submit representative sections of:1-3

    • Tumour including deepest point of penetration
    • Other lesions (ulcer one section, more of warty lesions or stricture)
    • Proximal and distal surgical resection margins

    Alternatively, submit the entire specimen for processing in sequential order with instructions to indicate the surface to be cut (e.g. ink marking of the obverse surface). This will allow mapping of the tumour and any associated carcinoma in situ which may be more extensive than apparent macroscopically.

    Submit all lymph nodes.


    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
    Proximal margin
     
    B
    Tumour deepest point of invasion
     
    C-F
    Tumour
     
    G
    Distal margin
     
     

    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. 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.
    3. McKenney JK, Amin MB, Epstein JI, Grignon DJ, Oliva E, Reuter VE, Srigley JR and Humphrey PA. Protocol for the examination of specimens from patients with carcinoma of the urethra, Cancer Committee, College of American Pathologists, 2012.

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    25-Mar-2019
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