Morcellated nephrectomies are generally performed for contained kidney tumor or cyst resections, ie. low stage. The procedure is a Nephrectomy (i.e. complete removal of the kidney and surrounding tissue) done laparoscopically. It becomes morcellated, or fragmented, as a consequence of it's removal from the body in small pieces (so the patient does not need a larger incision to remove the whole kidney in one piece). The benefit for the patient is a much quicker recovery from surgery. At the bench, it poses problems for getting accurate measurements and orientation. Sometimes this surgery is performed for non-tumor resections- nephrosis, atrophic kidney.
Note: You need to look through the adipose carefully looking for any vessels or portions of ureter. A section of this needs to be submitted as the possible margins. Remember to look for an adrenal gland even though one usually is not present. Attention to the patient's careweb history is helpful as it may provide an indication of tumor size and location.
Sometimes this type of specimen is submitted labelled "Radical Nephrectomy" but comes in pieces. In this case, be sure to mention in the gross description that the specimen is morcellated.
Sections for Histology
Labeled "Morcellated Kidney", received in formalin in a large container is a 160 gm aggregate of kidney parenchyma and adipose, 10 x 10 x 5 cm. Normal portions of ureter and vascular tissue are noted. A 5 x 3 x 3 cm aggregate of yellow-orange hemorrhagic focally cystic tumor is identified. No normal kidney is attached to the tumor. The remaining kidney has a well defined cortical medullary junction with no abnormalities, 8 x 8 x 3 cm. An adrenal gland is not present.
1 A- ureter and vascular margins (ns)
Modified February 2009