Evaluation of suspected malignancies: Difference between revisions
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{{General notes}} | {{General notes}} | ||
For [[evaluation]] of suspected malignancies, the most important | For [[evaluation]] of '''suspected malignancies''' such as ''tumors''', the most important aspect is whether it is benign or malignant. If malignant, then staging is necessary.<ref name=cancer>{{cite web |url= http://www.cancer.gov/cancertopics/factsheet/detection/staging |title=Cancer staging |date= |publisher=National Cancer Institute |accessdate=4 January 2013}}</ref> There are generally specific criteria for various forms of tumors, which should be used whenever applicable, but following are some generalizations. | ||
A general approach is to start looking at the slide which seems to contain most tumor (excluding any necrosis), facilitating a diagnosis, and shows what kind of cells to look for in the periphery. | A general approach is to start looking at the slide which seems to contain most tumor (excluding any necrosis), facilitating a diagnosis, and shows what kind of cells to look for in the periphery. | ||
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*Numerous mitotic figures | *Numerous mitotic figures | ||
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===Overall diagnosis=== | |||
For specific diagnoses by organ system, see anatomic map on Patholines '''[[Main page]]'''. | |||
Two relatively common forms of tumors are: | |||
<gallery mode=packed> | |||
File:Non-proliferative versus proliferative colonic crypts.jpg|'''[[Gland-like tumors]]''' (image shows normal colonic crypt compared to an adenoma) | |||
File:Histopathology of leiomyoma of the ileocecal valve.jpg|'''[[Spindle-cell tumors]]''' (image shows a leiomyoma) | |||
</gallery> | |||
==Staging== | ==Staging== | ||
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==Typing and grading== | ==Typing and grading== | ||
[[File:Histopathology of pancreatic adenocarcinoma with treatment effect.jpg|thumb|Also note "treatment effect", seen as fibroelastotic tissue, here with scattered remaining tumor cells.]] | [[File:Histopathology of pancreatic adenocarcinoma with treatment effect.jpg|thumb|Also note "treatment effect", seen as fibroelastotic tissue, here with scattered remaining tumor cells.]] | ||
Beyond determining overall malignancy, probable origin and staging, classification of tumors into a specific histopathologic type or grade is generally of relatively less value. In cases of clearly non-malignant tumors where it is difficult to determine the specific histopathologic type or grade, it is generally acceptable to conclude the evaluation and report it as such, unless the clinician specifically requests otherwise. For potentially malignant or high-risk tumors, typing and grading often still affects the management. | Beyond determining overall malignancy diagnosis (such as adenocarcinoma), probable origin and staging, classification of tumors into a specific histopathologic type or grade is generally of relatively less value. In cases of clearly non-malignant tumors where it is difficult to determine the specific histopathologic type or grade, it is generally acceptable to conclude the evaluation and report it as such, unless the clinician specifically requests otherwise. For potentially malignant or high-risk tumors, typing and grading often still affects the management. | ||
==Additional slices== | ==Additional slices== | ||
Additional slices are indicated in the following situations | Additional slices are indicated in the following situations: | ||
*Re-excision does not identify tumor cells in a clearly non-radical primary excision or biopsy.<ref group="notes">In such cases, step slices are taken rather than serial ones.</ref> | *Re-excision does not identify tumor cells in a clearly non-radical primary excision or biopsy.<ref group="notes">In such cases, step slices are taken rather than serial ones.</ref> | ||
*The most aggressive pattern is seen in the last available section, in which case more sections are indicated (from the same paraffin block if additional tissue is not available). | *The most aggressive pattern is seen in the last available section, in which case more sections are indicated (from the same paraffin block if additional tissue is not available). | ||