Ureters are rarely removed intentionally except as a part of radical cystectomy or radical nephrectomy for transitional cell carcinomas or if there is a tumor present in the ureter. Almost all the tumors of the ureter are transitional cell carcinomas.
Tumors arising within the proximal urethra tend to show urothelial differentiation and are analogous to those occurring within the bladder. Those lesions found within the distal urethra are more typically squamous carcinoma. Cancers arising within the prostatic urethra are dealt with in the section on the prostate.
- Orient the specimen, usually clips or sutures will be present at the proximal and/or distal ends.
- Measure the length and diameter, noting any areas of dilatation.
- Ink the outer surface and take thin cross-sections both the proximal and distal ends of the specimen, place en face in cassette.
- Try to determine whether there is an intraluminal mass. If none, serially section. If you are uncertain or believe that there is a mass, open the ureter with scissors. Try to cut through the part of the wall which is not attached to the mass. Measure and describe the mass or other abnormalities. Determine whether the mass infiltrates the wall. Describe the mucosa without lesions.
- If soft tissue is attached, lymph nodes should be sought.
Sections for Histology:
- Resection margins.
- If tumor is present, submit the entire specimen if six blocks or fewer; otherwise, minimum of 5 sections of tumor with attached full thickness ureter/urethra wall, plus 2 sections of adjacent uninvolved mucosa.
- If no abnormalities, submit 1-3 representative cross-sections.
Received in formalin in medium container is a 6 cm length x 0.6 cm average diameter segment of ureter which is oriented by a long suture = distal. The outer surface is tan and smooth. There is an area of luminal dilatation proximal to a 1 x 0.8 cm tan-pink papillary mucosal mass which obstructs 95% of the lumen and is 2 cm from the proximal margin and 3 cm from the distal margin. There is no invasion of the underlying ureter wall.
1A - Proximal margin.
1B - Distal margin.
1C-E - Central segment submitted from proximal to distal with mass in 1C (ns).
Modified February 2009