Principles of gross pathology

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This article discusses principles of gross pathology, also principles of grossing. It serves as an introduction to the topic of gross pathology and covers what is generally the minimum for a specimen.

Rectal excision at time of gross after marking ink has been applied.

Parameters

All specimens

  • How it was received, e.g. 10% formalin, fresh.
  • Label, e.g. "ECC".
  • Dimension - at the very least one.
  • Number of pieces - counted if less or equal to six, estimated if more.
  • Appearance, e.g. fibrofatty tissue, tan tissue.

Other parameters

  • Mass (weight).
  • Inking.
  • Tumour:
    • Size.
    • Distance to margins.
    • Border, e.g. infiltrative, well-circumscribed.
    • Colour.
    • Firmness.
    • Necrosis.
    • Hemorrhage.
    • Cystic component.

Multiple lesions

In the context of several (large) lesions it is good practice to:

  • Measure the distance between the lesions.‡
  • Take sections showing the interface between the lesions (if possible) or non-lesional tissue between the lesions.‡

Note:

  • ‡ If the tissue is studded with too many lesions to count this is impractical. Practically, two or three lesions is a reasonable limit; if more lesions are present the focus should be on (1) the largest lesions, (2) the distance to the margins for the largest lesions and the closest (smaller) lesion(s).

Report organization

  • A gross report that follows the order in which things are done may reduce omissions.
    • The cut-up generally is: (1) identification - patient/specimen type, (2) orientation & measurement, (3) external description/assessment, (4) painting, (5) opening, (6) internal description/assessment, (7) internal measurements, (8) blocking.
    • Generally, gross report elements are found in the order they are done at the grossing bench, e.g. identification patient/specimen type is first, blocks are last.

Blocking principles

It makes sense to consistently submit blocks in a certain order. This avoids mix-ups that can lead to problems, and may avoid that important things are forgotten.

A set of blocking conventions

Block ordering

  • Surgical margins are submitted first.
    • The rationale for this is: one is less likely to have tumour pickup if they are cut first.
  • Representative benign parenchyma is submitted last.

Laterality and orientation

  • Left before right.
  • Anterior before posterior.
  • Clockwise and starting at 12 o'clock.

The preceding conventions are arbitrary. The first pair can be remembered by... the first in the alphabet is first.

Measurement principles

  • It is preferable to make distance measurements to one reference point - this avoids calculations.
    • If the finding is a small tumour/mass (e.g. colonic polyp) it should be measured to the nearest margin if only one measure is given.

Identification of case and person (dictation)

Identify yourself:

  • Name.
  • Initials.
  • Date of dictation.

Specimen

  • Number of parts: [Single part specimen / multiple part specimen: A to ___].

Identifiers:

  • Last name (spell out).
  • First name (spell out)
  • Surgical number.
  • Specimen received: [fresh / in formalin].
  • Specimen identified as: [left kidney / ...].

See also