Practical issues and pitfalls in staging tumors of the genitourinary tract

Abstract

Accurate staging of tumors involving the genitourinary tract is critical to determine appropriate management options and subsequent clinical outcome for patients. The staging protocols, however, continue to evolve and are under constant revision and change. The new 2010 American Joint Committee on Cancer/Tumor Nodes and Metastasis (AJCC/TNM) staging system of the prostate, bladder, kidney, and testis is now recommended. Although the protocols are relatively straightforward, this article focuses on some practical issues and occasional pitfalls that may be encountered when staging cancers of the genitourinary tract. Specific issues that will be addressed include issues and pitfalls in radical prostatectomy specimens (substaging of pT2 tumors, extraprostatic extension, bladder neck invasion, positive surgical margins, seminal vesicle involvement, no residual tumor identified), cystectomy/cystoprostatectomy specimens (extravesicular extension and prostatic stromal invasion), nephrectomy specimens (renal sinus invasion, ipsilateral adrenal gland invasion, renal vein involvement, multifocal tumors), and orchiectomy specimens (pseudoangiolymphatic invasion of friable tumors, rete testis invasion, and spermatic cord invasion/metastasis). In addition, pitfalls in both prostate (extraprostatic extension, seminal vesicle/ejaculatory duct involvement in needle core biopsies, and quantification of tumor volume in transurethral resection specimens) and bladder (tumors with inverted growth pattern, muscularis propria invasion, extravesicular extension) biopsy interpretations that may have an impact on staging are also addressed.