Template:Vessels, soft tissue

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Arteries

Author: Mikael Häggström [note 1]

Presentations

Gross processing

A minimal gross processing of arteries includes a longitudinal dissection and inspection of tunica intima.

Consecutive cross-sections allows for a detection and estimation of atherosclerotic stenosis.

Plaque at different degrees of atherosclerotic stenosis.

Microscopic examination

  • Confirm that it is actually an artery (may be a vein, and a neuron may look grossly like a small artery).
  • Look for atherosclerosis and thrombosis.
  • Classify atherosclerosis as mild, moderate or severe.
  • If cross-sections were made, estimate the maximum percentage of occlusion for each artery.
Evaluate for giant cell arteritis at least upon request. It is characterized by a granulomatous inflammation of arteries with discontinuous and fragmented internal elastic lamina.[2]

Microscopy report

  • Classify any atherosclerosis as mild, moderate or severe.
  • If cross-sections were made, state the maximum percentage of stenosis for each artery.

Example:

Sections of the three main coronary arteries reveal << mild / moderate / severe>> atherosclerosis, with approximately __%, __% and __% stenosis of the left anterior descending, left circumflex coronary artery and right coronary artery, respectively.

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. 1.0 1.1 1.2 1.3 1.4 Yang, Wen Jie; Fisher, Mark; Zheng, Lu; Niu, Chun Bo; Paganini-Hill, Annlia; Zhao, Hai Lu; Xu, Yun; Wong, Ka Sing; et al. (2017). "Histological Characteristics of Intracranial Atherosclerosis in a Chinese Population: A Postmortem Study ". Frontiers in Neurology 8. doi:10.3389/fneur.2017.00488. ISSN 1664-2295. 
  2. Nat Pernick, M.D.. Eye - Orbit & optic nerve - Temporal arteritis. PathologyOutlines. Last author update: 1 February 2014. Last staff update: 29 December 2020

Image sources


Thrombus

Author: Mikael Häggström [note 1]

Composition of a fresh thrombus.

Microscopic evaluation

An organizing thrombus.[1]

Look for presence of fibroblasts or myofibroblasts, conferring a diagnosis of an organizing thrombus.

Reporting

Example:

Right profunda femoris artery clot, excision: Organizing thrombus.

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. Picture from:Pantanowitz, Liron; Duke, Wayne H (2008). "Intravascular lesions of the hand ". Diagnostic Pathology 3 (1): 24. doi:10.1186/1746-1596-3-24. ISSN 1746-1596. 
    - "Figure- available via license: Creative Commons Attribution 2.0 Generic"

Image sources


Aneurysm

Author: Mikael Häggström [note 1]

Cross-section of an arterial aneurysm, showing most of the area consisting of organized mural thrombus (tan-brown area).

Gross processing

  • Describe the shape (generally either fusiform or saccular).
  • Measure the length and diameter

Make several cross-sections and look for any dissection in the wall.

Gross report

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))
(( A. Labeled -left upper extremity aneurysm. The specimen is received in formalin and consists of a segment of)) fusiformly dilated vessel measuring 11.5 cm in length and the diameter is 6.5 (x 6.5 cm). Upon sectioning, <<most \ (( __ %))>> of the area is occupied by tan-yellow to tan-red non-homogenous surface, consistent with an organized mural thrombus. (No visible wall dissection.)

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

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References


Image sources


Soft tissues

Tophus/gout

Author: Mikael Häggström [note 1]

Preparation

A tophus specimen should be sent dry to the pathology department, and not be put in formalin.[note 2]

Gross processing

A large tophus.

Preferably make a touch prep for polarized light microscopy. At least if urate crystals are not initially detected, take sections to be put in 100% alcohol and tell the histology lab to prepare it as per gout protocol.[note 2] With characteristic crystals on a touch prep, sections may possibly be submitted in formalin.[note 2]

Microscopy evaluation

On a touch prep, look for needle-shaped crystals of urate. On polarized light, these will have negative birefriengence.

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
  2. 2.0 2.1 2.2 Formalin dissolves the crystals.

Main page

References

  1. Bruce M Rothschild. Gout and Pseudogout Workup. Medscape. Updated: Jun 30, 2020

Image sources


Soft tissue tumor

Author: Mikael Häggström [note 1]

Gross processing

Generally sample one slice per centimeter.

Evaluation

A solitary fibrous tumor, an example of spindle cell tumor.

In case of spindle cell tumors (having elongated nuclei), the following features may help to roughly classify the tumor:

  • Pointed on both ends: True fibroblastic tumors
  • Pointed on one end and blunted on the other ("bullet-shaped"): Neural/nerve sheath tumors (see section below)
  • Blunted on both ends ("cigar-shaped"): Smooth muscle tumor
  • Triangular: Myofibroblastic

In uncertain cases, the following immunohistochemistry markers are usually helpful:

  • CD34, indicating a solitary fibrous tumor
  • S100, indicating a neural or nerve sheath tumor (see section below)
  • Desmin, indicating a muscular tumor (skeletal muscle or Smooth muscle tumor)
  • Beta catenin, indicating fibromatosis

Neural or nerve sheath tumors

Further information: Evaluation of suspected malignancies

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

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References


Image sources


Peripheral nerve sheath tumor

  1. REDIRECT Soft tissue tumor

Lipomatous tumor

Author: Mikael Häggström [note 1]

Lipomatous tumor.

Fixation

Generally 10% neutral buffered formalin.

  See also: General notes on fixation


Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

Gross processing

  • Perform consecutive slicing of the entire specimen.
  • Look for signs of liposarcoma: Mainly by firm volumes.[1] Color varies from yellow to white (and firm) depending on the proportion of adipocytic, fibrous and/or myxoid content.[2] Areas of fat necrosis are common in larger lesions. Rarely, infiltrative growth is seen.[2]
  • Submit slices from any suspicious parts, or at least one representative slice from the specimen.[3] (A more comprehensive practice is to submit 1 section per centimeter, and 2 sections per cassette.[4])

Gross report

  • Color
  • Even absence of hemorrhage or necrosis.

Example:

Mass ((weighing 121 grams)) and measuring 10 x 6,5 x 3,5 cm. ((The surgical margin is intact.)) Cut sections show homogenous yellow color, with no hemorrhage or necrosis. ((The specimen is serially sectioned, and representative sections are submitted for microscopic examination in __ cassettes.))

  See also: General notes on gross processing


Microscopic evaluation

A pedunculated lipomatous skin tumor may be a pedunculated lipofibroma:

Microscopy/Histopathology report

For lipomas: (Absence of signs of malignancy.)

Histopathology of lipoma.jpg
(Chest wall, left lateral, excision:)
  • Lipoma.
  • (Negative for malignancy)

((Microscopic description: Tissue composed of univacuolar fat cells and delicate and inconspicuous fibrous septa.))

  See also: General notes on reporting


Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg (1997-02-13). Lilla utskärningen.
  2. 2.0 2.1 Andreas F Mavrogenis, Panayiotis J Papagelopoulos (2013-02-01). Soft Tissues: Well-differentiated liposarcoma. Atlas of Genetics and Cytogenetics in Oncology and Haematology.
  3. Pathology Department at NU Hospital Group, Sweden, 2019-2020.
  4. . Lipoma. Gross Pathology Manual - By The University of Chicago Department of Pathology. Retrieved on 2020-08-26.
  5. . Lipoma Variant: Fibrolipoma. Stanford University School of Medicine. Retrieved on 2020-02-10.
  6. Vijay Shankar. Soft tissue - Adipose tissue tumors - Lipoma and variants - Angiolipoma. Pathology Outlines. Topic Completed: 1 August 2012. Minor changes: 20 March 2019
  7. Michael R. Clay, M.D.. Liposarcoma. PathologyOutlines. Topic Completed: 1 November 2017. Minor changes: 11 May 2021
  8. Michael R. Clay. Soft tissue - Adipose tissue - Myxoid liposarcoma. PathologyOutlines. Topic Completed: 1 January 2018. Revised: 20 March 2019

Image sources


Hernia sac

Author: Mikael Häggström [note 1]

File:Gross pathology of hernia sac.jpg
Gross pathology of a hernia sac.

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

Fixation

Generally 10% neutral buffered formalin.

Gross processing

A gross inspection is almost always enough, and tissue generally does not need to be submitted except in unique circumstances.[1] ((Still you may submit 1 cassette of one or more representative sections for an inguinal hernia sac in a patient aged up to 16 years of age, or in case of hernia sacs from other regions than inguinal.))

Gross report
((A. Labeled - ___. The specimen is received in formalin and consists of)) __ fragment(s) of pink-tan fibromembranous tissue, measuring ___ cm in greatest dimension and ___ cm in greatest thickness. The surfaces are smooth. There are no sections submitted for microscopic examination. (Representative sections are submitted for microscopic examination in __ cassettes.)

Microscopic report

In case of a gross only examination, the microscopic report may still be given as a formality:

Right inguinal region, herniorrhaphy:
Hernia sac, gross examination only.

When microscopy slides of the case are available, you may screen the sample at low magnification to rule out obvious pathology:

Umbilical hernia sac, hernia repair:
Connective tissue lined by mesothelium, consistent with hernia sac.

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. Chesley PM, Black GE, Martin MJ, Johnson EK, Maykel JA, Steele SR (2015). "The utility of pathologic evaluation of adult hernia specimens. ". Am J Surg 209 (5): 783-6; discussion 786. doi:10.1016/j.amjsurg.2014.12.019. PMID 25725504. Archived from the original. . 

Image sources