• The kidney is usually submitted within the perinephric fat, which is surrounded by Gerota’s fascia.  Use the ureter to orient the organ.  Examine the renal hilum and take a cross-section of the ureter and renal vessels at their resection margins.  Open the remaining ureter, renal artery, and renal vein longitudinally with scissors and note any abnormalities, particularly if there is involvement by tumor (if so, measure its distance from the resection margin).  Look for and dissect any perirenal lymph nodes in the perinephric fat.  Ink the perinephric fat if tumor involvement is suspected.  Do not remove the fat from the kidney and do not peel off the renal capsule in the area of the tumor!
• Cut the kidney sagittally (i.e. bivalve) and open the pelvis, calyces, and ureter.  Measure (3 dimensions) and describe the tumor (color, solid vs. cystic, necrosis, hemorrhage, papillary features), noting its location within the kidney (pole, cortex, medulla, pelvis, etc.).  For transitional cell carcinoma or pelvocalyceal tumors, note whether the tumor is exclusively mucosal or invasive.  Look for invasion of perinephric fat.

• Describe the adjacent and distant renal parenchyma and pelvocalyceal system as in Nephrectomy for Non-Tumoral Condition.

• Submit any stones for chemical analysis if requested.
• Take photographs.
• Look for the adrenal gland and determine whether it is directly infiltrated by tumor or contains any nodules.

• See Pediatric Nephrectomy for Tumor for pediatric kidney tumor specimens.

• Tumor:  minimum of five sections, including one each with adjacent kidney, nearest perinephric fat, renal pelvis.
• Renal parenchyma without tumor: two sections (opposite poles).
• Renal pelvis:  one section, with (if pelvis is involved) or without tumor; possibly additional sections in transitional cell carcinoma.
• Ureter, renal artery, renal vein:  one complete cross-section each, at the resection margin, en face.  Can be submitted in a single cassette.
• Perinephric lymph nodes:  submit entirely, if present.
• Adrenal gland:  one section (cortex and medulla), if present; possibly additional sections if needed to document invasion by tumor.

Internal use only

Received without fixative/in formalin, labeled ____ and "_____" is an intact/portion of kidney with attached perinephric fat measuring __ x __ x __ cm and weighing __ g collectively.  The isolated kidney measures __ x __ x __ cm and weighs __ g.  Extending from the renal pelvis are a ureter (___ cm in length and ___ cm in diameter), renal vein (__ cm in length and __ cm in diameter), and renal artery (__ cm in diameter and __ cm in diameter).  Tumor extends/does not extend into the ureter/artery/vein and is/is not present/is __ cm from/at the resection margin.  There is a __ x __ x __ cm well/poorly circumscribed, solid/cystic, _____ (color) mass with/without hemorrhage and necrosis in the _____ (pole, cortex, medulla, pelvis).  It is __ cm from the renal hilum.  The mass is/is not confined by the renal capsule and does not invade/invades _____ (perinephric fat, Gerota’s fascia, adrenal gland, calyces, pelvis).  The uninvolved renal parenchyma is tan-brown with a well-defined cortico-medullary junction and orderly cortical striations and medullary rays.  The pelvis and calyces appear _____ (smooth, gray-white, dilated, blunted, hemorrhagic).  There is a __ x __ x __ cm adrenal gland with a __ x __ x __ cm yellow cortical nodule/without a focal lesion.  No lymph nodes or stones are identified.  Gross photographs are taken.  Representatively submitted as follows:

#__ = ureter, renal artery, and renal vein resection margins, en face; __ pieces.

#__ - #__ = mass with nearest ___ perinephric fat margin(s); __ pieces in each.

#__ & #__ = mass with pelvis and adjacent renal parenchyma; __ pieces in each.

#__ & #__ = uninvolved kidney (renal parenchyma and pelvis); __ pieces in each.

#__ = adrenal gland; __ pieces.

__ blocks, __ H&E