Difference between revisions of "Renal tumor"
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| + | {{Top | ||
| + | |author1=[[User:Mikael Häggström|Mikael Häggström]] | ||
| + | |author2= | ||
| + | }} | ||
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| + | ==Presentations== | ||
| + | Usually total nephrectomy.<ref name=stora>{{Stora utskärningen}}</ref> | ||
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| + | ==Gross processing== | ||
| + | ===Gross examination=== | ||
| + | For orientation, the ureter stump points to the inferior pole.<ref name=stora/> | ||
| + | |||
| + | Components:<ref name=stora/> | ||
| + | *Note the appearance of the renal surface | ||
| + | *Inspect the capsule and pericapsular soft tissue, and possibly an accompanying adrenal gland | ||
| + | *Measure dimensions (and optionally the weight) | ||
| + | *Identify the surgical margin of the ureteral stump, renal vein and renal artery | ||
| + | *In cases of a bulging tumor, apply ink to the surface of pericapsular fatty tissue by the tumor. | ||
| + | *Dissect the ureteral stump | ||
| + | *Split the kidney in the middle, in the coronal plane. Release the fibrous capsule. Dissect the renal pelvis and calyces. Inspect the parenchyma on cut surfaces. | ||
| + | :*Note and possibly measure the medullary thickness and the width of the renal pelvis | ||
| + | |||
| + | <!-- | ||
| + | ===Gross reporting=== | ||
| + | |||
| + | *The appearance of the calyces and the papilla, possible changes in the renal pelvis, or the appearance of concretions | ||
| + | |||
| + | · In cases of tumor, the location and size of the tumor, macroscopic appearance of the incision surface, delimitation of surrounding structures, and relation to fibrous capsule and pericapsular tissue are indicated. If the fibrous capsule can be detached from the tumor surface, the inside of the capsule is examined where it rests against the tumor with regard to suspected tumor overgrowth or breakthrough | ||
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| + | Bits for microscopic examination: | ||
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| + | · At least 3-4 pieces from the tumor, showing relationship to capsule, pericapsular tissue, surrounding kidney tissue, renal pelvis, hilus adipose tissue and blood vessels | ||
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| + | · Particular pieces are taken from the part of the fibrous capsule that rests against the tumor (orientated directly to the canopy surface) | ||
| + | |||
| + | · Particular pieces are taken from resection strips on the ureteral stump, renal vein and renal artery, and from hilus tissue (to examine possible tumor invasion of smaller blood vessels) | ||
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| + | · A bit from normal kidney tissue | ||
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| + | · Pieces from any proven lymph nodes in hilus fat | ||
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| + | · A piece from macroscopically normal adrenal gland; in pathological changes, representative bits are taken | ||
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| + | · In kidney pelvic cancer, at least three pieces are taken from the macroscopically tumor-suspected area, including borderline to normal mucosa, and adjacent peripelvic fatty tissue. Take about 1 piece per cm2 from other parts of the renal pelvis, as well as a piece from the resection border on the ureteral stump. In case of changes in the ureteral stump, take pieces from these as well | ||
| + | |||
| + | · In transplant cases, the entire hilus region for histology is taken, with parallel vessels including all vessels. From the parenchyma, pieces are taken from necrosis, bleeding and other aberrant cures, as well as 2-3 pieces from macroscopically normal parts. | ||
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| + | Partial nephrectomy (usually due to tumor): | ||
| + | |||
| + | · Paint the resection surface with ink | ||
| + | |||
| + | · Take pieces perpendicular to the resection surface to assess the radicality | ||
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| + | The answer should include information on: | ||
| + | |||
| + | · Type of operation / preparation | ||
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| + | In tumor: | ||
| + | |||
| + | · Tumor size | ||
| + | |||
| + | · Location | ||
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| + | · Relationship to capsule, pericapsular tissue, renal pelvis, adrenal gland, hilus blood vessels | ||
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| + | · Histological type, degree of differentiation | ||
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| + | · Radicalism | ||
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| + | · Metastases, possibly lymph nodes present | ||
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| + | · Pathological changes in general | ||
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| + | For non-neoplastic changes: | ||
| + | |||
| + | · Type of change | ||
| + | |||
| + | · Location / distribution | ||
| + | |||
| + | · Degree / intensity | ||
| + | --> | ||
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https://www.dovepress.com/unclassified-renal-cell-carcinoma-diagnostic-difficulties-and-treatmen-peer-reviewed-fulltext-article-RRU | https://www.dovepress.com/unclassified-renal-cell-carcinoma-diagnostic-difficulties-and-treatmen-peer-reviewed-fulltext-article-RRU | ||
https://www.dovepress.com/cr_data/article_fulltext/s154000/154932/img/rru_154932_T001.jpg | https://www.dovepress.com/cr_data/article_fulltext/s154000/154932/img/rru_154932_T001.jpg | ||
Revision as of 07:10, 4 February 2020
Author:
Mikael Häggström [note 1]
Presentations
Usually total nephrectomy.[1]
Gross processing
Gross examination
For orientation, the ureter stump points to the inferior pole.[1]
Components:[1]
- Note the appearance of the renal surface
- Inspect the capsule and pericapsular soft tissue, and possibly an accompanying adrenal gland
- Measure dimensions (and optionally the weight)
- Identify the surgical margin of the ureteral stump, renal vein and renal artery
- In cases of a bulging tumor, apply ink to the surface of pericapsular fatty tissue by the tumor.
- Dissect the ureteral stump
- Split the kidney in the middle, in the coronal plane. Release the fibrous capsule. Dissect the renal pelvis and calyces. Inspect the parenchyma on cut surfaces.
- Note and possibly measure the medullary thickness and the width of the renal pelvis
https://www.dovepress.com/cr_data/article_fulltext/s154000/154932/img/rru_154932_T001.jpg
Cite error: <ref> tags exist for a group named "note", but no corresponding <references group="note"/> tag was found, or a closing </ref> is missing
- ↑ 1.0 1.1 1.2 Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.
