Removal of the kidney (nephrectomy) (PG046)

Pathomorphological examination during nephrectomy is a comprehensive histological analysis of the entire kidney removed surgically. The study includes evaluation of the kidney itself, its capsule, adjacent fatty tissue (Herota's fascia), a fragment of the ureter and, in some cases, the adrenal gland. The code PG046 corresponds to the full pathomorphological protocol, which is mandatory for establishing a definitive diagnosis and staging of the disease.

Research objective: The main task is to accurately determine the stage of the tumor process according to the TNM system and assess the radicality of the surgical intervention. Since nephrectomy is usually performed for large or invasive tumors, the histological conclusion allows us to understand whether cancer cells remain in the body and whether the patient needs systemic therapy (immunotherapy or targeted therapy).

What does the pathologist evaluate:

• Tumor type and subtype: verification of the type of cancer (clear cell, papillary, chromophobe renal cell carcinoma, etc.).

• Malignancy grade (Grade): assessment of tumor aggressiveness according to the ISUP/Fuhrman scale.

• Depth and extent of invasion (pT): whether the tumor has grown into the renal pelvis, fatty tissue, large vessels (renal vein), or the adrenal gland.

• Status of resection margins: checking the ureteral cut-off line and vascular pedicle for the absence of tumor cells.

• Lymph node status (if submitted): search for metastases in regional lymph nodes.

• Background pathology: assessment of the condition of the healthy part of the kidney parenchyma (presence of nephrosclerosis or diabetic nephropathy).

Clinical significance: For the oncologist, the PG046 study result is a «roadmap» for further treatment. For example, tumor extension beyond the renal capsule or involvement of the renal vein significantly changes the prognosis and requires more intensive follow-up. Accurate histological staging is critical to determine the risk of recurrence.

When is it prescribed:

• after radical nephrectomy (complete removal of the kidney) due to large tumors;

• removal of the kidney in case of terminal hydronephrosis or pyonephrosis (when the organ has lost function);

• kidney removal due to complex developmental anomalies or trauma;

• in case of suspected transitional cell carcinoma of the renal pelvis.