Grossing of Mandibulectomy with radical neck dissection specimen for CA buccal mucosa

Received a Hemi/ Partial/ Middle third/ Extended mandibulectomy specimen

Measuring ---- cm along the alveolar margin.

---- teeth identified.

Externally , skin flap identified/ not identified measuring --- X --- cm. The skin shows/ does not show evidence of ulceration/ infiltration by the tumor.

An ulcerative/ ulceroproliferative/ polypoidal growth identified along the medial/lateral/anterior/posterior mucosae measuring --- X ---- X ---- cm in the greatest dimension.
On cutting open, ----- in colour,  ----- in consistency. Areas of haemorrhage/ necrosis present/ not present.

The distance of the growth from
Anterior mucosal margin is ----- cm
Posterior mucosal margin is ----- cm
Medial mucosal margin is ----- cm
Lateral mucosal margin is ----- cm
Anterior bony margin is ----- cm.

The ----- margins appear to be involved while ---- cm appear to be free of the tumour.

Also received a neck dissection specimen.

The submandibular gland identified superomedial to the sternomastoid muscle.

Level I Lymph nodes, ----- in number dissected.

Level II lymph nodes, ---- in number, Level III Lymph nodes, ---- in number and Level IV lymph nodes ---- in number, dissected along the upper, middle and the lower part of the sternomastoid.

Level V lymph nodes, ---- in number, dissected in the region posteroinferior to the stenomastoid.

Grossing of a CA Esophagus specimen

Received a esophagectomy/esophagogastrectomy specimen measuring -------- cm in length.

Esophagus measures  ------  cm in length.

Stomach measures ----- cm in length along the lesser curvature and ---- cm in length along the greater curvature. ( Wherever applicable)

Externally, the esophageal adventitia and the stomach appear ---- (UR/not UR)

A growth ulcerative/ ulceroinfiltrative/ polypoidal identified along the cervical/ mid esophagus/ distal esophagus measuring --- X --- X --- cm.

The distance of the growth from Proximal resection margin is ---- cm, from distal resection margin is ---- cm, from the gastroesophageal junction is ---- cm.

Externally, ------ in colour.

On cutting open, -------- in colour, with regular/ irregular borders, firm/ soft in consistency. The tumor appears to extend upto the submucosa/ muscularis propria/ adventitia

Areas of haemorrhage & necrosis identified/ not identified.

The rest of the esophageal mucosa appears ------.

Lymph nodes dissected
1. ----- in number above the tumor
2. ----- at the level of the tumor
3. ----- below the level of the tumor
4. ---- along the greater curvature
5. -----along the lesser curvature.
( 4 & 5 wherever applicable)

Standard sections to be taken for microscopy-
Proximal and distal esophageal margins, gastroesophageal junction, 4 sections from the tumor, 1 non- involved area of the esophagus and the stomach, Lymph nodes above, at and below the level of tumor.

Ink the adventitia before sectioning so that commenting on extention upto the adventitia is easier on microscopy.

Pulmonary Edema

Pulmonary Edema is accumulation of excess fluid in the interstitium or the alveolar airspaces of the lung parenchyma. The causes of Pulmonary Edema are mainly-

a. Cardiogenic- where backward venous congestion leads to accumulation of fluid in the interstitium and the alveoli. Examples- Left heart failure, Constrictive pericarditis etc.

b. Non cardiogenic- where primary injury to the alveolocapillary membrane leads to the edema. Examples- Pneumonia, any other toxin damaging the alveolocapillary membrane.

On microscopy, pink acellular fluid collection is seen in the interstitium initially and in long standing cases, in the alveoli. The lungs, on gross examination, are heavy and boggy in consistency.
 

Multinodular Goiter

  Goiter means enlargement of the thyroid gland. It can be -
 1. Simple( showing uniform enlargement of the gland) OR
 2. Multinodular

 Multinodular goiter may also eventually develop in long     standing cases of simple goiter.

Patients are frequently euthyroid but may eventually  progress into hypothyroidism. They present with markedly enlarged thyroid gland.

On gross examination, the entire gland is markedly enlarged in size. Externally, it shows multiple nodules of variable sizes, some of the nodules may show necrosis and hemorrhages.

On microscopy, follicles of varying sizes lined by cuboidal to flattened epithelium are seen. The colloid may show scalloping in few follicles. Besides this, there are abundant areas of haemorrhage and necrosis, as seen in the microscopic pic.

The problems associated with Multinodular Goiter are -

1. They tend to cause pressure effects by compressing the larynx and the esophagus.

2. Long standing goiters carry a definite risk of transformation into follicular carcinoma.

Introduction

Pathology is literally 'study' of diseases.

The study of diseases revolves around 4 principal factors-

1. Etiology ( Cause) - which may be Genetic or Acquired

2. Pathogenesis- It is the ' temporal' sequence of events right from the exposure of the tissue to the injurious agent to the development of clinical manifestations.

3. Morphologic changes- This involves the study of the Gross and Microscopic changes that occur in a cell/ tissue/ organ. Gross changes are usually described in terms of colour, consistency, size and shape.

4. Clinical manifestations- This includes
a. Signs- which the doctor elicits while examination and which indicate the presence of an underlying pathology
b. Symptoms- Which the patient presents with.
c. Complications
d. Prognosis.

Thus, any pathological entity must be described with respect to these factors.

Dr Pranav Patwardhan