Art of Grossing Flashcards
Is mobile or immobile tumor worse?
immobile
Mammotome biopsy
machine assisted breast core biopsy procedure - more accurate than a typical core biopsy
whats important to dictate?
count - how many
color - one color/ multi
consistency - fat, solid, soft, friable, mucoid
what is it - mucosa, soft tissue, organ
size
A good gross step 1
document patients name, MRN, specimen label how the specimen is recieved
A good gross step 2
document the outside
A good gross step 4
document the secondary pathologic findings
A good gross step 3
document the principle pathologic finding
A good gross step 5
document incidental findings and normal structures
A good gross step 6
document any special tasks preformed
A good gross step 7
document the sections submitted- block summary
consistency - soft indicates
extensive necrosis
consistency - firm indicates
fibrous stroma
tumor cells
consistency - hard indicates
normal bone
calcified tissue
Whats important before grossing?
- research patient history
- confirm orientation
- identify key structures
- determine proper plane of sectioning
- follow “good grossing tips”
En face margin
entirety of margin is submitted and laid “face down”
Perpendicular margin
section of the margin taken perpendicular
cold ischemic time
time between collection and time put in fixative
things that need to be removed from sections
hair when possible
staples
clips
sutures
be mindful of
the amount of tissue in a block and the thickness of the tissue
what to do before decalcifying
fix the tissue
when is ulceration indicating malignancy
when it is invasive with irregular boarders
when is an ulcer likely benign
when well- circumscribed
polypoid
usually benign
connective tissue tumors
less definitive for malignancy or benign upon gross examination
Invasion
the single most important criterion of malignancy and is determined by:
1. decreased cellular motility
2. secretion of proteolytic enzymes
3. abnormal or increased cellular motility
metastasis
consequence of invasion, unequivocal marker of malignancy
process whereby malignant tumors spread from primary to secondary, distant site
Note: metastais can be the primary presentation
where does invasion occur primarily
perineal spaces, nerves and vessels
how metastasis occurs
hematogenous
lymphatic
transcoelomic
transcoelomic
via effusion = seeding in body cavity
Cancer staging T
primary TUMOR (size, extense, superficial vs deep)
Cancer staging N
regional lymph NODE involvement (how many positive)
Cancer staging M
Metastasis (if present)
