SURGICAL PATHOLOGY
Collected on December 15, 2023 11:04 AM, December 15, 2023 12:10 PM, December 15, 2023 12:18 PM, December 15, 2023 1:12 PM, December 15, 2023 4:10 PM, December 15, 2023 4:41 PM
Lab tests - Tissue (Pelvic Lymph Node, Left), Tissue (Pelvic Lymph Node, Right), Tissue (Ureter, Right), Tissue (Ureter, Left), Tissue (Other <free text>)
Results
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CASE: EHS-23-14633
PATIENT: JOHN CARCERANO
Pre-Op Diagnosis: Rule out tumor, malignant neoplasm of trigone of urinary bladder
Post-Op Diagnosis: None Given
Clinical History: None Given
FINAL DIAGNOSIS:
A) Ureter, right (distal):
- Mild chronic inflammation.
- No dysplasia or malignancy present.
B) Ureter, left (distal):
- No diagnostic abnormality.
- No dysplasia or malignancy present.
C) Urinary bladder, robot-assisted laparoscopic radical cystoprostatectomy:
- High-grade urothelial carcinoma. See Comment and Case Summary.
- Findings compatible with effects of neoadjuvant therapy.
- Mild acute and chronic inflammation.
- Margin free of tumor.
Prostate gland, robot-assisted laparoscopic radical cystoprostatectomy:
- Prostatic acinar adenocarcinoma. See Case Summary.
- Nodular hyperplasia.
Seminal vesicles, left and right, robot-assisted laparoscopic radical
cystoprostatectomy:
- No diagnostic abnormality.
- No malignancy present.
Ureter, right, robot-assisted laparoscopic radical cystoprostatectomy:
- Mild chronic inflammation.
- No dysplasia or malignancy present.
Ureter, left, robot-assisted laparoscopic radical cystoprostatectomy:
- No diagnostic abnormality.
- No dysplasia or malignancy present.
D) Lymph nodes, left pelvic, robot-assisted laparoscopic regional resection:
- No diagnostic abnormality.
- No malignancy present in fifteen nodes (0/15).
E) Lymph nodes, right pelvic, robot-assisted laparoscopic regional resection:
- No diagnostic abnormality.
- No malignancy present in nineteen nodes (0/19).
F) Ureter, left (final margin):
- No diagnostic abnormality.
- No dysplasia or malignancy present.
G) Ureter, right (final margin):
- Mild chronic inflammation.
- No dysplasia or malignancy present.
COMMENT (part C): A microscopical focus of residual urothelial carcinoma is present in
block C17. An incidental prostatic acinar carcinoma is present in block C30 (this finding
h
as received intradepartmental review). Please see the Case Summaries below for further
details.
URINARY BLADDER:
SPECIMEN
Procedure: Radical cystoprostatectomy
TUMOR
Tumor Site: Right lateral wall
Histologic Type: Urothelial carcinoma, invasive
Histologic Grade: High-grade
Tumor Size: 0.1 cm (greatest dimension)
Tumor Extent: Invades deep muscularis propria (outer half)
Lymphovascular Invasion: Not identified
MARGINS
Margin Status for Invasive Tumor: All margins negative for invasive tumor
Margin Status for Carcinoma in situ / Noninvasive Papillary Urothelial Carcinoma: All
margins negative for carcinoma in situ / noninvasive papillary urothelial carcinoma
REGIONAL LYMPH NODES
Regional Lymph Node Status: All regional lymph nodes negative for tumor
Number of Lymph Nodes Examined: 34
DISTANT METASTASIS
Distant Site(s) Involved: Not applicable
PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition)
Reporting of pT, pN, and (when applicable) pM categori
es is based on information available
to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.)
it is the managing physician's responsibility to establish the final pathologic stage
based upon all pertinent information, including but potentially not limited to this
pathology report.
TNM Descriptors: y (post-treatment)
pT Category: pT2b
pN Category: pN0
pM Category: Not applicable - pM cannot be determined from the submitted specimen(s)
Comment(s): Only a microscopic focus of residual urothelial carcinoma present in block
C17
PROSTATE CARCINOMA RADICAL PROSTATECTOMY CASE SUMMARY
SPECIMEN
Procedure: Radical cystoprostatectomy
TUMOR
Histologic Type: Acinar adenocarcinoma
Histologic Grade
Grade: Grade group 1 (Gleason Score 3 + 3 = 6)
Intraductal Carcinoma (IDC): Not identified
Cribriform Glands: Not identified
Treatment Effect: Not identified
TUMOR QUANTITATION
Via percentage
Estimated Percentage of Prostate Involved by Tu
mor: Less than 1%
Extraprostatic Extension (EPE): Not identified
Urinary Bladder Neck Invasion: Not identified
Seminal Vesicle Invasion: Not identified
Lymphovascular Invasion: Not Identified
MARGINS
Margin Status: All margins negative for invasive carcinoma
REGIONAL LYMPH NODES
Regional Lymph Node Status: All regional lymph nodes negative for tumor
Number of Lymph Nodes Examined: 34
DISTANT METASTASIS
Distant Site(s) Involved: Not applicable
PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition)
Reporting of pT, pN, and (when applicable) pM categories is based on information available
to the pathologist at the time the report is issued. As per the AJCC (Chapter 1, 8th Ed.)
it is the managing physician's responsibility to establish the final pathologic stage
based upon all pertinent information, including but potentially not limited to this
pathology report.
TNM Descriptors: y (post-treatment)
Primary Tumor (pT): pT2
pN Category: pN0
pM Category: Not
applicable - pM cannot be determined from the submitted specimen(s)
Block for Ancillary Studies: C30
For parts F & G, requisition states: "Final margin opposite clip"
GROSS:
A) Received fresh for intraoperative consultation labeled "right distal ureter" is a 0.6
x 0.5 x 0.3 cm unoriented tubular piece of tissue with a 0.2 cm (greatest dimension)
lumen. The specimen is entirely placed on one chuck for frozen section analysis; the
remnant is submitted in cassette A1.
B) Received fresh for intraoperative consultation labeled "left distal ureter" is a 0.6 x
0.4 x 0.3 cm unoriented tubular piece of tissue with a 0.2 cm (greatest dimension) lumen.
The specimen is entirely placed on one chuck for frozen section analysis; the remnant is
submitted in cassette B1.
SSHA 12/15/2023 (EH)
C) Received fresh labeled "bladder and prostate" is a 14.0 x 11.5 x 4.0 cm radical
cystoprostatectomy specimen which includes the 4.5 x 4.0 x 4.0 cm urinary bladder, the 2.1
cm long, 0.5 cm
diameter left and 1.9 cm long, 0.7 cm diameter right ureteral stumps, the
5.0 x 4.5 x 4.0 cm prostate gland, the 3.5 x 1.5 x 1.0 cm left and 4.0 x 1.2 x 1.1 cm
right seminal vesicles, and the 8.0 cm long, 0.2 cm diameter left and 6.5 cm long, 0.2 cm
diameter right vasa deferentia. The serosal surface of the bladder is smooth and shiny.
The prostate capsule is smooth. The specimen is inked as follows: anterior soft tissue
margin = green, posterior soft tissue margin = black, left side of prostate = black, right
side of prostate = green. The bladder is opened in the usual manner to expose a 3.0 x 1.8
x 1.5 cm slightly-raised, mucosal-based irregular hemorrhagic area occupying the right
lateral wall, posterior wall and trigone. This area is sectioned to show rubbery
underlying cut surfaces without a discrete lesion. The bladder wall is up to 1.7 cm thick.
The rubbery consistency extends to the right anterior aspect of the soft tissue margin, is
0.4 cm from the left lateral asp
ect of the soft tissue margin, and is 0.7 cm from the
posterior aspect of the soft tissue margin. Away from the hemorrhagic area, the bladder
mucosa is wrinkled and congested. The left ureter is probe patent; the right ureter is not
probe patent. The prostate gland is serially sectioned into seven slices from superior to
inferior to expose a 0.5 x 0.4 x 0.5 cm yellow-tan periurethral nodule (in slices 1 and 2)
and a 0.3 x 0.5 x 0.5 cm white-tan nodule (in slices 5 & 6). No lymph nodes are
identified. A digital image is captured. Representative sections are submitted in
cassettes as follows:
C1 = right and left ureteral margin, en face left inked blue
C2 = right ureter
C3 = left ureter
C4 = prostatic apical/urethral margin, anterior half, perpendicular
C5 = prostatic apical/urethral margin, posterior half, perpendicular
C6 = bladder lesion with deepest extension
C7 = bladder lesion with right anterior soft tissue margin
C8 = bladder lesion the posterior soft tissue margin
C9 = bladder lesion with left lateral soft tissue margin
C10 = bladder lesion at possible right vesico ureteral junction
C11 = left vesico-ureteral junction
C12 = bladder lesion at trigone area
C13 = bladder lesion with adjacent mucosa
C14 = anterior wall of bladder
C15 = posterior wall of bladder
C16 = dome of bladder
C17 = right lateral wall of bladder
C18 = left lateral wall of bladder
C19 = urethral-vesical junction
C20 = right seminal vesicle and vas deferens
C21 = left seminal vesicle and vas deferens
C22 = right anterior prostate, slice 2 (RA2)
C23 = right intermediate prostate, slice 2 (RI2; includes nodule)
C24 = right posterior prostate, slice 2 (RP2)
C25 = left anterior prostate, slice 2 (LA2)
C26 = left intermediate prostate, slice 2 (LI2)
C27 = left posterior prostate, slice 2 (LP2)
C28 = RA4
C29 = RI4
C30 = RP4
C31 = LA4
C32 = LI4
C33 = LP4
C34 = RA6
C35 = RP6 (includes white nodule)
C36 = LA6
C37 = LP6.
D) Received in formalin labeled "lef
t pelvic lymph node" is a 6.0 x 4.0 x 2.0 cm fat pad.
With sectioning, palpation and dissection, fifteen lymph nodes are identified, 1.5 to 0.4
cm in greatest dimension. The specimen is entirely submitted in cassettes as follows:
D1 = 6 nodes, intact
D2 = 1 node, bisected
D3 = 5 nodes, intact
D4 = 2 nodes, bisected (differentially inked)
D5 = 1 node, serially-sectioned
D6-D8 = remaining tissue.
E) Received in formalin labeled "right pelvic lymph nodes" is an 8.5 x 3.5 x 2.0 cm fat
pad. With sectioning, palpation and dissection, sixteen lymph nodes are identified, 2.5 to
0.4 cm in greatest dimension. The specimen is entirely submitted in cassettes as follows:
E1 = 1 node, bisected
E2 = 2 nodes, bisected inked blue
E3 = 6 nodes, intact
E4 = 7 nodes, intact
E5-E8 = remaining tissue.
F) Received in formalin labeled "left distal ureter" is a 2.0 x 1.5 x 0.4 cm soft piece
of tissue, marked with a clip, with a 0.5 x 0.3 cm piece of mucosa. The specimen is inked
green at t
he final margin. The specimen is sectioned perpendicular to the final margin and
entirely submitted in cassette F1.
G) Received in formalin labeled "right distal ureter" is a 3.5 x 1.0 x 0.3 cm soft piece
of tissue, marked with a clip, with a 0.5 x 0.3 cm piece of mucosa. The specimen is inked
green at the final margin. The specimen is sectioned perpendicular to the final margin and
entirely submitted in cassettes G1 and G2.
PRAV 12/16/2023 (EH)
INTRAOPERATIVE CONSULTATION REPORT:
A) Ureter, right distal:
- Mild acute and chronic inflammation with reactive atypia.
- No dysplasia or malignancy present. (CRH)
B) Ureter, left distal:
- No diagnostic abnormalities.
- No dysplasia or malignancy present. (CRH)
MICROSCOPIC:
Microscopic examination was performed. See diagnosis.
The electronic signature indicates that the named Attending Pathologist has evaluated the
specimen referred to in the signed section of the report and formulated the diagnosis
therein.
Curtis R Hall, M.D. Pathologist Electronically signed 12/21/2023 12:01:07PM This case
was signed out at EVANSTON HOSPITAL, Department of Pathology, 2650 Ridge Avenue, EVANSTON,
IL., 60201
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