Initial procedure

• testes are often received having been incised prior to receipt and this may make assessment of invasion through the tunica albuginea difficult and accurate staging impossible. Urologists should be encouraged to send the intact testis to the laboratory rapidly to allow bisection by the pathologist.

• some tumours spread to involve the cord and this should be looked for and sampled prior to opening the testis to minimise the risk of contamination by tumour.

• the testis is incised in a plane that bisects the epididymis and rete testis such that invasion of these structures can be recognised (Figure 32.3).

• fix by immersion in 10% formalin for 24-36 hours.

• cuts parallel to the incised plane to examine the entire testis are then performed.

• photograph tumour and individual slices if appropriate.

• measurements:

- dimensions (cm) of testis and length (cm) of spermatic cord.

- weight of specimen in total (g).

- tumour - length x width x breadth or maximum dimension (cm).

• identify different tumour appearances looking particularly for areas of haemorrhage and necrosis.

• all areas of different macroscopic appearances should be sampled in order to identify all the histological patterns present (seminomatous versus NSGCT).

Epididymis

Epididymis

Transverse section the proximal spermatic cord margin

Transverse cord sections

Hemisect anteroposteriorly

Testis

Transverse section the proximal spermatic cord margin

Transverse cord sections

Tumour and epididymis

Tumour and spermatic cord

Hemisect anteroposteriorly

Tumour, rete testis and epididymis

Testis

Tumour and spermatic cord

Tumour and epididymis

Tumour, rete testis and epididymis

Tumour and layers of tunica

Tumour and adjacent testis

Tumour and layers of tunica

Tumour and adjacent testis

Testis and coverings

Figure 32.3. Blocking of an orchidectomy specimen for tumour.

• count and submit any lymph nodes with the main specimen.

• examine the cord and surrounding tissue for abnormality.

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