Specimen Preparation:

Grossing and Sectioning

Manuelito A. Madrid, MD, FPSP

The Gross Lab Work Station
The Gross Lab Work Station
The Gross Lab Work Station
The Dissecting Area
The Dissecting Tools
Specimen identification
Assign each case a unique ID number
1 case = all samples derived from
same patient and performed on same
day
Identify and verify all components of
sample
Label of sample container: patient
name, birth date, hospital number
Specimen rejection
Discrepancies between requisition
and specimen label
Unlabeled or mislabeled specimens
Contaminated specimen/leaking
container
No clinical data/ history
Pathologists cannot accurately predict
clinical data from glass slides alone
Inappropriately identified specimen
Samples ready for gross study
Samples ready for gross study
Lost in translation
After specimen log, histotechnologist
hands over the case for gross study
(usually) to pathologist
After gross study, case is returned to
histotechnologist for processing of
tissue sections taken
In handing back the case, it is crucial
to convey clearly the salient points
and special instructions
Ideal: Comments space on worksheet
Gross study
Tissue must be fixed for 6-48 hours
and sectioned (5mm) for proper
fixative penetration
Gross worksheet
Accession no., number of sections and
blocks taken per case, manner of
embedding
Gross study
Samples for gross description only
Specimen submitted for documentation
purposes
No microscopic exam; no histologic
diagnosis
Special requests:
ex. abortus or calculi to be returned to
patient
Tissues for gross description only
Prepuce/foreskin Lens cataracts
Vaginal mucosa Nasal septum
Scars/cicatrix (rhinoplasty)
Foreign bodies (e.g., Calculi, stones
bullets, ortho/ Eyelid
medical devices, Placenta from normal
silicone implants) spontaneous delivery
Hair, fingernails and Teeth
toenails removed for Fetuses
cosmetic reasons
Gross examination and dissection
Each specimen approached with clear
goals in mind based on type of
specimen and reason/s for surgery
Identify all anatomic structures
present (may use diagrams)
Orientation markers
Inking (1 or more colors, liquid paper)
Nicking (usually for laterality)
Sutures: long lateral (LL), short-
superior (SS)
Gross examination and dissection
Measurements
Weights taken on intact specimens and in
nearest 0.1 grams
3 dimensions in nearest 0.1cm
Inking margins
Inking small samples may ensure that
the entire face of specimen fragment is
present on glass slide
When in doubt, ink
Gross examination and dissection
Artifactual ink in non-marginal areas
Blot specimens dry after inking, or
Allow specimen to air dry before cutting
to avoid such artifacts
Dissect specimen thoroughly
Identify pathologic processes
Take judicious, representative
histologic sections
Selection of tissue for microscopic
exam
All lesions
Lesional tissue placed in special
fixatives for histologic exam
ex. Decalcify, EM
Representative sections of all normal
structures not included in other
sections
Lymph nodes
All margins, when appropriate
Frozen section remnants
Special issues in processing
Lymph nodes: sample all!
Margins
En face: lesion 0.5cm away from margin
Perpendicular: lesion close/abutting
margin
Multiple lesions: sample all
if multiple similar lesions, tissue between
lesions is sampled to know whether
separate or connected
Other gross exam issues
Tissue thickness
<3mm, especially fatty tissues
Tissue cassette must not bulge when
closed (allow space)
Paper tags:
Use pencil or computer print (prefer dot
matrix), not pen or marker
Dissect fat away from lymph nodes
before loading
Other gross exam issues
Labeling of sections and blocks
Indicate number of sections and
blocks(cassettes) taken
Document samples taken systematically
Ex. A1: mass, S3B2, A2: margin,S1B1
Document color code of inked margins (if
>1 color)
Minute and multiple fragments
wrap tissues in filter paper or similar
material to prevent loss in processing
 Cutting area considerations
If specimen is entirely submitted for
processing, save specimen containers
in one area until case is signed-out
Problems with labels, laterality, lost
sample
Save biohazard waste bag from gross
processing room for an extra day to
allow for recovery of lost specimens or
cassettes if needed (inadvertently
thrown)
Thank you for your attention

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