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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.
The process of cutting up specimens is known as '''grossing''' (North American term), '''cut-up''' or '''macroscopic cut-up''' (Australian term).


==Specimen opening==
==Specimen opening==
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===Components===
===Components===
*Painting with ink - if applicable.
#Orient the specimen.
**A good general rule is: ''ink before you think''.
#Paint with [[marking ink|ink]] - if applicable.
*Cutting open for fixation - if not immediately finished.
#*A good general rule is: ''ink before you think''.
#Cut open for fixation - if not immediately blocked.
#+/-Weigh.
#+/-Insert paper towels in the cuts (book marking) for [[fixation]].


==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>


===Common gross only specimens===
===Common gross only specimens===
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*[[Calcific aortic stenosis]].
*[[Calcific aortic stenosis]].


==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]].
*[[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]].
*[[Atrial septal defect]].
*[[Ventricular septal defect]].
*Patent foramen ovale.
 
===Cardiovascular===
*[[Aortic dissection]].
*Aortic rupture.
*Cerebral aneurysm.
 
===Lungs===
*[[Pulmonary thromboembolism]].
*[[Pulmonary infarct]].
*Lung abscess.
*Lung tumour (primary).
*Metatstatic tumour lung - usu. multiple and peripheral.
*[[Malignant mesothelioma]].
*[[Pleural plaques]].
*[[Emphysema]].
*[[Pneumothorax]].
*[[Hemothorax]].
*Hypoplasia secondary to [[diaphragmatic hernia]].
 
===Gastrointestinal pathology===
[[Esophagus]]:
*Squamous cell carcinoma - mid esophagus classically.
*Adenocarcinoma - distal esophagus.
*[[Barrett's esophagus]].
*[[Esophageal varices]].
*Esophageal perforation.
 
Stomach:
*Malignant gastric ulcer.
*Peptic ulcer.
*[[Gastric antral vascular ectasia]].
*[[Leopard spots]] - seen in hypothermia.
*[[GIST]].
 
[[Duodenum]]:
*Peptic ulcer.
*[[Duodenal adenocarcinoma]] - classically assoc. with [[FAP]].
 
[[Liver]]:
*[[Cirrhosis]].
*[[Hydatid cyst]].
*[[Hepatocellular carcinoma]] - in the context of cirrhosis.
*[[Metastases]].
*[[Hemangioma]].
*[[Focal nodular hyperplasia]].
*[[Hepatic adenoma]].
*[[Cholangiocarcinoma]].
*[[Congestive hepatopathy]] (nutmeg liver) - seen in [[congestive heart failure]].
*Hepatic infarct - classically at the periphery, red and wedge-shaped.
 
[[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.
*[[ovarian fibroma|Fibroma]].
*[[Brenner tumour]] - may be yellow, typically solid.
*[[Endometrioma]].
 
Uterine tube:
*[[Ectopic pregnancy]].
*Tubal abscess.
*[[Adenomatoid tumour]].
 
Uterus:
*[[Adenomyosis of the uterus|Adenomyosis]].
*[[Uterine leiomyoma|Leiomyoma]] - multiple.
*Endometrial carcinoma.
*[[Uterine leiomyosarcoma|Leiomyosarcoma]] - friable, solitary, fish flesh.
*[[Bicornuate uterus]].
*[[Uterus didelphys]].
*[[Sarcoma botryoides]] (embryonal rhabdomyosarcoma).
 
Uterine cervix:
*[[Nabothian cyst]].
*[[Cervical polyp]].
*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]] - hypertensive, usu. thalamus.
|}
**Lobar hemorrhage - periphery of cortex.
*[[Duret hemorrhage]] - pontine hemorrhage.
 
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]].
*Cerebral infarction - classically MCA territory.
 
Neurodegenerative:
*[[Alzheimer disease]] - atrophy spares occipital lobe.
*Frontotemporal dementia.
*[[Huntington disease]] - young, caudate nucleus missing.
 
===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:
*[[Seminoma]] - solid.
*[[Mixed germ cell tumour]] - cystic (often teratoma) & solid.<ref name=Ref_AoGP447>{{Ref AoGP|447}}</ref>
*[[Leydig cell tumour]] - brown.
*Testicular torsion.
 
Paratesticular:
*[[Liposarcoma]].


===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]]
|}


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.
|
|-
| [[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]]
|}


Cord:
===Gastrointestinal===
*[[Two vessel umbilical cord]].
{| class="wikitable sortable"
*False knot.
! Specimen
*True knot.
! Comments
*Membranous insertion ([[AKA]] velamentous insertion).
|-
*Furcate insertion - vessels separate before inserting.
| [[Partial colectomy for diverticular disease]]
|
|-
| [[Lower anterior resection for cancer]]
|
|}


===Fetal===
===Gynecologic===
*[[Amniotic rupture sequence]] - includes [[amniotic band syndrome]].
{| class="wikitable sortable"
*[[Twin-to-twin transfusion syndrome]] (TTTS).
! Specimen
! Comments
|-
| [[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]]
|
|}


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]].
*[[Turner syndrome]].


==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)].
*[http://www.rcpa.edu.au/Library/Practising-Pathology/Macroscopic-Cut-Up/Home.aspx 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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