Difference between revisions of "Lung wedge resection and lobectomy"

From patholines.org
Jump to navigation Jump to search
(→‎Grossing: +Report)
(→‎Grossing: +Palpate for tumors intermittently.)
Line 13: Line 13:
 
:*In '''intraoperative consultations''' use a section that is presumably closest to a tumor for [[frozen sectioning]], with the tissue [[enface]], for radicality. This is generally enough to report intraoperatively to the surgeon, unless otherwise requested.
 
:*In '''intraoperative consultations''' use a section that is presumably closest to a tumor for [[frozen sectioning]], with the tissue [[enface]], for radicality. This is generally enough to report intraoperatively to the surgeon, unless otherwise requested.
 
*{{Comprehensive-begin}}Sample the entire surgical margin for standard processing.{{Comprehensive-end}}
 
*{{Comprehensive-begin}}Sample the entire surgical margin for standard processing.{{Comprehensive-end}}
*Cut open the '''bronchi''' of the specimen with a pair of scissors, as far as they can fit within the lumina. Attempt to cut so as to be able to take a section that includes both any tumor and nearest bronchus. Describe the cut surface, including color and consistency, and any focal lesions.
+
*Cut open the '''bronchi''' of the specimen with a pair of scissors, as far as they can fit within the lumina. Attempt to cut so as to be able to take a section that includes both any tumor and nearest bronchus. Palpate for tumors intermittently. Describe the cut surface, including color and consistency, and any focal lesions.
*Turn the specimen to the side with least cuts so far, and '''serially section''' it.
+
*Turn the specimen to the side with least cuts so far, and '''serially section''' it. Palpate for tumors intermittently.
 
*For any found '''[[lung tumor]]''':
 
*For any found '''[[lung tumor]]''':
 
:*Measure '''tumor size''' as a maximum diameter {{Moderate-begin}}or 3 dimensions{{Moderate-end}}
 
:*Measure '''tumor size''' as a maximum diameter {{Moderate-begin}}or 3 dimensions{{Moderate-end}}

Revision as of 12:22, 19 March 2021

Author: Mikael Häggström [note 1]

Comprehensiveness

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

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

Grossing

Surgical margin sampling of a lobectomy for intraoperative consultation.

Perform the following:[1]

  • Measure the specimen in 3 dimensions.
  • Describe pleural surface, including color, and any presence of granularity, adhesions, retraction, or tumor.
  • Palpate for any tumors.
  • Ink the surgical margin and cut it away just below any sutures or staples. If the margin is substantially stapled (and their removal would be either too tissue-damaging or otherwise inconvenient), ink and use another section of the tissue underneath it for frozen sectioning.
  • In intraoperative consultations use a section that is presumably closest to a tumor for frozen sectioning, with the tissue enface, for radicality. This is generally enough to report intraoperatively to the surgeon, unless otherwise requested.
  • ((Sample the entire surgical margin for standard processing.))
  • Cut open the bronchi of the specimen with a pair of scissors, as far as they can fit within the lumina. Attempt to cut so as to be able to take a section that includes both any tumor and nearest bronchus. Palpate for tumors intermittently. Describe the cut surface, including color and consistency, and any focal lesions.
  • Turn the specimen to the side with least cuts so far, and serially section it. Palpate for tumors intermittently.
  • For any found lung tumor:
  • Measure tumor size as a maximum diameter (or 3 dimensions)
  • Determine location: Which lobe if applicable, and if it is peripheral, central or hilar.
  • Margin length to pleura and hilum/surgical margin.
  • Any involvement of major bronchi or blood vessels.
  • Describe any lymph nodes, including location, range of sizes and appearance of cut surface.

Gross report

((A. Labeled - ___. The specimen is received fresh for intraoperative consultation and consists of)) a wedge-shaped piece of lung which measures __ cm and has a staple line along one aspect measuring __ cm in length. The stapled surgical margin is inked black. The visceral pleura is mottled tan-pink and slightly puckered in the center. Cut sections show a tan, soft, tumor measuring __ cm in greatest dimension, located __ cm from the visceral pleura and __ cm from the surgical margin. The remaining parenchyma is pink and spongy. (Representative sections are submitted for microscopic examination in __ cassettes.)

Microscopic evaluation

Look mainly for carcinoma. Further information: Lung tumor

Microscopy report

Lung synoptic reports contain information (number and station) on all lymph nodes received per accession. For example, if Parts A-D are mediastinal nodes (8 in total) and Part E is a lobectomy containing 2 additional peribronchial nodes, the synoptic report for Part E should document all 10 nodes, for example:

A. Lymph node, station 1:
Negative for carcinoma. (0/1, 2 etc)

B. Lymph node, station 2:
Negative for carcinoma. (0/1, 2 etc)

C. Lobectomy, RLL: Adenocarcinoma

Size:
Histologic type
Margins

  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. Partially using the following procedure:. Pulmonary pathology grossing guidelines. Retrieved on 2021-03-17.

Image sources