Difference between revisions of "Gross pathology"

Jump to navigation Jump to search

Gross pathology (view source)

Revision as of 13:57, 9 January 2017

3,283 bytes removed ,  13:57, 9 January 2017
→‎External links
m (+image)
(21 intermediate revisions by the same user not shown)
Line 11: Line 11:
===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]].


==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===
Line 24: Line 26:
*[[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 saccular 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 of the esophagus]] - classically mid esophagus.
*[[Adenocarcinoma of the esophagus]] - usually 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 of the appendix]].
*[[Mucinous tumour of the appendix]].
 
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 of the ovary]].
*[[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==
Line 251: Line 154:
*[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.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
48,453

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/32496...46738"

Navigation menu