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| | [[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 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. |
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| ===Components=== | | ===Components=== |
| #Orient the specimen. | | #Orient the specimen. |
| #Paint with ink - if applicable. | | #Paint with [[marking ink|ink]] - if applicable. |
| #*A good general rule is: ''ink before you think''. | | #*A good general rule is: ''ink before you think''. |
| #Cut open for fixation - if not immediately blocked. | | #Cut open for fixation - if not immediately blocked. |
| | #+/-Weigh. |
| | #+/-Insert paper towels in the cuts (book marking) for [[fixation]]. |
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| ==Gross only== | | ==Gross only== |
| 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 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> |
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| ===Common gross only specimens=== | | ===Common gross only specimens=== |
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| *[[Calcific aortic stenosis]]. | | *[[Calcific aortic stenosis]]. |
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| ==Gross spot diagnosis== | | ==How to gross== |
| ===Heart===
| | ===Principles of grossing=== |
| [[Heart valve]]:
| | {{Main|Principles of grossing}} |
| *[[Infective endocarditis]].
| | This article is discusses generalities in grossing. |
| *[[Bicuspid aortic valve]].
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| *[[Nonbacterial thrombotic endocarditis]] - non-distructive.
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| *[[Rheumatic heart disease]] - fish mouth valve, thick cordae tendinae.
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| *[[Calcific aortic stenosis]].
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| Heart - other:
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| *[[Fibrinous pericarditis]].
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| *[[Hypertrophic cardiomyopathy]] - septal thickness > free wall thickness.
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| *Cardiac hypertrophy.
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| *[[Dilated cardiomyopathy]].
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| *[[Arrhythmogenic right ventricular cardiomyopathy]].
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| *[[Atrial septal defect]].
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| *[[Ventricular septal defect]].
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| *Patent foramen ovale.
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| ===Cardiovascular===
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| *[[Aortic dissection]].
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| *Aortic rupture.
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| *Cerebral aneurysm.
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| ===Lungs===
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| *[[Pulmonary thromboembolism]].
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| *[[Pulmonary infarct]].
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| *Lung abscess.
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| *Lung tumour (primary).
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| *Metatstatic tumour lung - usu. multiple and peripheral.
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| *[[Malignant mesothelioma]].
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| *[[Pleural plaques]].
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| *[[Emphysema]].
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| *[[Pneumothorax]].
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| *[[Hemothorax]].
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| *Hypoplasia secondary to [[diaphragmatic hernia]].
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| ===Gastrointestinal pathology=== | |
| [[Esophagus]]:
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| *Squamous cell carcinoma - mid esophagus classically.
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| *Adenocarcinoma - distal esophagus.
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| *[[Barrett's esophagus]].
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| *[[Esophageal varices]].
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| *Esophageal perforation.
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| Stomach:
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| *Malignant gastric ulcer.
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| *Peptic ulcer.
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| *[[Gastric antral vascular ectasia]].
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| *[[Leopard spots]] - seen in hypothermia.
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| *[[GIST]].
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| [[Duodenum]]:
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| *Peptic ulcer.
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| *[[Duodenal adenocarcinoma]] - classically assoc. with [[FAP]].
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| [[Liver]]:
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| *[[Cirrhosis]].
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| *[[Hydatid cyst]].
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| *[[Hepatocellular carcinoma]] - in the context of cirrhosis.
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| *[[Metastases]].
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| *[[Hemangioma]].
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| *[[Focal nodular hyperplasia]].
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| *[[Hepatic adenoma]].
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| *[[Cholangiocarcinoma]].
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| *[[Congestive hepatopathy]] (nutmeg liver) - seen in [[congestive heart failure]].
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| *Hepatic infarct - classically at the periphery, red and wedge-shaped.
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| [[Gallbladder]]:
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| *[[Cholelithiasis]].
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| *[[Cholesterolosis of the gallbladder]].
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| *Gallbladder polyp.
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| [[Pancreas]]:
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| *[[Solid pseudopapillary neoplasm]] - with age & sex provided.
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| *[[Pancreatic adenocarcinoma]].
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| *[[Neuroendocrine tumour]].
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| *[[Chronic pancreatitis]].
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| [[Small bowel]]:
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| *Ischemic small bowel.
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| *[[Meckel's diverticulum]].
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| *[[Intussusception]].
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| *Neuroendocrine tumour - if on section.
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| *[[GIST]].
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| *Incarcerated hernia.
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| [[Appendix]]:
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| *[[Acute appendicitis]].
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| *Neuroendocrine tumour.
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| *Mucinous tumour.
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| Large bowel:
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| *[[Colorectal adenocarcinoma]].
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| *Bowel infarction.
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| *[[Ulcerative colitis]] - no skip lesions, no wall thickening.
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| *[[Crohn's disease]] - [[creeping fat]], cobble stone pattern, skip lesions, fistulas.
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| *[[Pseudomembranous colitis]].
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| ===Gynecologic pathology===
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| Ovary:
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| *Mucinous tumour.
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| *[[Mature teratoma]].
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| *Serous cystadenoma.
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| *[[ovarian fibroma|Fibroma]].
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| *[[Brenner tumour]] - may be yellow, typically solid.
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| *[[Endometrioma]].
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| Uterine tube:
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| *[[Ectopic pregnancy]].
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| *Tubal abscess.
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| *[[Adenomatoid tumour]].
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| Uterus:
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| *[[Adenomyosis of the uterus|Adenomyosis]].
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| *[[Uterine leiomyoma|Leiomyoma]] - multiple.
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| *Endometrial carcinoma.
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| *[[Uterine leiomyosarcoma|Leiomyosarcoma]] - friable, solitary, fish flesh.
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| *[[Bicornuate uterus]].
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| *[[Uterus didelphys]].
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| *[[Sarcoma botryoides]] (embryonal rhabdomyosarcoma).
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| Uterine cervix:
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| *[[Nabothian cyst]].
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| *[[Cervical polyp]].
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| *Cervical carcinoma.
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| ===Dermatopathology=== | | ===Dermatopathology=== |
| Tumour:
| | {| class="wikitable sortable" |
| *[[Basal cell carcinoma]].
| | ! Specimen |
| *[[Squamous cell carcinoma]].
| | ! Comments |
| *[[Malignant melanoma]].
| | |- |
| | | [[Abdominal pannus grossing|Abdominal pannus]] |
| | | often [[gross only]] |
| | |} |
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| 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]]
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| *[[Subdural hematoma]].
| | | [[Mitral valve grossing|Mitral valve]] |
| *[[Subarachnoid hematoma]] - [[berry aneurysm]].
| | | may be [[gross only]] |
| *[[Intracerebral hematoma]] - hypertensive, usu. thalamus.
| | |} |
| **Lobar hemorrhage - periphery of cortex.
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| *[[Duret hemorrhage]] - pontine hemorrhage.
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| Tumours:
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| *[[Meningioma]] - intradural, extramedullary.
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| *Glioma.
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| *[[Schwannoma]] - cerebellopontine angle.
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| *[[Myxopapillary ependymoma]] - filum terminale.
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| Non-tumour:
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| *[[Diffuse axonal injury]] - classically corpus callosum.
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| *[[Fat embolism]].
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| *[[Cerebral contusion]].
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| **[[Plaque jaune]].
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| *Cerebral infarction - classically MCA territory.
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| Neurodegenerative:
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| *[[Alzheimer disease]] - atrophy spares occipital lobe.
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| *Frontotemporal dementia.
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| *[[Huntington disease]] - young, caudate nucleus missing.
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| ===Genitourinary pathology===
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| Kidney:
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| *[[Clear cell renal cell carcinoma]] - yellow.
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| *[[Papillary renal cell carcinoma]] - friable.
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| *[[Chromophobe renal cell carcinoma]] - brown +/-hemorrhage, no central scar.
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| *[[Renal oncocytoma]] - brown, central scar.
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| *[[Autosomal dominant polycystic kidney disease]].
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| *[[Angiomyolipoma]] - fat.
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| Testis:
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| *[[Seminoma]] - solid.
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| *[[Mixed germ cell tumour]] - cystic (often teratoma) & solid.<ref name=Ref_AoGP447>{{Ref AoGP|447}}</ref>
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| *[[Leydig cell tumour]] - brown.
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| *Testicular torsion.
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| Paratesticular:
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| *[[Liposarcoma]].
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| ===Placenta=== | | ===Orthopedic=== |
| Membranes:
| | {| class="wikitable sortable" |
| *Marginal inserion - normal.
| | ! Specimen |
| *[[Circumvallate placenta]].
| | ! Comments |
| *[[Circummarginate placenta]].
| | |- |
| | | [[Femoral head grossing|Femoral head]] |
| | | may be [[gross only]] |
| | |- |
| | | [[Knee replacement specimen grossing|Knee replacement]] |
| | | [[Soft tissue pathology]] |
| | |} |
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| Disc:
| | ===Genitourinary=== |
| *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]].
| | | [[Cystoprostatectomy]] |
| *[[Amnion nodosum]].
| | | indication: urothelial carcinoma |
| *[[Squamous metaplasia of the amnion]].
| | |- |
| *Succenturiate placenta (placenta with accessory lobe(s)).
| | | [[Orchiectomy]] |
| *Bilobate placenta.
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| | |- |
| | | [[Partial cystectomy]] |
| | | indication: [[urachal carcinoma]] |
| | |- |
| | | [[Partial nephrectomy]] |
| | | indication: [[renal cell carcinoma]] |
| | |- |
| | | [[Penectomy]] |
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| | |- |
| | | [[Prostate biopsy]] |
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| | |- |
| | | [[Prostate chips]] |
| | | indication: [[nodular hyperplasia of the prostate|BPH]] |
| | |- |
| | | [[Radical cystectomy]] |
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| | |- |
| | | [[Radical prostatectomy]] |
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| | |- |
| | | [[Total nephrectomy for tumour]] |
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| | |- |
| | | [[Nephroureterectomy]] |
| | | indication: [[urothelial carcinoma]] |
| | |} |
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| Cord:
| | ===Gastrointestinal=== |
| *[[Two vessel umbilical cord]].
| | {| class="wikitable sortable" |
| *False knot.
| | ! Specimen |
| *True knot.
| | ! Comments |
| *Membranous insertion ([[AKA]] velamentous insertion).
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| *Furcate insertion - vessels separate before inserting.
| | | [[Partial colectomy for diverticular disease]] |
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| | |- |
| | | [[Lower anterior resection for cancer]] |
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| | |} |
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| ===Fetal=== | | ===Gynecologic=== |
| *[[Amniotic rupture sequence]] - includes [[amniotic band syndrome]].
| | {| class="wikitable sortable" |
| *[[Twin-to-twin transfusion syndrome]] (TTTS).
| | ! Specimen |
| | ! Comments |
| | |- |
| | | [[Hysterectomy for fibroids]] |
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| | |- |
| | | [[Cervical cone]] |
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| | |- |
| | | [[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]] |
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| | |- |
| | | [[Vulvectomy]] |
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| | |} |
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| Genetic:
| | ==Gross pathology spot diagnoses== |
| *[[Down syndrome]].
| | {{Main|Gross pathology spot diagnoses}} |
| *[[Edwards syndrome]].
| | This is a long list of things that can be identified with a reasonable certainty on gross. |
| *[[Patau syndrome]].
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| *[[Turner syndrome]].
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| ==See also== | | ==See also== |
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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)]. |
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| [[Category:Basics]] | | [[Category:Gross pathology]] |