04 Pathologic Examination A. The Gross Description
Description
This article is from the The Biopsy Report: A Patient's Guide, by Ed Uthman uthman@neosoft.com with numerous contributions by others.
04 Pathologic Examination A. The Gross Description
The pathologist begins the examination of the specimen by dictating
a description of the specimen as it looks to the naked eye. This is
the "gross exam" or the "gross." Some pathologists may refer to the
gross exam as the "macroscopic." Most biopsies are small,
nondescript bits of tissue, so the gross description is brief and
serves mostly as a way to code which biopsy came from what area and
to use for troubleshooting if there is a question of specimen
mislabeling. A typical gross description of an endoscopic colon
biopsy follows:
"Polyp of sigmoid colon." An ovoid, smooth- surfaced,
firm, pale tan nodule, measuring 0.6 x 0.4 x 0.3 cm.
Cassette 'A', all, bisected.
In the above example, the first item (in quotes) is an exact
recitation of how the specimen was labeled by the doctor who took
the biopsy. After that is a textual description of what the specimen
looked like, followed by measurements indicating its size. The
"Cassette 'A', all, bisected" phrase indicates that the specimen was
cut in half ("bisected"), submitted for tissue processing in its
entirety ("all") in a small container (cassette) labeled "A," which
will eventually be placed in the tissue processor.
Larger organs removed as biopsies have correspondingly longer and
more detailed gross descriptions. The following is the gross
description of a spleen removed to assess whether Hodgkin's disease
(a cancer of lymph tissues) has spread into it:
"Spleen". An entire spleen, weighing 127 grams, and
measuring 13.0 x 4.1 x 9.2 cm. The external surface is
smooth, leathery, homogeneous, and dark purplish-brown.
There are no defects in the capsule. The blood vessels
of the hilum of the spleen are patent, with no thrombi
or other abnormalities. The hilar soft tissues contain
a single, ovoid, 1.2-cm lymph node with a dark grey cut
surface and no focal lesions
On section of the spleen at 2 to 3 mm intervals, there
are three well-defined pale-grey nodules on the cut
surface, ranging from 0.5 to 1.1 cm in greatest
dimension. The remainder of the cut surface is
homogeneous, dark purple, and firm.
Summary of cassettes: 1, hilar blood vessels; 2, hilar
lymph node, entirely submitted; 3 - 6 spleen nodules,
entirely submitted; 7 - 8, spleen, away from nodules.
In the spleen described above, the pathologist found a few lumps
(nodules), representing the most important data in this gross
examination. These possibly represent the tumors of Hodgkin's
disease, subject to confirmation by the microscopic examination.
Much of the remainder of the verbage relates to "pertinent
negatives," or things that were routinely looked for but not found,
such as a rupture of the spleen capsule (suggesting an
intraoperative accident), blood clots ("thrombi") in the vessels
supplying the spleen, and evidence of an infection (in which case
the cut surface of the spleen would be soft instead of firm). In
addition, a lymph node was serendipitously found adherent to the
spleen, and this was briefly described as having a normal
appearance.
The last paragraph of the gross description gives the identifying
"codes" of the slices of the specimen submitted for microscopic
examination in cassettes. The microscope slides prepared from the
processed samples will be labeled with the same numbers as the
cassettes, and the pathologist doing the microscopic examination
can, by referring to the typed gross description, know from what
part of the specimen the tissue on the slide came.
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