The Surgical Pathology Report
The surgical pathology report is a comprehensive statement that integrates the macroscopic and mi-croscopic findings. It represents the summation of efforts on the part of the prosector, the histotech-nologist, and the pathologist. Forms are now avail-able that have standardized the reporting of the pathologic findings in a comprehensive way. For the prosector facing a complex and intimidating specimen, the time to contemplate the content of the surgical pathology report is not after the dis-section is completed but before the first cut is even made. With this in mind, this manual describes the dissections of various specimens, including a tabulation of important issues to address in the surgical pathology report. These lists are provided so relevant clinical issues can be kept in mind as specimens are dissected, described, and sampled.
· Sections from the periphery of a tumor are usu-ally more informative than are sections from the center of a tumor.
· For heterogeneous tumors, sample all compo-nents of the tumor.
· For cystic lesions, sample areas of the cyst wall that are thickened or lined by a complex surface.
· If there is concern about a hidden focus ofmalignant transformation within a benign neoplasm or premalignant process (e.g., in-filtrating carcinoma arising in a pre-existing villous adenoma), the lesion should be ex-tensively, or even entirely, sampled for histo-logic evaluation.
· Always sample the specimen margins, even from lesions that are clinically thought to be benign (e.g., gastric ulcers).
· Perpendicular sections show the relationship of the lesion to the margin. Perpendicular sections are usually preferred to parallel sections, espe-cially when the margin is closely approached by the tumor.
· Shave (i.e., parallel) sections are sometimes best when the margin appears widely free of tumor or for samples of a cylindrical or tubular struc-ture (e.g., optic nerve or ureter margins).
· Orient the specimen, submit soft tissue mar-gins, and designate regional lymph node levels before dissecting the soft tissues for lymph nodes.
· Lymph nodes are easiest to find in unfixed tis-sues where they can be more readily appreci-ated by palpation.
· Lymph nodes larger than 5 mm should be sec-tioned to facilitate tissue fixation.
· Never submit multiple sections from more than one lymph node in a single tissue cassette.
· At least one representative section should be taken from each grossly normal structural com-ponent of the specimen.