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Difference between revisions of "Lymph node grossing"
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[[Image: Gross pathology of a mesenteric lymph node.jpg|thumb| Picture showing a lymph node at gross (arrow). (Mikael Häggström/WC)]] | [[Image: Gross pathology of a mesenteric lymph node.jpg|thumb| Picture showing a lymph node at gross (arrow). (Mikael Häggström/WC)]] | ||
'''Lymph node grossing''' is an important element of the lymph node assessment in [[cancer staging]]. | '''Lymph node grossing''' is an important element of the [[lymph node]] assessment in [[cancer staging]]. | ||
==General== | ==General== | ||
In many cancer types, the lymph node count is important to quantify, as it is used as a quality metric. | In many cancer types, the lymph node count is important to quantify, as it is used as a [[quality]] metric. | ||
Cases with too few lymph nodes may be under-staged and thus under-treated. | Cases with too few lymph nodes may be under-staged and thus under-treated. | ||
There is no universal lymph node count target; the ideal number of lymph nodes is dependent on the type of cancer. | |||
==Gross== | ==Gross== | ||
| Line 19: | Line 21: | ||
Pathologic lymph node: | Pathologic lymph node: | ||
*White lesions, especially irregular = suggestive of carcinoma. | *White lesions, especially irregular = suggestive of carcinoma. | ||
*White, glistening | *White, glistening with lobulated surface - "fish flesh" = suggestive of lymphoma. | ||
**Subtle lobulation (~1 mm) on section suggestive of ''[[follicular lymphoma]]''.<ref>Bailey, D. 5 August 2010.</ref> | **Subtle lobulation (~1 mm) on section suggestive of ''[[follicular lymphoma]]''.<ref>Bailey, D. 5 August 2010.</ref> | ||
===Submission=== | ===Submission=== | ||
*The number of lymph nodes in each block should be noted in the gross report. † | *The number of lymph nodes in each block should be noted in the gross report. † | ||
*If multiple lymph nodes are present in the one block they should ''not'' be | *If multiple lymph nodes are present in the one block they should ''not'' be sectioned unless [[tissue inking|inked]]. ‡ | ||
** | **For multiple lymph nodes in one block either 1 or 2: | ||
**#Submit the lymph nodes without sectioning. | **#Submit the lymph nodes without sectioning. | ||
**#Ink the individual lymph nodes before sectioning - so | **#Ink the individual lymph nodes different colours before sectioning - so the sections can be matched under the microscope. | ||
Notes: | Notes: | ||
<br>† It is useful to use the word "possible" when describing lymph nodes; in the gross report "possible lymph node" is preferred over "lymph node". Lymph nodes are not reliably identified at gross. | <br>† It is useful to use the word "possible" when describing lymph nodes; in the gross report "possible lymph node" is preferred over "lymph node". Lymph nodes are not reliably identified at gross. | ||
<br>‡ If multiple lymph nodes are sectioned and these are not marked: it is not possible to reliably count the number of positive lymph nodes. Example: two lymph nodes are bisected and two sections have a small amount of cancer. Is that two positive lymph nodes or one positive lymph node that was bisected? Answer: It is not possible to tell. | <br>‡ If multiple lymph nodes are sectioned and these are not marked: it is not possible to reliably count the number of positive lymph nodes. Example: two lymph nodes are bisected and two sections have a small amount of cancer. Is that [[lymph node metastasis|two positive lymph nodes]] or one positive lymph node that was bisected? Answer: It is not possible to tell. | ||
==See also== | ==See also== | ||
*[[Lymph nodes]]. | *[[Lymph nodes]]. | ||
*[[Lymph node metastasis]]. | |||
==References== | ==References== | ||