Gross examination of soft tissue specimen

The role of preoperative biopsy is to distinguish a benign from a malignant tumour. A specific subtyping is less important at this stage.

FNA, frozen section or trucut biopsy should be interpreted by experienced pathologists.
The tumour may have heterogenous areas (fibrous pseudocapsule and surrounding reactive tissue), which may lead to sampling errors.
Trucut biopsy and FNA can be useful in establishing whether there is local recurrence of the tumour.

Excisional biopsy - The lesion is usually 'shelled out' and the margins are often inadequate. A thin rim of normal tissue is included in some cases.

To have an adequate incisional biopsy is the most reliable way to diagnose soft tissue tumour.
If the tumour is malignant a definitive surgery should be performed immediately including the biopsy site and tract to prevent possible spread of tumour from the biopsy site.

1. Grade of the tumour
2. Size
3. Positive margin or distance of the tumour from the nearest margin.
4. Depth of the tumour
5. Extent of necrosis
6. Relation of the tumour to other important structures
7. Cytology and growth pattern

Further reading:

Rosai and Ackerman's Surgical Pathology:CLICK HERE

Surgical Pathology Dissection : An Illustrated Guide by F.B. Askin (Foreword), et al:CLICK HERE

Macro Techniques in Diagnostic Histopathology : CLICK HERE

Histology for Pathologists by Stephen S., Md. Sternberg :CLICK HERE

Diagnostic Immunohistochemistry :CLICK HERE

Surgical Pathology.com ; Histopathology-India.net ; Eye Pathology Online ; Cardiac Path Online ; Pulmonary Pathology Online ; Soft Tissue Tumour Online; GI Path Online-India ; Pathology Quiz Online; Case Index ; Mesothelioma-Online ; Infectious Disease Online;

Modern pathological evaluation of soft tissue sarcoma specimens and its potential role in soft tissue sarcoma research.Curr Treat Options Oncol. 2004 Dec;5(6):441-50.

GROSS EXAMINATION:

If the specimen is orientated, it will be useful to draw a diagram.
Ink all the margins (use minimum 2 colours).

Gross examination includes:

Detailed description of the tumour:
-Size
-Colour
-Extent of necrosis ( more than 50% necrosis indicates bad prognosis.)
-Mucoid slimy areas,
-Gritty areas of calcification
-Cystic changes ,
-Areas of haemorrhage,

Distance of the tumour from various margins and vital structures.
(Clearly describe the fascial margins and the surgical cut margins.)

BLOCKS:

It is essential to get the right section.
Sections are taken from -

-Tumour
Ideally one section of the tumour taken for every centimeter of the maximum diameter of the tumour.
-Margins
-Viable tissue with necrosis.
-Tumour with surrounding structures.
-Any unusual area.

Fresh tissue should be kept for further studies-

1. Electron microscopy (tissue kept in glutaraldehyde)
2. Cytogenetics
3. Flow cytometry
4. Molecular studies