Procedure: Laparoscopic right nephroureterectomy.
Gross description: The specimen comprises a kidney and perinephric fat along with a 15 cm long ureter. The kidney weighs 198 grams and measures 10 x 6 x 3 cm. When the perinephric fat is removed, the kidney surface shows hemorrhagic patches. The capsule is thin but adherent to the surface and difficult to remove. On opening, the kidney shows dilated calyces and a small cortical cyst measuring 7 mm. The pelvicalyceal system contains blood clots and necrotic debris. A well-circumscribed, small white nodule measuring 8 mm is seen in the peripelvic fat. The attached renal vessels are identified and appear grossly unremarkable. The ureter is present separately within the specimen pot, showing one end that is relatively dilated as compared to the other end. The proximal end contains blood clots similar to that seen with the dilated calyces.
Diagnosis: High-grade urothelial carcinoma of renal pelvis (ISUP/WHO 2004).
Tumor size: Cannot be determined both grossly and microscopically. Vascular and ureteric margins: Free of tumor. Lymphovascular space invasion: Present (tumor embolus seen in the venule). Tumor invades beyond the muscularis propria into the peripelvic fat but not renal parenchymal tissue. Renal parenchymal tissue shows the changes of chronic interstitial nephritis. The cortical cyst is simple and benign.
Pathological staging: pT3, pNx, pMx.