Partial Nephrectomy

PARTIAL NEPHRECTOMY

 

Partial nephrectomies are generally performed for peripheral, smaller kidney tumors (under 7 cm). Usually, the resected specimen consists predominantly of tumor with a rim of kidney at one edge (the resection margin). There may be some fat overlying the tumor capsule. These specimens are usually unoriented; however sutures may be present to identify a specific area, such as the resection margin. Note: No major vessels or ureter will be present. It is also common that surgeon during the intraoperative procedure will send the parenchymal margin for frozen section. In that event frozen section margin should be considered true margin.

 

Procedure

 

Weigh and measure specimen, also measure tumor size in 3 dimensions.

 

• Describe the parenchymal resection margin, capsule and any other outer surfaces covered by either sinus fat or peri-renal adipose. Describe if any visible lesion is identified and location.

 

• Ink parenchymal margin and capsule/adipose separate colors.

 

• Serially section along the long axis, showing tumor to respective margins.

 

• Describe tumor cut surfaces (i.e. color, hemorrhagic, cystic, necrotic, etc.) and mention if the tumor is well encapsulated/circumscribed or invasive.

 

• If frozen section for the parenchymal margin is not submitted initially, attempt to give the distance between the closest tumor and resection margin. If tumor abuts the margin, indicate that and submit representative sections.

 

• Describe uninvolved renal parenchyma (cortex and medulla) and attached adipose.

 

• Mention if any calyces or pelvis are identified.

 

Sections for Histology

 

• 1 section per cm of tumor to resection margins/outer capsule (closest to), renal sinus area minimum of 2-3 sections representing tumor to capsule/renal sinus area. Submit entire specimen in 5 cassettes if possible.

 

• Submit 1 section of uninvolved parenchyma/pelvis/calyces if present.

 

Sample Dictation

 

Labeled “partial nephrectomy”, received in formalin in a small container is an unoriented portion of kidney, 6.7 grams and 5.0 x 3.0 x 2.5 cm. The specimen is partially covered by tan unremarkable parenchyma and yellow, lobular unremarkable peri-renal adipose. Inking as follows: parenchymal –blue and peri-renal adipose-black. Sectioning reveals a bright yellow, well encapsulated mass (4.0 x 2.5 x 2.0 cm), which contains diffusely hemorrhagic cut surfaces and is located 0.5 cm from the parenchymal/resection margin and 0.6cm from the capsule/peri-renal adipose. The remaining uninvolved cortex and medulla are unremarkable.
Cassette summary:
1A-1C Mass closest to resection margin (ss)
1D Mass closest to capsule/peri-renal adipose (ss)
1E Uninvolved parenchyma (ss)

 

 

 

 

Modified February 2009