Triage

1. Check radiology reports and previous biopsies for tumor location.
2. Weigh and measure specimen in 3 dimensions.
3. Measure length and diameter of attached ureter and/or bladder cuff.
4. Ink:
   • 1st color: entire outer surface of the ureter/bladder cuff except the distal 1-2mm, and the outer surface of the kidney adjacent to tumor mass.
   • 2nd color: outer surface of the distal 1-2mm of the ureter or periphery of bladder cuff (ie, the distal margin) such that the true margin can be oriented under the scope after sections are taken.
5. Open the entire ureter longitudinally to examine for lesions.
6. Take margins (VERIFY ANATOMY AND SECTIONS WITH PA AS NEEDED):
   • Amputate the distal centimetre of the ureter/bladder cuff, and take perpendicular (radial) sections of the entire circumferential margin.
   • Identify renal vessels at the hilum, and take circumferential en face sections of the artery/arteries and vein.
   • If there is only ureter, ink proximal and distal margins as above and take perpendicular circumferential sections.
   • Save all in cassettes for grossing day.
7. Bisect the kidney through renal hilum and surrounding perinephric fat and examine for lesions in renal pelvis, major or minor calyces or ureteropelvic junction.
8. Measure kidney, including cortical thickness.
9. Check for hilar lymph nodes and save in cassettes.
10. Identify and measure adrenal gland, if present.
11. Photograph representative tumor.
12. If kidney is large, consider serially sectioning each half perpendicular to the long axis to aid fixation.

Gross

1. Serially section each half of the kidney along the long axis.
2. Examine and describe:
   • how much of the renal pelvis mucosa is involved by tumor
   • extension of tumor into renal sinus adipose tissue or renal parenchyma
   • extension of tumor into perinephric adipose tissue and inked external soft tissue margin (Gerota’s fascia)
3. For ureter segments:  section ureter and examine for deepest extension of the tumor (subepithelial, lamina propria, periureteral adipose tissue) and for involvement of inked external soft tissue margin.
4. Take representative sections of tumor (1 per cm), including its association with renal sinus fat, renal parenchyma, perinephric fat, nearest peripheral soft tissue margins (at kidney and within ureter).
5. Take representative upper, middle, and lower thirds of ureter, even if grossly uninvolved by tumor.
6. Take representative uninvolved renal parenchyma (add PAS-nephrectomy stain to this block).