Determine the indications for the procedure (torsion/infarction, infection, therapeutic castration for prostate cancer, failure to descend, tumor).
Weigh and measure the overall specimen. Examine the external surface for lesions. Check the spermatic cord margin for tumor and take a transverse section of the margin. Immediately place it in a cassette, en face, in order to avoid transfer of tumor when the rest of the specimen is incised.
Orient the testis using the location of spermatic cord attachment and epididymis (posterior). Incise the tunica vaginalis along the anterior aspect. Measure (three dimensions) the testis. Measure the epididymis. Measure the length and diameter of the spermatic cord (taking into account the removed margin).
Serially section the testis, with the first cut bisecting the testis through the anterior surface of the tunica albuginea and continuing through the epididymis posteriorly. Make incomplete cuts through the posterior aspect of the tunica albuginea in order to hold the specimen together. Measure any lesions. Note the cut surface of the testicular parenchyma (color, consistency) and any lesions (tumor, cyst, fibrosis, color, consistency, hemorrhage, necrosis, friability, infiltration of adjacent structures).
Note the presence or absence of lesions in the epididymis.
Open the entire spermatic cord longitudinally and examine for lesions.
Take photographs of tumors or other abnormalities.
Margin: one cross section, en face. Take this section before cutting the testis, as some testicular tumors are very friable and may contaminate the knife blade and cutting board.
One additional cross section from midway between the margin and testis in a separate cassette if no lesions are found. Additional sections of lesions.
If no tumor present: two sections. Additional sections of abnormalities.
If tumor present:
Tumor: one section per centimeter of tumor. Include uninvolved adjacent testis and tunica albuginea in at least one or two sections. Sample areas of differing appearances, including those with hemorrhage and necrosis (which may represent more aggressive tumor).
Uninvolved testis: two sections.
Epididymis: one cassette if no lesions are found. Additional sections of lesions.
Received without fixative/in formalin, labeled _____ and “_____”, is a testis with attached spermatic cord and surrounding soft tissues measuring __ x __ x __ cm and weighing __ g overall. The testis measures __ x __ x __ cm. The epididymis measures __ x __ x __ cm. The spermatic cord is __ cm in length and __ cm in average diameter. Tumor is/not identified at the spermatic cord resection margin. The tunica vaginalis is _____ (describe). The tunica albuginea is gray-tan and smooth/rough. The testis parenchyma is _____ (color, homogeneous, hemorrhagic, soft, necrotic). There is a __ x __ x __ cm _____ (color, solid, fleshy, cystic) mass with foci of _____ (hemorrhage, necrosis) within the testis. It does not infiltrate surrounding structures/infiltrates the _____ (tunica albuginea, epididymis, spermatic cord, tunica vaginalis). Tumor fills the proximal spermatic cord and is __ cm from the margin. Representatively submitted as follows:
#__ = spermatic cord margin, en face; __ pieces.
#__ = spermatic cord midway between margin and testis; __ pieces.