1. TITLE : Criteria for Macroscopic Examination 2. PURPOSE: This policy addresses guidelines for performing gross examination of surgical pathology specimens. 3. POLICY: 3.1.All surgical specimens are dissected and described by pathology Resident. 3.2.All malignant, major surgical cases, cases with Frozen Section and biopsy requiring adequacy assessment (i.e. renal biopsies) are regularly reviewed by pathologists. 3.3.The adequacy of the tissue is done during the gross description and documentation of that statement is included in the final pathology report. 3.4.All tissues and organs removed or extracted from the patient shall be submitted to Anatomic Pathology for routine histopathology except surgical specimens submitted for “Gross Description only” (see specimen reception IPP03). These are submitted for documentation purpose only, no microscopic Examination is performed and so no histologic diagnosis shall be issued. 4. PROCEDURE: 4.1.SAFETY 4.1.1. Caution when handling reagents. Use disposable gloves when handling carcinogens or toxic materials. 4.1.2. Smoking, eating or drinking in areas where specimens or reagents are handled is strictly prohibited. 4.1.3. Avoid contact of reagents with eyes and/ or mucous membranes. If contact occurs with sensitive areas wash with plenty of water. 4.1.4. Patient’s specimens should be handled as biohazard materials and disposed of with standard precautions. 4.1.5. Review the Safety Data sheet (SDS) before handling reagents and solutions. 4.2.REAGENTS 4.2.1. 10% neutral buffered formalin. 4.2.2. Decalcifying solution. 4.2.3. India ink / Tissue marking dye. 4.2.4. Bouin’s fixative. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.com 4.3. SUPPLIES · Gross manual. · Gross station: fully and adequately equipped. · Dictation software and microphone headset. · Blades, Scissors, Forceps, Probes, Knives Magnifier Bone saw. Ruler. Lens paper Tissue cassettes Plastic apron Gloves (small, large, medium). Macropath-D (Camera) 4.4. Gross Cutting Time: Cutting is to begin at least by 9:00 AM every day. 4.5. SURGICAL PATHOLOGY GUIDE 4.5.1. If resident need help or was in doubt as how to proceed, he/she should ask questions to pathologist on duty. 4.5.2. In general, a pathologic description of tissue should include: · Patient’s name, pathology accession number and specimen number. · Clinical diagnosis and source of tissue. · Frozen section diagnosis, if performed. · Size (definite measurements), shape and weight (when indicated). · Location of the lesion in the tissue removed. · Size, color, consistency, relation to surrounding tissues (capsule, infiltration, etc.) relation to margins when pertinent. · Descriptions should be completely objective and in proper anatomical terms. · If a statement of adequacy, preliminary diagnosis, or recommendations for additional studies is provided at the open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.com time of tissue and cytology sample collection or gross examination, documentation of that statement is maintained and included in the final pathology report. · Know the anatomy of the part from which the tissue comes. If you do not, consult the grossing manual available at Grossing area or the surgeon who performed the operation. · After completion the description of specimen, a “Summary of Sections” must be dictated. This should include the meaning of each designation. It is extremely important that this be accurate. For uniformity, various blocks or sections be labeled with alphabet and numeric , i.e. A1, B1, C1 etc. 4.6.Gross dissection instructions 4.6.1. The primary section from any specimen should pass through the border of the lesion in order to show both the lesion and the adjacent tissue. In addition, one or more sections of the “normal” tissue should be taken depending on the lesion present. Any residual tissue is to be kept in “save” bottles. If a specimen is totally embedded, a label must be placed on an empty bottle and initialed and the phrase “totally submitted” should be included in the dictation. This indicates specimen has been processed. 4.6.2. Handle tissues gently. Do not rub or wash mucosal surfaces. If washing is necessary for photographic purposes, it should be done with care. 4.6.3. Sections in general are selected from the fresh material before fixation and must not exceed 4 mm in thickness (ideal thickness 2-3 mm). If tissues are too soft or friable, allow to fix until a thin section can be cut. If it is desired that a section be cut from a specific surface, that surface may be marked mercurochrome or India ink. Sections of bone, cut on the electric saw, are labeled and placed in cassettes in the usual way, and then deposited in special DECAL receptacles. 4.6.4. Photographic record of any unusual specimen is desirable and it is the responsibility of the cutter to arrange the specimen as it is to be photographed. If the specimen is in any way out of the ordinary, or has any unusual gross features of interest, it may be photographed in the camera bench adjacent to the cutting bench, and logged in the photography logbook. Frequently, members of the clinical staff request photographs of gross specimens. When such a specimen arrives in the laboratory, the cutter is notified so that he may prepare the specimen for photography promptly. Unnecessary delay must be avoided in order to prevent deterioration of tissue. Specimens received too late to be photographed on Thursday may be carefully sectioned for diagnosis. Care should be taken to preserve as much of the specimen as possible without sacrificing diagnostic material. 4.7.CUTTING SUGGESTIONS 4.7.1. Before putting the tissue in the cassette, make sure that the cassette has the appropriate accession number. 4.7.2. Do not make blocks too thick. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.com 4.7.2. Do not make blocks too thick. 4.7.3. Blocks should be no larger than 2 x 2 x 0.3 cm. 4.7.4. Do not crowd all lymph nodes into one cassette. 4.7.5. Remove sutures, clips and bone fragments. 4.7.6. Try to cut blocks with flat surface and squared corners. The length of the tissue block should be no more than 20 mm and the thickness ideally about 2-3 mm. it is absolutely mandatory that sections be thin or these will not properly be fixed. 4.7.7. The block used for frozen section must be embedded and designated “FS” for frozen section. 4.7.8. Usually one block for 1 cm. tumor size is recommended for adequate sampling of large tumors such as Wilms’ and sarcoma. 4.7.9. Place recuts in cassettes in the usual way. Mark the blocks as the next appropriate continues number. 4.7.10. Mark area to be cut with India ink. (Skin, epithelium, vessels, etc.) 4.7.11. Problems on surgical specimens will be called to pathologist attention by technicians. 4.7.12. Pathologists are responsible for all changes in numbers, etc. Technicians cannot make changes without the pathologist’s consent. All such changes should be brought to the attention of the supervisor of histology and of pathologists. 4.8. GROSS BRIEF GUIDELINES TABLE (for more details refer to GROSS Manual available in grossing room). No. Of No. Specimen GROSS GUIDELINES CASSETTES Note measurements of length and greatest diameter 1. Appendix 2-3 sections transverse and one longitudinal from the tip, if it 1-2 appears normal submit all. Note color and number, submit all. 2. Bladder chips 1-2 Wrap in a lens paper or sponge pads. Decalcify until the tissue is soft enough to cut The piece for decalcification should be small, thin if possible 3. Bone so it does not take long time to decalcify. 1-2 Immersing the tissue in LiCO3 for 5 min. then wash in running water should stop the action of the decalcifying solution. Note if opened or not, measure length, greatest diameter and wall thickness. 4. Gall bladder Note if gallstones are present or not. 1 One section from distal end and one from the duct. open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.com Put extra sections if there are suspicious or thickened areas. Note color and number, submit all wrap in a lens paper or 1 5. Liver Bx sponge pad. Weigh, note color and submit as follows: Prostatic chips · 10 grams or less→→ →→→→→→→→→→ Submit all >10 grams: 6. First 10grams→→→→→→→→→→→→→ 5 cassettes For every additional 10 grams→→→→→→ 2 cassettes · Note color, and average measurements. Weigh, note measurements, insertion of umbilical cord with Placenta length measurement and number of blood vessels Describe fetal surface and maternal surface. Any abnormal 4 7. appearance i.e. infarcts, solid areas indicating the percentage of placenta involvement should be indicated in gross description. Note color and measurements and any discoloration etc. Cut transverse sections, note the color of the cut surfaces, and submit all. 1 8. Skin Cases requested by clinician for IF( immunoflourescence) are bisected and submitted for frozen section and permanent if possible. Note color, measure, and color of cut surfaces, Adenoids 9. No tissue submitted unless abnormal areas are noted. None Note color, measure, and color of cut surfaces, No tissue 10. Tonsils None submitted unless abnormal areas are noted. Weigh, note measurements in aggregate. Products of open in browser PRO version Are you a developer? Try out the HTML to PDF API pdfcrowd.com Products of 11. conception Note if blood present, gestational sac. (POC) Look for fetal tissue.