Kidney tumor - Adult malignancies
Adult malignancies - Miscellaneous
Grossing

Author: Sean Williamson, M.D. (see Authors page)

Revised: 10 February 2017, last major update July 2012

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: grossing kidney tumor

Table of Contents
Definition / general
Cite this page: Grossing. PathologyOutlines.com website. http://pathologyoutlines.com/topic/kidneytumormalignantgrossing.html. Accessed September 20th, 2017.
Definition / general
  • Ink surface opposite tumor before sectioning, which causes capsular retraction
  • Measure and weigh kidney (important for some clinical trials)
  • Check renal vein for thrombus (submit in separate block)
  • Suggested to open through venous system to avoid misinterpreting retrograde venous invasion (within the kidney) as tumor multifocality or larger overall tumor size (Mod Pathol 2011;24:1578)
  • Bivalve kidney
  • In adults only, remove perirenal fat (Gerota fascia) by blunt dissection, except over tumor or areas of adherence
  • Submit fresh tissue for special studies (cytogenetics, flow cytometry, EM)

Optional:
  • Weigh kidney without perirenal fat (generally of greater significance than weight including perirenal fat, although preservation of the tumor fat interface may be helpful if involvement is uncertain)
  • Make parallel cuts in sagittal plane; refrigerated fixation is recommended for better sections

Sections:
  • 1 of tumor per cm of tumor diameter, include all areas with different colors, especially whitish grey
  • Sample all tumor nodules
  • Also tumor and adjacent kidney, capsule, Gerota fascia, renal sinus (Am J Surg Pathol 2007;31:1089, Am J Surg Pathol 2004;28:1594), other adjacent tissue, surgical margins
  • Tumor thrombi, other kidney lesions, normal kidney, renal pelvis, renal artery and vein, ureter margin, lymph nodes, adrenal gland

  • For Wilms tumor of childhood, take sections through renal pelvis / sinus and include medial sinus margin (medial end of soft tissues surrounding renal artery and vein), junction between normal kidney and tumor, tumor capsule and uninvolved kidney
  • Document where sections are taken on a diagram; snap freeze tumor and normal kidney for molecular studies

Kidney morcellation:
  • Fragmentation of kidney and associated tumors due to laparoscopic nephrectomy
  • Suggested sampling is influenced by radiologic features, probably should sample 5% of specimen including grossly visible tumor; staging is severely limited (Am J Surg Pathol 2001;25:1158)