Art of Grossing

Question 1

Is mobile or immobile tumor worse?

Answer 1

immobile

Question 2

Mammotome biopsy

Answer 2

machine assisted breast core biopsy procedure - more accurate than a typical core biopsy

Question 3

whats important to dictate?

Answer 3

count - how many
color - one color/ multi
consistency - fat, solid, soft, friable, mucoid
what is it - mucosa, soft tissue, organ
size

Question 4

A good gross step 1

Answer 4

document patients name, MRN, specimen label how the specimen is recieved

Question 5

A good gross step 2

Answer 5

document the outside

Question 6

A good gross step 4

Answer 6

document the secondary pathologic findings

Question 7

A good gross step 3

Answer 7

document the principle pathologic finding

Question 8

A good gross step 5

Answer 8

document incidental findings and normal structures

Question 9

A good gross step 6

Answer 9

document any special tasks preformed

Question 10

A good gross step 7

Answer 10

document the sections submitted- block summary

Question 11

consistency - soft indicates

Answer 11

extensive necrosis

Question 12

consistency - firm indicates

Answer 12

fibrous stroma
tumor cells

Question 13

consistency - hard indicates

Answer 13

normal bone
calcified tissue

Question 14

Whats important before grossing?

Answer 14

1. research patient history
2. confirm orientation
3. identify key structures
4. determine proper plane of sectioning
5. follow “good grossing tips”

Question 15

En face margin

Answer 15

entirety of margin is submitted and laid “face down”

Question 16

Perpendicular margin

Answer 16

section of the margin taken perpendicular

Question 17

cold ischemic time

Answer 17

time between collection and time put in fixative

Question 18

things that need to be removed from sections

Answer 18

hair when possible
staples
clips
sutures

Question 19

be mindful of

Answer 19

the amount of tissue in a block and the thickness of the tissue

Question 20

what to do before decalcifying

Answer 20

fix the tissue

Question 21

when is ulceration indicating malignancy

Answer 21

when it is invasive with irregular boarders

Question 22

when is an ulcer likely benign

Answer 22

when well- circumscribed

Question 23

polypoid

Answer 23

usually benign

Question 24

connective tissue tumors

Answer 24

less definitive for malignancy or benign upon gross examination

Question 25

Invasion

Answer 25

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

Question 26

metastasis

Answer 26

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

Question 27

where does invasion occur primarily

Answer 27

perineal spaces, nerves and vessels

Question 28

how metastasis occurs

Answer 28

hematogenous
lymphatic
transcoelomic

Question 29

transcoelomic

Answer 29

via effusion = seeding in body cavity

Question 30

Cancer staging T

Answer 30

primary TUMOR (size, extense, superficial vs deep)

Question 31

Cancer staging N

Answer 31

regional lymph NODE involvement (how many positive)

Question 32

Cancer staging M

Answer 32

Metastasis (if present)