Initial procedure Figure 293

• orientate the specimen with the help, if present, of attached pelvic organs (uterus and seminal vesicles are posterior to the bladder) or the peritoneal reflection, which descends further on the posterior bladder wall than anteriorly.

Blocks

1. Urethral and ureteric limits

2. Prostate

3. Bladder away from tumour

4. Tumour with adjacent mucosa, underlying wall and perivesical

Figure 29.3. Blocking a cystoprostatectomy specimen for bladder cancer. Based on Hermanek P, Hutter RVP, Sobin LH, Wagner G, Wittekind Ch (eds.). TNM Atlas: illustrated guide to the TNM/pTNM classification of malignant tumours, 4th edition. SpringerVerlag: Berlin and Heidelberg, 1997.

• locate both ureters in the lateral perivesical fat (may be marked with sutures).

• place a probe in the bladder via the urethra and open the specimen anteriorly (through the prostate if present) with a sagittal cut using a knife or scissors, trying if possible to avoid cutting into any localised tumour. Keep the posterior aspect of the specimen intact to maintain orientation. Some pathologists prefer to inflate the bladder with 10% formalin and allow fixation prior to opening. Others like to divide the specimen into anterior and posterior halves.

• if there is an obvious tumour, paint the nearest deep perivesical soft tissue margin; if no tumour is grossly obvious (e.g., following preoperative treatment), paint all peripheral soft tissue margins, using different coloured inks for orientation. Paint the prostate, if present.

• measurements:

- dimensions (cm) of bladder and, if present, prostate, seminal vesicles, female pelvic organs.

- lengths(cm) of ureters (limits may be submitted separately) and urethra, if attached.

distances to urethral and ureteric margins (cm).

• fix by immersion in 10% formalin for at least 24-36 hours preferably pinned out or using a wick to fully expose the mucosal surface.

• locate the ureteric orifices at the trigone and open the ureters along their full length with small scissors.

• make 3-5 mm parallel, transverse sections through the tumour to demonstrate its deepest point of invasion and its relationship to the ureters, prostate or any other adjacent structures.

• look for and measure lymph nodes in perivesical fat (usually none found).

• if not involved by the bladder tumour, serially section the prostate perpendicular to the urethra looking for occult primary tumour.

• if not involved by the bladder tumour, process female pelvic organs.

• photograph suitable slices.

• partial cystectomies are processed in a similar manner, although orientation may be more difficult (or impossible). The mucosal edges should be treated as surgical margins, i.e., inked and measurements given from tumour (cm).

• if a tumour is identified as arising from the urachal tract (usually in a partial cystectomy specimen comprising dome of bladder, urachal tract and umbilicus), the bladder portion is processed as before, soft tissue margins surrounding the urachal tract are painted and the tract serially sectioned transversely up to the umbilicus.

• conduits, augmentation cystoplasty and neobladder specimens containing tumours are processed as before, opening along the urethra and ureters if possible, painting the nearest deep soft tissue margin and noting the relationship of the tumour to the enteric, bladder or ureteric mucosa. It may be best to serially section the tumour perpendicular to lines of anastomoses.

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