Principles of gross pathology

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

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.

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.‡
• Document with images (photographs).

Note:

• ‡ If the tissue is studded with too many lesions to count this is impractical. Practically, four or five 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.

Note:

• It should be clear to people not in the gross room whether it was an en face margin or an on edge margin.

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

• Gross pathology.
• Specimen opening - also known as freshing.
• Marking ink.