Gross Analysis (Ch. 3)

Question 1

What pertinent information regarding the specimen is provided by the gross description?

Answer 1

Orientation
Results of any intraoperative consultations
Description of the specimen as received and observations after dissection
Disposition of tissues submitted for special studies
Block summary of microscopic sections

Question 2

What is the gross description important for?

Answer 2

Diagnosis (some lesions and disease processes are only visible grossly)
Correlation with the microscopic exam
Documentation for medical and legal purposes
Training (developing the ability to recognize what is most likely to provide diagnostic information)

Question 3

What are the characteristics of a good gross description?

Answer 3

Succinct and precise
Well-organized
Includes the results of adequate dissection (especially lymph nodes!)
Standardized

Question 4

What are the six components of a gross description?

Answer 4

1) Label, fixatives, and structures present
2) Principle pathologic findings
3) Secondary pathologic findings
4) Lymph nodes, incidental findings, and normal structures
5) Special studies
6) Block summary

Question 5

What information should be included in the opening statement for each container?

Answer 5

Container designation (A, B, C…)
Specimen site as indicated on the container
Whether the specimen was received fresh or in fixative
Time and date the specimen was placed in formalin (for breast specimens and cases received fresh from the OR)

Question 6

What should you indicate in your gross if the container doesn’t list the specimen site?

Answer 6

What is on the label, usually the patient’s name, MRN, and date
Statement of the site if it is listed on the requisition form

Question 7

What should you address in your description of the main pathology?

Answer 7

Important parameters of the major lesion
Pertinent negatives
If the clinical diagnosis is different from the actual findings

Question 8

How should you phrase pertinent negatives in order to avoid confusion and mistakes?

Answer 8

Say “absent” instead of “no _____” (i.e. “gallstones are absent” instead of “no gallstones present”)

Question 9

What phrase can you use to describe normal structures?

Answer 9

“Grossly unremarkable”

Question 10

What should you document as part of special studies?

Answer 10

Anything outside of the usual routine formalin fixation and block submission

Question 11

What are some specific “special studies” that are commonly noted during gross analysis?

Answer 11

Frozen section submission
Lymphoma workup
Bone decalcification
Cytogenetics
Electron microscopy
Depilatory (Nair) treatment
100% ethanol fixation
Special or unusual orientation
Photographs
Radiographs
Whole mount preps
Permanent archiving
Fresh freezing then bandsawing

Question 12

What is included in a lymphoma workup?

Answer 12

Flow cytometry
Molecular diagnostics
Touch preps
Formalin fixation

Question 13

What specimens are Nair used for?

Answer 13

Finger and toenails

Question 14

What specimen is 100% ethanol used for?

Answer 14

Gout

Question 15

What does the phrase “representative sections” imply?

Answer 15

That the tissue submitted includes each different element or type of gross change in the specimen

Question 16

What should be the last paragraph of your gross analysis for each container?

Answer 16

Block summary

Question 17

What physical characteristics should you note in your gross description of each specimen?

Answer 17

Size
Numbers of fragments, if multiple
Weight
Color
Shape, contour, texture
Consistency

Question 18

What specimens is it important to weigh?

Answer 18

Whole or significant parts of organs
Transurethral resection prostate (TURP)
Reduction mammoplasty
Parathyroid specimens

Question 19

What general things should you keep in mind to keep your dictation precise and complete?

Answer 19

Avoid describing the details of how something is dissected or found
Condense related facts into single sentences
Describe each abnormality completely in one place
Use descriptive, not diagnostic terms
Proofread your reports!

Question 20

How should you submit tissue from small biopsies for diagnosis?

Answer 20

Entirely, unless tissue is needed for special studies

Question 21

How should you submit tissue from small specimens for documentation?

Answer 21

Entirely if they can fit into one block (fallopian tubes/vas deferens)
By representative section if they can’t fit into one block

Question 22

How should you submit tissue from small OR specimens removed for pathologic processes, and from benign whole/partial organs?

Answer 22

Representative sections which follow a specific protocol

Question 23

How should you submit tissue from large/radical cancer resections?

Answer 23

Representative sections which follow a specific protocol

Also an extensive search for lymph nodes

Question 24

What must be included in submitted sections?

Answer 24

Any lesions, as well as relations to closest margin
Any tissue submitted in special fixatives
Uninvolved normal tissue
Margins
Frozen section remnants
Lymph nodes if applicable

Question 25

What are Pam’s Rules of Thumb?

Answer 25

Always use present tense
Always ask, “Do I need to ink this?”
Always ask, “Does this specimen need to be submitted in a bag/microcassette/sponge/etc.?”
Always check the lid and walls of a container
Clean your instruments early and often
Check patient numbers and identifiers
Always have enough clinical information
Never have more than one open container at once
Always get rid of excess blocks
Clean up after yourself!