Gross processing: Difference between revisions

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{{Top

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|author1=[[User:Mikael Häggström|Mikael Häggström]]

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Following are general notes on selection and trimming in pathology.

<noinclude>{{Comprehensiveness|otherlegend=yes}}</noinclude>

==Priority==

{|class=wikitable align=right

|+ Priority

|

1. More invasive intraoperative consultations (such as open surgery)

2. Less invasive intraoperative consultations (such as skins)

3. Fresh lymph nodes

4. Fresh breast tissue (should be in formalin within an hour from surgery)

5. Other fresh tissue

6. Tissue in formalin

|}

For '''prioritizing''' when you have more than one thing ongoing at the same time, the list at right can be used.

==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==

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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 '''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 '''[[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}}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>

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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>

*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==

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*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.

*'''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===

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==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==

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==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>

==By organ or organ system==

*[[Gross processing of skin excisions]]

</noinclude>

@@ Line 1: / Line 1: @@
-{{Top
+<noinclude>{{Top
 |author1=[[User:Mikael Häggström|Mikael Häggström]]
 |author2=
-}}
+}}</noinclude>
 Following are general notes on selection and trimming in pathology.
-{{Comprehensiveness|otherlegend=yes}}
+<noinclude>{{Comprehensiveness|otherlegend=yes}}</noinclude>
+==Priority==
+{|class=wikitable align=right
+|+ Priority
+|
+. More invasive intraoperative consultations<br>(such as open surgery)<br>
+. Less invasive intraoperative consultations<br>(such as skins)<br>
+. Fresh lymph nodes<br>
+. Fresh breast tissue (should be in<br>formalin within an hour from surgery)<br>
+. Other fresh tissue<br>
+. Tissue in formalin
+|}
+For '''prioritizing''' when you have more than one thing ongoing at the same time, the list at right can be used.
+==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==
@@ Line 13: / Line 34: @@
 *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.
-*{{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 '''[[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}}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>
@@ Line 20: / Line 41: @@
 *{{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.
+*'''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==
@@ Line 25: / Line 47: @@
 *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.
-*'''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===
@@ Line 35: / Line 57: @@
 ==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==
@@ Line 62: / Line 84: @@
 ==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>
 <noinclude>
 ==By organ or organ system==
 *[[Gross processing of skin excisions]]
 {{General notes}}
 {{Bottom}}
 </noinclude>

Gross processing: Difference between revisions

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