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'''Gross pathology''' is the macroscopic assessment of pathology specimens.  It is an essential part of pathologic assessments.
[[Image:Renal oncocytoma.jpg|right|thumb|A kidney tumour ([[renal oncocytoma]]) at the time of grossing.]]
'''Gross pathology''', also simply '''gross''', refers to the macroscopic pathology, and the macroscopic assessment of pathology specimens.  It may include preparation of tissue for a microscopic examination.  It is an essential part of pathologic assessments.


==Gross only==
The process of cutting up specimens is known as '''grossing''' (North American term), '''cut-up''' or '''macroscopic cut-up''' (Australian term).
Which specimens are "gross only" typically depends on institutional policy.<ref name=pmid10050786>{{Cite journal  | last1 = Zarbo | first1 = RJ. | last2 = Nakhleh | first2 = RE. | title = Surgical pathology specimens for gross examination only and exempt from submission: a College of American Pathologists Q-Probes study of current policies in 413 institutions. | journal = Arch Pathol Lab Med | volume = 123 | issue = 2 | pages = 133-9 | month = Feb | year = 1999 | doi = 10.1043/0003-9985(1999)1230133:SPSFGE2.0.CO;2 | PMID = 10050786 }}</ref>
 
==Gross spot diagnosis==
===Heart===
[[Heart valve]]:
*[[Infective endocarditis]].
*[[Bicuspid aortic valve]].
*[[Nonbacterial thrombotic endocarditis]] - non-distructive.
*[[Rheumatic heart disease]] - fish mouth valve, thick cordae tendinae.
*[[Calcific aortic stenosis]].
Heart - other:
*[[Fibrinous pericarditis]].
*[[Hypertrophic cardiomyopathy]] - septal thickness > free wall thickness.
*Cardiac hypertrophy.
*[[Dilated cardiomyopathy]].
*[[Arrhythmogenic right ventricular cardiomyopathy]].


===Cardiovascular===
==Specimen opening==
*[[Aortic dissection]].
:Usually referred to simply as ''opening''.
*Aortic rupture.
:May go by the term ''freshing''.
*Cerebral aneurysm.
*The first part of a gross pathologic assessment.


===Lungs===
===Components===
*[[Pulmonary thromboembolism]].
#Orient the specimen.
*Lung abscess.
#Paint with [[marking ink|ink]] - if applicable.
*Lung tumour (primary).
#*A good general rule is: ''ink before you think''.
*Metatstatic tumour lung - usu. multiple and peripheral.
#Cut open for fixation - if not immediately blocked.
*[[Malignant mesothelioma]].
#+/-Weigh.
*[[Pleural plaques]].
#+/-Insert paper towels in the cuts (book marking) for [[fixation]].
*[[Emphysema]].
*[[Pneumothorax]].
*[[Hemothorax]].
*Hypoplasia secondary to [[diaphragmatic hernia]].


===Gastrointestinal pathology===
==Gross only==
Esophagus:
Gross only specimens are examined only at the grossing bench; no microscopy is done. Which specimens are considered "gross only" typically depends on institutional policy.<ref name=pmid10050786>{{Cite journal  | last1 = Zarbo | first1 = RJ. | last2 = Nakhleh | first2 = RE. | title = Surgical pathology specimens for gross examination only and exempt from submission: a College of American Pathologists Q-Probes study of current policies in 413 institutions. | journal = Arch Pathol Lab Med | volume = 123 | issue = 2 | pages = 133-9 | month = Feb | year = 1999 | doi = 10.1043/0003-9985(1999)1230133:SPSFGE2.0.CO;2 | PMID = 10050786 }}</ref>
*Squamous cell carcinoma.
*Adenocarcinoma.
*[[Barrett's esophagus]].
*Esophageal varices.
*Esophageal perforation.


Stomach:
===Common gross only specimens===
*Malignant gastric ulcer.
*Teeth.
*Peptic ulcer.
*Foreign bodies.
*[[Gastric antral vascular ectasia]].
*[[Femoral head]] with [[osteoarthritis]] - no [[hip fracture|fracture]] & no history of cancer.
*[[Leopard spots]].
*[[Calcific aortic stenosis]].
*[[GIST]].


Duodenum:
==How to gross==
*Peptic ulcer.
===Principles of grossing===
*Duodenal adenocarcinoma - classically assoc. with [[FAP]].
{{Main|Principles of grossing}}
 
This article is discusses generalities in grossing.
Liver:
*[[Cirrhosis]].
*[[Hydatid cyst]].
*[[Hepatocellular carcinoma]] - in the context of cirrhosis.
*[[Metastases]].
*[[Hemangioma]].
*[[Focal nodular hyperplasia]].
*[[Hepatic adenoma]].
*[[Cholangiocarcinoma]].
*Congestive hepatopathy (nutmeg liver).
 
Gallbladder:
*[[Cholelithiasis]].
*[[Cholesterolosis of the gallbladder]].
*Gallbladder polyp.
 
Pancreas:
*[[Solid pseudopapillary neoplasm]] - with age & sex provided.
*[[Pancreatic adenocarcinoma]].
*[[Neuroendocrine tumour]].
*[[Chronic pancreatitis]].
 
Small bowel:
*Ischemic small bowel.
*[[Meckel's diverticulum]].
*[[Intussusception]].
*Neuroendocrine tumour - if on section.
*[[GIST]].
*Incarcerated hernia.
 
Appendix:
*[[Acute appendicitis]].
*Neuroendocrine tumour.
*Mucinous tumour.
 
Large bowel:
*[[Colorectal adenocarcinoma]].
*Bowel infarction.
*[[Ulcerative colitis]] - no skip lesions, no wall thickening.
*[[Crohn's disease]] - creeping fat, cobble stone pattern, skip lesions, fistulas.
*[[Pseudomembranous colitis]].
 
===Gynecologic pathology===
Ovary:
*Mucinous tumour.
*[[Mature teratoma]].
*Serous cystadenoma.
 
Tube:
*Ectopic pregnancy.
*Tubal abscess.
 
Uterus:
*[[Adenomyosis of the uterus|Adenomyosis]].
*[[Uterine leiomyoma|Leiomyoma]] - multiple.
*Endometrial carcinoma.
*[[Uterine leiomyosarcoma|Leiomyosarcoma]] - friable, solitary, fish flesh.
 
Uterine cervix:
*Cervical carcinoma.


===Dermatopathology===
===Dermatopathology===
Tumour:
{| class="wikitable sortable"
*[[Basal cell carcinoma]].
! Specimen
*[[Squamous cell carcinoma]].
! Comments
*[[Malignant melanoma]].
|-
| [[Abdominal pannus grossing|Abdominal pannus]]
| often [[gross only]]
|}


Possible syndromic:
===Cardiovascular===
*[[Seborrheic keratosis]] - [[Leser–Trélat sign]]
{| class="wikitable sortable"
*[[Neurofibroma]] - [[neurofibromatosis]].
! Specimen
*[[Angiofibroma]] - [[Fabry disease]].
! Comments
 
|-
===Neuropathology===
| [[Aortic valve grossing|Aortic valve]]
Bleeds:
| may be [[gross only]]
*[[Epidural hematoma]]
|-
*[[Subdural hematoma]].
| [[Mitral valve grossing|Mitral valve]]
*[[Subarachnoid hematoma]] - [[berry aneurysm]].
| may be [[gross only]]
*[[Intracerebral hematoma]].
|}
 
Tumours:
*[[Meningioma]] - intradural, extramedullary.
*Glioma.
*[[Schwannoma]] - cerebellopontine angle.
*[[Myxopapillary ependymoma]] - filum terminale.
 
Non-tumour:
*[[Diffuse axonal injury]] - classically corpus callosum.
*[[Fat embolism]].
*[[Cerebral contusion]].
**[[Plaque jaune]].
 
===Genitourinary pathology===
Kidney:
*[[Clear cell renal cell carcinoma]] - yellow.
*[[Papillary renal cell carcinoma]] - friable.
*[[Chromophobe renal cell carcinoma]] - brown +/-hemorrhage, no central scar.
*[[Renal oncocytoma]] - brown, central scar.
*[[Autosomal dominant polycystic kidney disease]].
*[[Angiomyolipoma]] - fat.


Testis:
===Orthopedic===
*[[Seminoma]].
{| class="wikitable sortable"
*[[Mixed germ cell tumour]].
! Specimen
*[[Leydig cell tumour]] - brown.
! Comments
*Testicular torsion.
|-
| [[Femoral head grossing|Femoral head]]
| may be [[gross only]]
|-
| [[Knee replacement specimen grossing|Knee replacement]]
| [[Soft tissue pathology]]
|}


Paratesticular:
===Genitourinary===
*[[Liposarcoma]].
{| class="wikitable sortable"
! Specimen
! Comments
|-
| [[Cystoprostatectomy]]
| indication: urothelial carcinoma
|-
| [[Orchiectomy]]
|
|-
| [[Partial cystectomy]]
| indication: [[urachal carcinoma]]
|-
| [[Partial nephrectomy]]
| indication: [[renal cell carcinoma]]
|-
| [[Penectomy]]
|
|-
| [[Prostate biopsy]]
|
|-   
| [[Prostate chips]]
| indication: [[nodular hyperplasia of the prostate|BPH]]
|-
| [[Radical cystectomy]]
|
|-
| [[Radical prostatectomy]]
|
|-
| [[Total nephrectomy for tumour]]
|
|-
| [[Nephroureterectomy]]
| indication: [[urothelial carcinoma]]
|}


===Placenta===
===Gastrointestinal===
Membranes:
{| class="wikitable sortable"
*Marginal inserion - normal.
! Specimen
*Circumvallate insertion.
! Comments
*Circummarginate insertion.
|-
| [[Partial colectomy for diverticular disease]]
|
|-
| [[Lower anterior resection for cancer]]
|
|}


Disc:
===Gynecologic===
*Retroplacental blood clot - suggestive of [[placental abruption]].
{| class="wikitable sortable"
*[[Chorangioma]] - big red intraparenchymal.
! Specimen
*[[Placental infarct]] - white = old, red = recent.
! Comments
*[[Twin-to-twin transfusion syndrome]] - one side beefy red the other pale.
|-
*Meconium staining/[[chorioamnionitis]].
| [[Hysterectomy for fibroids]]
|
|-
| [[Cervical cone]]
|
|-
| [[Hysterectomy for endometrial hyperplasia]]
| see also ''[[hysterectomy for endometrial cancer]]''
|-
| [[Hysterectomy for endometrial cancer]]
| see also ''[[hysterectomy for endometrial hyperplasia]]''
|-
| [[Radical hysterectomy for cervical cancer]]
|
|-
| [[Vulvectomy]]
|
|}


Cord:
==Gross pathology spot diagnoses==
*[[Two vessel umbilical cord]].
{{Main|Gross pathology spot diagnoses}}
*False knot.
This is a long list of things that can be identified with a reasonable certainty on gross.
*True knot.


==See also==
==See also==
*[[Basics]].
*[[Basics]].
*[[EIT]].
*[[Tissue loss]].


==References==
==References==
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==External links==
==External links==
*[http://www.artandmedicine.com/Index.html Old (black & white) gross pathology (artandmedicine.com)].
*[http://www.artandmedicine.com/Index.html Old (black & white) gross pathology (artandmedicine.com)].
*[https://www.rcpa.edu.au/Manuals/Macroscopic-Cut-Up-Manual Cut-up manual from the RCPA (rcpa.edu.au)].
*[http://www.qmul.ac.uk/bartspathology/specimens/index.html Barts Pathology Museum (qmul.ac.uk)].
*[http://pathinfo.wikia.com/wiki/Specimen_Grossing_Manual Grossing Manual - Pathology Resident Wiki (wikia.com)].
*[https://grosspathology-sites.uchicago.edu/ Gross Pathology - U of Chicago (uchicago.edu)].


[[Category:Basics]]
[[Category:Gross pathology]]
Michael
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