Gross processing - Revision history

Mikael Häggström: /* Before cutting */ Plan

2023-03-12T03:39:36Z

Before cutting: Plan

← Older revision		Revision as of 23:39, 11 March 2023
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	*{{Moderate-begin}}At least for larger samples, consider looking for '''medical imaging''' or '''biopsy reports''' in order to better guide the process.{{Moderate-end}}<ref name=chicago>{{cite web\|url=https://voices.uchicago.edu/grosspathology/head-neck/thyroid/#primary-column\|title=Gross Pathology Manual By The University of Chicago Department of Pathology}} Updated 2-14-19 NAC.</ref>		*{{Moderate-begin}}At least for larger samples, consider looking for '''medical imaging''' or '''biopsy reports''' in order to better guide the process.{{Moderate-end}}<ref name=chicago>{{cite web\|url=https://voices.uchicago.edu/grosspathology/head-neck/thyroid/#primary-column\|title=Gross Pathology Manual By The University of Chicago Department of Pathology}} Updated 2-14-19 NAC.</ref>
	*Fix '''bone''' in formalin prior to decalcification. Use reminders so not to forget bone that is decalcifying.		*Fix '''bone''' in formalin prior to decalcification. Use reminders so not to forget bone that is decalcifying.
			*'''Plan''' in which order to cut different parts so as to be able to take all relevant sections. Generally sample relevant surgical margins and smaller parts first, as these may be harder to find or even be fragmented later on.

	==Cutting==		==Cutting==

Mikael Häggström:

2022-11-29T00:39:31Z

← Older revision		Revision as of 20:39, 28 November 2022
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	}}</noinclude>		}}</noinclude>
	Following are general notes on selection and trimming in pathology.		Following are general notes on selection and trimming in pathology.
	{{Comprehensiveness\|otherlegend=yes}}		<noinclude>{{Comprehensiveness\|otherlegend=yes}}</noinclude>
	==Priority==		==Priority==
	{\|class=wikitable align=right		{\|class=wikitable align=right

Mikael Häggström:

2022-11-29T00:38:19Z

← Older revision		Revision as of 20:38, 28 November 2022
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	{{Top		<noinclude>{{Top
	\|author1=[[User:Mikael Häggström\|Mikael Häggström]]		\|author1=[[User:Mikael Häggström\|Mikael Häggström]]
	\|author2=		\|author2=
	}}		}}</noinclude>
	Following are general notes on selection and trimming in pathology.		Following are general notes on selection and trimming in pathology.
	{{Comprehensiveness\|otherlegend=yes}}		{{Comprehensiveness\|otherlegend=yes}}
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	==Marking cassettes==		==Marking cassettes==
	Use only hard pencil (or specially purchased histology markers), as marks made with pens, Sharpie markers, or scientific freezer-safe markers can get dissolved in tissue processing.<ref>{{cite web\|url=https://unclineberger.org/pathologyservices/instructions/histopathology-services/\|title=Histopathology Services\|website=UNC School of Medicine\|accessdate=2021-11-15}}</ref>		Use only hard pencil (or specially purchased histology markers), as marks made with pens, Sharpie markers, or scientific freezer-safe markers can get dissolved in tissue processing.<ref>{{cite web\|url=https://unclineberger.org/pathologyservices/instructions/histopathology-services/\|title=Histopathology Services\|website=UNC School of Medicine\|accessdate=2021-11-15}}</ref>

	<noinclude>		<noinclude>
	==By organ or organ system==		==By organ or organ system==

Mikael Häggström: Moved

2022-10-14T13:51:14Z

Moved

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 Following are general notes on selection and trimming in pathology.
 {{Comprehensiveness|otherlegend=yes}}
 ==Fresh specimens==

Mikael Häggström: /* Before cutting */ Linked

2022-10-03T21:20:47Z

Before cutting: Linked

← Older revision		Revision as of 17:20, 3 October 2022
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	*Generally '''weigh''' entire organs, after having any attached tissue trimmed away if feasible.		*Generally '''weigh''' entire organs, after having any attached tissue trimmed away if feasible.
	*{{Moderate-begin}}Note the color of the sample, even when unremarkable, but do not linger on deciding it.{{Moderate-end}}<ref group=note>The color of gross specimens generally has very limited clinical significance.</ref>		*{{Moderate-begin}}Note the color of the sample, even when unremarkable, but do not linger on deciding it.{{Moderate-end}}<ref group=note>The color of gross specimens generally has very limited clinical significance.</ref>
	*Generally, use '''[[inking]]''' for resection margins where ~~cancer~~ radicality is important. {{further\|inking\|linebreak=no}}		*Generally, use '''[[inking]]''' for resection margins where '''[[tumor]]''' radicality is important. {{further\|inking\|linebreak=no}}
	*{{Moderate-begin}}On fatty or greasy surfaces, apply '''vinegar''' to emulsify and remove the fat, dry the specimen and then ink. Otherwise, vinegar can be used either before or after inking to "dry" it.{{Moderate-end}}		*{{Moderate-begin}}On fatty or greasy surfaces, apply '''vinegar''' to emulsify and remove the fat, dry the specimen and then ink. Otherwise, vinegar can be used either before or after inking to "dry" it.{{Moderate-end}}
	*{{Moderate-begin}}Preferably '''photograph''' or make a drawing where slices have been taken.{{Moderate-end}}<ref name=Roychowdhury>{{cite web\|url=https://www.pathologyoutlines.com/topic/breastmalignantgrossing.html\|title=Grossing (histologic sampling) of breast lesions\|author=Monika Roychowdhury\|website=Pathologyoutlines.com}} Topic Completed: 1 August 2012. Revised: 19 September 2019</ref>		*{{Moderate-begin}}Preferably '''photograph''' or make a drawing where slices have been taken.{{Moderate-end}}<ref name=Roychowdhury>{{cite web\|url=https://www.pathologyoutlines.com/topic/breastmalignantgrossing.html\|title=Grossing (histologic sampling) of breast lesions\|author=Monika Roychowdhury\|website=Pathologyoutlines.com}} Topic Completed: 1 August 2012. Revised: 19 September 2019</ref>

Mikael Häggström: +Fresh

2022-06-21T21:16:32Z

+Fresh

← Older revision		Revision as of 17:16, 21 June 2022
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	Following are general notes on selection and trimming in pathology.		Following are general notes on selection and trimming in pathology.
	{{Comprehensiveness\|otherlegend=yes}}		{{Comprehensiveness\|otherlegend=yes}}

			==Fresh specimens==
			The initial processing of fresh specimens is also termed '''triaging'''.

			*For intraoperative consults including frozen sectioning, see separate article on '''[[Emergent pathology]]'''.

			When triaging a specimen, the measurements are most important as these may change after fixation. Other descriptions can generally be made after the specimen is fixed.

			*See also separate article on '''[[fixation]]''', including what specimens should not immediately be put in formalin (mostly [[tophus]], [[lymph node]]s and [[products of conception]]).

	==Before cutting==		==Before cutting==

Mikael Häggström: note

2022-06-19T19:35:56Z

note

← Older revision		Revision as of 15:35, 19 June 2022
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	*Generally '''measure''' in 3 dimensions, or in volume, but the greatest dimension is generally enough for specimens less than 0.4 cm.		*Generally '''measure''' in 3 dimensions, or in volume, but the greatest dimension is generally enough for specimens less than 0.4 cm.
	*Generally '''weigh''' entire organs, after having any attached tissue trimmed away if feasible.		*Generally '''weigh''' entire organs, after having any attached tissue trimmed away if feasible.
	*{{Moderate-begin}}Note the color of the sample, even when unremarkable, but do not linger on deciding it.{{Moderate-end}}<ref group=~~notes~~>The color of gross specimens generally has very limited clinical significance.</ref>		*{{Moderate-begin}}Note the color of the sample, even when unremarkable, but do not linger on deciding it.{{Moderate-end}}<ref group=note>The color of gross specimens generally has very limited clinical significance.</ref>
	*Generally, use '''[[inking]]''' for resection margins where cancer radicality is important. {{further\|inking\|linebreak=no}}		*Generally, use '''[[inking]]''' for resection margins where cancer radicality is important. {{further\|inking\|linebreak=no}}
	*{{Moderate-begin}}On fatty or greasy surfaces, apply '''vinegar''' to emulsify and remove the fat, dry the specimen and then ink. Otherwise, vinegar can be used either before or after inking to "dry" it.{{Moderate-end}}		*{{Moderate-begin}}On fatty or greasy surfaces, apply '''vinegar''' to emulsify and remove the fat, dry the specimen and then ink. Otherwise, vinegar can be used either before or after inking to "dry" it.{{Moderate-end}}
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	*Generally, strive to make slices perpendicular to visible '''interfaces''' of relevant tissues.		*Generally, strive to make slices perpendicular to visible '''interfaces''' of relevant tissues.
	*Generelly dissect and inspect the '''entire''' specimen, while keeping relevant parts intact enough for presentation to seniors and/or maintaining orientation.		*Generelly dissect and inspect the '''entire''' specimen, while keeping relevant parts intact enough for presentation to seniors and/or maintaining orientation.
	*'''Trim''' tissues for microscopy examination to a thickness of maximum 3-4 mm.<ref group=~~notes~~>Thicker slices may not become adequately fixated in formalin.</ref>		*'''Trim''' tissues for microscopy examination to a thickness of maximum 3-4 mm.<ref group=note>Thicker slices may not become adequately fixated in formalin.</ref>

	===Perpendicular versus en face sections===		===Perpendicular versus en face sections===
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	==Tissue selection==		==Tissue selection==
	When sampling sections to submit for microscopic examination, whenever you sample from something that looks abnormal, generally try to also sample from the same type of tissue that looks '''normal'''.<ref group=~~notes~~>Normal sections from the same tissue helps identifying what is histologically abnormal in the grossly abnormal tissue, versus normal individual variations.</ref>		When sampling sections to submit for microscopic examination, whenever you sample from something that looks abnormal, generally try to also sample from the same type of tissue that looks '''normal'''.<ref group=note>Normal sections from the same tissue helps identifying what is histologically abnormal in the grossly abnormal tissue, versus normal individual variations.</ref>

	==Biopsy wraps, bags and sponges==		==Biopsy wraps, bags and sponges==
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	==By organ or organ system==		==By organ or organ system==
	*[[Gross processing of skin excisions]]		*[[Gross processing of skin excisions]]

	{{General notes}}		{{General notes}}
	{{Bottom}}		{{Bottom}}
	</noinclude>		</noinclude>

Mikael Häggström: /* By organ or organ system */ more

2022-06-18T20:16:28Z

By organ or organ system: more

← Older revision		Revision as of 16:16, 18 June 2022
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	Use only hard pencil (or specially purchased histology markers), as marks made with pens, Sharpie markers, or scientific freezer-safe markers can get dissolved in tissue processing.<ref>{{cite web\|url=https://unclineberger.org/pathologyservices/instructions/histopathology-services/\|title=Histopathology Services\|website=UNC School of Medicine\|accessdate=2021-11-15}}</ref>		Use only hard pencil (or specially purchased histology markers), as marks made with pens, Sharpie markers, or scientific freezer-safe markers can get dissolved in tissue processing.<ref>{{cite web\|url=https://unclineberger.org/pathologyservices/instructions/histopathology-services/\|title=Histopathology Services\|website=UNC School of Medicine\|accessdate=2021-11-15}}</ref>

			<noinclude>
	==By organ or organ system==		==By organ or organ system==
	*[[Gross processing of skin excisions]]		*[[Gross processing of skin excisions]]
	~~<noinclude>~~
	{{General notes}}		{{General notes}}
	{{Bottom}}		{{Bottom}}
	</noinclude>		</noinclude>

Mikael Häggström: /* Before cutting */ Wording

2022-04-21T11:58:02Z

Before cutting: Wording

← Older revision		Revision as of 07:58, 21 April 2022
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	*{{Moderate-begin}}Check for any '''discrepancy''' between the specimen description on the container and on the referral or requisition form, such as left versus right.{{Moderate-end}}		*{{Moderate-begin}}Check for any '''discrepancy''' between the specimen description on the container and on the referral or requisition form, such as left versus right.{{Moderate-end}}
	*Don't omit any piece in the container, such as ones '''hidden''' in wraps.		*Don't omit any piece in the container, such as ones '''hidden''' in wraps.
	*Generally '''measure''' ~~estimated volume or~~ 3 dimensions ~~for samples greater than 0.4 cm~~ in greatest dimension~~.<ref group=notes>Specifying dimensions in 3 dimensions~~ is generally ~~a waste of time~~ for specimens less than 0.4 cm.~~</ref>~~		*Generally '''measure''' in 3 dimensions, or in volume, but the greatest dimension is generally enough for specimens less than 0.4 cm.
	*Generally '''weigh''' entire organs, after having any attached tissue trimmed away if feasible.		*Generally '''weigh''' entire organs, after having any attached tissue trimmed away if feasible.
	*{{Moderate-begin}}Note the color of the sample, even when unremarkable, but do not linger on deciding it.{{Moderate-end}}<ref group=notes>The color of gross specimens generally has very limited clinical significance.</ref>		*{{Moderate-begin}}Note the color of the sample, even when unremarkable, but do not linger on deciding it.{{Moderate-end}}<ref group=notes>The color of gross specimens generally has very limited clinical significance.</ref>

Mikael Häggström: /* Before cutting */ Hidden

2022-04-05T18:35:34Z

Before cutting: Hidden

← Older revision		Revision as of 14:35, 5 April 2022
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	*Confirm that the patient '''identity''' on the specimen container matches the identity that will be applied to the gross description and cassettes. {{Finding-begin}}If the referral or requisition form is available, confirm the patient identity on that one as well.{{Finding-end}}		*Confirm that the patient '''identity''' on the specimen container matches the identity that will be applied to the gross description and cassettes. {{Finding-begin}}If the referral or requisition form is available, confirm the patient identity on that one as well.{{Finding-end}}
	[[File:Right or left renal stone.jpg\|thumb\|160px\|For unclear or potentially ambiguous handwriting (here "Right" or "Left" renal stone), look at the referral or requisition form {{Comprehensive-begin}}and the medical record if available{{Comprehensive-end}}.]]		[[File:Right or left renal stone.jpg\|thumb\|160px\|For unclear or potentially ambiguous handwriting (here "Right" or "Left" renal stone), look at the referral or requisition form {{Comprehensive-begin}}and the medical record if available{{Comprehensive-end}}.]]
	*{{Moderate-begin}}Check for any discrepancy between the specimen description on the container and on the referral or requisition form, such as left versus right.{{Moderate-end}}		*{{Moderate-begin}}Check for any '''discrepancy''' between the specimen description on the container and on the referral or requisition form, such as left versus right.{{Moderate-end}}
			*Don't omit any piece in the container, such as ones '''hidden''' in wraps.
	*Generally '''measure''' estimated volume or 3 dimensions for samples greater than 0.4 cm in greatest dimension.<ref group=notes>Specifying dimensions in 3 dimensions is generally a waste of time for specimens less than 0.4 cm.</ref>		*Generally '''measure''' estimated volume or 3 dimensions for samples greater than 0.4 cm in greatest dimension.<ref group=notes>Specifying dimensions in 3 dimensions is generally a waste of time for specimens less than 0.4 cm.</ref>
	*Generally '''weigh''' entire organs, after having any attached tissue trimmed away if feasible.		*Generally '''weigh''' entire organs, after having any attached tissue trimmed away if feasible.