Grossing Simple and Complex Specimens PDF

Grossing simple and complex specimens Terms to know: LEEP- loop electrosurgical excision procedure. A small electrical wire (electrocautery) is used to remove abnormal cells from the cervix. Usually performed after abnormal cells have been detected by Pap test. The specimen is submitted s...

Grossing simple and complex specimens Terms to know: LEEP- loop electrosurgical excision procedure. A small electrical wire (electrocautery) is used to remove abnormal cells from the cervix. Usually performed after abnormal cells have been detected by Pap test. The specimen is submitted similar in appearance to a cone biopsy. Moist commonly the procedure produces two or more specimens including anterior and posterior cervix Cone biopsy of cervix During a cone biopsy, a doctor surgically removes a cone- shaped piece of tissue from the cervix. Typically, the cone- shaped piece includes tissue from both the upper and lower part of the cervix. Resection (surgery)- the removal by surgery of all or part of an organ or other body structure Segmental resection (segmentectomy)- the partial removal of an organ or other body structure Salpingo- oophorectomy- is the removal of the fallopian tube (salpingectomy) and ovary (oophorectomy) Simple specimen grossing- Appendix Appendices are generally removed due to acute appendicitis, occasionally “incidentally” during operations for other reasons, and as part of a right colectomy Sample dictation for appendix Received fresh, labeled with the patient’s name and unit number and “appendix,” is a 5 cm in length × 0.9 cm in diameter appendix with attached mesoappendix (5 × 1 × 0.8 cm). There is a 0.3 cm in diameter perforation of the appendiceal wall, 1.5 cm from the tip. The serosal surface is dull and covered with purulent material. The mesoappendix (connects the ileum to the appendix) is edematous, tan/brown, and has areas of focal hemorrhage. The mucosal surface is red/brown and ulcerated. There is a 0.5 × 0.5 × 0.5 cm brown friable fecalith in the lumen of the proximal appendix Processing the appendix 1. Record dimensions (length, diameter including range), color (tan/pink, gray/green), external surface (edematous, fibrinous exudate, hyperemia, purulence, perforations, hemorrhagic (may be seen in endometriosis). If the mesoappendix (the portion of the mesentery connecting the ileum to the appendix) is present, record dimensions, color, appearance (edema, fibrinous exudate, purulence). 2. Make a longitudinal section of the tip, just long enough to fit into a cassette. The serosal side may be inked to orient the tip for embedding. The remainder of the appendix is sectioned at 3 mm intervals Processing the appendix 3. Record the thickness of the wall, the diameter of the lumen (dilated, fibrosed, constricted), the condition of the mucosa (glistening, ulcerated, hyperemic), and the contents of the lumen: Fecalith- hard stony mass of feces in the intestinal tract Foreign body (e.g., seeds, gallstone calculus) Purulence or blood (acute appendicitis) Parasites (Oxyuris vermicularis) Mucin – may be associated with a mucocele (benign, mucus containing cyst) or a mucinous neoplasm (check for mucinous implants on serosa) Fibrous obliteration 4. Submit one longitudinal section of the tip and two transverse sections (one near the resection margin and one near the tip), including any abnormalities seen (perforations, ulcerations, serositis- (inflammation inside the appendix) If there is mucin accumulation in the lumen (i.e., a possible cystadenoma or cystadenocarcinoma) or an area suspicious for tumor, submit the entire appendix and submit the resection margin in a separate cassette. If the appendectomy was performed for appendicitis, and the appendix is grossly normal, the entire specimen must be submitted Cassettes for appendix Cassette #1: longitudinal section of tip and proximal margin, 2 frags, RSS. Cassette #2: cross sections including area of perforation, 4 frags, RSS * RSS -Representive section submitted * ESS- Entire specimen submitted  Complex specimen grossing Hysterectomy and Salpingo-Oophorectomy The type of hysterectomy (total or radical) and the disease (benign or malignant) determine the method for processing the specimen. Specimens fall into three categories: 1. Total hysterectomies for benign conditions (e.g., prolapse or fibroids). 2. Total hysterectomies for malignant conditions (e.g., endometrial carcinoma). 3. Radical hysterectomies for malignant conditions (e.g., cervical carcinoma) that include vaginal cuff, parametrium, and regional lymph nodes. Gynecologic Pathology Processing the specimen The entire specimen is submitted. One level is examined for women