Table 4 Reporting of cystectomy specimens

Gross findings

 Fresh or fixed specimen

 Nature of the specimen: partial cystectomy, radical cystectomy, cystoprostatectomy, pelvic exenteration

 Three-dimensional measurements of recognizable anatomic structures, and of tumors or other recognizable lesions

Site of involvement

Growth pattern (papillary, ulcerated, solid, nodular, infiltrative)

Gross assessment of invasion (into lamina propria or muscularis propria)

Gross extravesical fat extension

Gross invasion into adjacent organs, such as prostate, ureter, urethra, uterus, vagina, pelvic, and abdominal wall

Gross assessment of margin status

 Lymph nodes

Location and the number of lymph nodes sampled

 Report if the lymph nodes are bisected or completely embedded

 Report if the lymph nodes are grossly involved by cancer

Microscopic findings

 Anatomic location of the tumor

 Histological diagnosis

 Tumor size and multifocality

 Histological grade

 Pattern of invasion (nodular, trabecular, or infiltrative)

 Extent of invasion (pathological staging)

No invasion (pTa or pTis)

Invasion into the lamina propria (pT1)

Invasion into inner or outer half of muscularis propria (pT2)

Invasion into perivesical soft tissue (pT3)

Tumor arising in a diverticulum (specify whether detrusor muscle is present)

 Surgical margins

Ureteral margin

Urethral margins

Perivesical soft tissue margin

Pelvic soft tissue margin (or pelvic exenteration specimens)

 The presence or absence of lymphovascular invasion

 Other intraepithelial abnormalities

The presence or absence of dysplasia and carcinoma in situ in adjacent mucosa

Location and multifocality

Other findings such as intestinal metaplasia, therapeutic treatment effects etc.

 Extent of tumor invasion into adjacent organs

Prostate

 a. Involvement of the prostatic urethra with or without stromal invasion

 b. Involvement of prostatic ducts/acini without stromal invasion

 c. Prostatic stromal invasion

 d. Direct extension into the prostate from carcinoma through the bladder neck

 e. Direct extravesical extension into the prostatic parenchyma

 f. Seminal vesicle invasion through intraprostatic epithelium or by direct perivesical extension

Ureter and urethra

 a. Report any dysplastic/neoplastic change of the mucosa, including pagetoid spread of carcinoma in situ

 b. Report invasion into adjacent lamina propria or muscularis propria

Seminal vesicles

 Report spread of carcinoma in these organs either through epithelium or by direct extension of an infiltrative carcinoma

Vagina/uterus

 Report direct extension or metastases to either organ

Rectum, pelvic and abdominal wall

 Report direct extension or metastases

Lymph node status

Report the number of lymph nodes sampled

Report the presence or absence of metastases

 If metastases are present, state the followings in the report

The number of positive nodes

The overall size the largest positive (<2, 2.1–5, >5 cm) (for N staging)

The diameter of the largest metastasis

The presence or absence of extranodal extension

 Final pathological staging (using the most current TNM staging)

 Results of ancillary studies (if performed)

 Correlation with frozen section diagnosis (if performed)