Surgical and Autopsy- Exam 1
What is subglottic?
1.0 cm below the level of the true vocal cord to the inferior rim of cricoid cartilage
PT4a
2 sites
PT4b
3-5 sites
What is a pyramidal lobe of the thyroid?
3rd lobe of the thyroid
CPT code for Synovial cysts
83304
CPT code for bone resection
83309
Gross only CPT code
88300
CPT code for Fallopian tube for sterilization
88302
CPT code for finger/toe amputation, traumatic
88302
CPT code for incidental vagina mucosa
88302
What is an incidental thymus CPT code
88302
CPT code for Bone Fragment
88304
CPT code for Cartilage shavings
88304
CPT code for Soft tissue debridement
88304
CPT code for Tendon/tendon sheath
88304
CPT code for a Bartholins gland cyst
88304
CPT code for an inflammatory nasal or sinusoidal polyp
88304
CPT code for femoral head other than fx
88304
CPT code for hydatid of morgagni
88304
CPT code for induced abortion
88304
CPT code for joint loose body
88304
CPT code for lipoma
88304
CPT code for meniscus
88304
CPT code for soft tissue debridement?
88304
CPT code for tonsil and adenoids
88304
What is the CPT code for a mucocele?
88304
CPT code for Bone marrow bx
88305
CPT code for Endometrium bx/Curettings
88305
CPT code for Fallopian tube bx
88305
CPT code for Fallopian tube for ectopic pregnancy
88305
CPT code for Leiomyoma. uterine myomectomy w/o uterus
88305
CPT code for Muscle bx
88305
CPT code for Traumatic extremity amputation
88305
CPT code for a dental cyst?
88305
CPT code for a paranasal bx?
88305
CPT code for bone exostosis
88305
CPT code for cervix bx
88305
CPT code for endocervix bx/currettings
88305
CPT code for femoral head for fx
88305
CPT code for joint resection
88305
CPT code for labia bx
88305
CPT code for non traumatic amputation for fingers/toes
88305
CPT code for parathyroid gland?
88305
CPT code for placenta other than 3rd trimester, up to 28 weeks
88305
CPT code for soft tissue bx
88305
CPT code for spontaneous/missed abortion
88305
CPT code for synovium
88305
CPT code for thymus bx?
88305
CPT code for tongue bx
88305
CPT code for tonsil bx
88305
CPT code for trachea bx
88305
CPT code for uterus for prolapse
88305
CPT code for vaginal bx
88305
What is the CPT code for a Larynx Bx?
88305
What is the CPT code for a gingiva/Oral mucosa bx?
88305
What is the CPT code for a lip bx (needle/Wedge)?
88305
What is the CPT code for a lymph node bx?
88305
What is the CPT code for a nasal mucosa and nasopharynx/oropharynx bx?
88305
What is the CPT code for a salivary gland bx?
88305
CPT code for ureter bx and resection
88305, 88307
CPT code for Bone Bx
88307
CPT code for Mediastinum mass
88307
CPT code for Uterus LEEP and anything other than neoplastic/prolapse
88307
CPT code for an odontogenic tumor?
88307
CPT code for bone fragments, pathologic fx
88307
CPT code for cervical cone
88307
CPT code for lymph node resection
88307
CPT code for non traumatic amputation of extremity
88307
CPT code for placenta third trimester, 28 weeks +
88307
CPT code for soft tissue mass bx/simple excision
88307
CPT code for soft tissue mass- BX/Simple excision
88307
CPT code for thymus tumor?
88307
CPT code for total/lobe of thyroid
88307
What is the CPT code for a Partial/total resection of larynx?
88307
What is the CPT code for a Regional lymph node resection?
88307
What is the CPT code for a salivary gland other than bx?
88307
CPT code for a tonsil resected for tumor
88309
CPT code for extremity disarticulation
88309
CPT code for fetus w/dissection
88309
CPT code for neoplastic uterus
88309
CPT code for soft tissue extensive resection
88309
CPT code for tongue resection for tumor
88309
CPT code for total/subtotal resection of vulva
88309
What is the CPT code for a partial/total resection w/ regional lymph nodes?
88309
CPT code for decalcification
88311
CPT code for frozen sections:
88331 (main specimen) 88332 (each additional block on that specimen
CPT code for frozen section
88331 and 88332
CPT code for touch prep/squash prep
88333 (main specimen) 88334 (each additional)
CPT code for touch prep
88333 and 88334
PT1c2
Capsule ruptured before surgery or tumor on ovarian or Fallopian tube surface
The term "caking" is referring to?
Carcinomatosis
What is supraglottis?
Epiglottis down to the apex of the ventricle. Structures include (epiglottis, aryepiglottic folds, arytenoids, false vocal cords and the ventricle
what are the parts of a long bone such as femur
Epiphysis Metaphysis Diaphysis Apophysis (trochanter)
does ovary have epithelium or endothelium
Epithelium
PT4b
Evidence of gross vascular invasion or tumor thrombus in the great vessels
PT2a
Extension and/or implants on uterus and or Fallopian tubes and or ovaries
PT2b
Extension beyond serosa (mesentery)
PT4
Extension into the spinal canal or great vessels
PT4a
Extension into the spinal spinal canal
PT2b
Extension to and or implants on other pelvic tissues
What sections should you take on a uterus with non-atypical hyperplasia?
Extra section from each side
What should be on your differential for thyroid gland?
Follicular adenoma (benign) Multinodular or (simple) diffuse goiter Hashimotos thyroiditis (hurthle) Malignant: Papillary carcinoma (most common) Follicular carcinoma Medullary carcinoma Anaplastic (worst)
What should be on your differential for ovary? Metastatic cancer
Gastrointestinal carcinoma involving the ovaries is termed: Krunkenberg tumor
How should you gross parathyroids and why are they removed?
Generally evaluated intraoperatively Weigh it Measure it If large enough, ink it Section it Removed for Hyperparathyroidism Adenoma Hyperplasia secondary to chronic renal failure
what should be on your differential for ovary? sex cord stromal
Granulosa- Resemble granulosa of developing follicle Fibromas Fibrothecomas Thecomas (, fibrothecomas, thecomas = yellow fat droplets)
PT3b ""
Gross extra thyroidal extension invading only strap muscles (sternohyoid, sternothyroid, thyrohyoid, or omohyoid) from a tumor of any size
PT4b ""
Gross extra thyroidal extension invading pre vertebral fascia or encasing the carotid artery or mediastinal vessels from a tumor of any size
PT4a ""
Gross extra thyroidal extension invading subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve from a tumor of any size
What is most important for staging ovary cases
Implants, pelvic washings, and intactness
PT4 ""
Includes gross extrathyroidal extension beyond the strap muscles
PT3
Invades another organ
PT2a
Invades serosa or visceral peritoneum
PT1a
Invasive carcinoma dx by microscope only.
What is the margin of a hemithyroidectomy?
Isthmus
PT4
Multifocal involvement
Medullary carcinoma
Neuroendocrine neoplasm Solitary nodule, firm, light gray to tan, infiltrative
Does size of the cyst correlate to malignancy?
No
How many sections of the tumor should you take
One section per CM if it is heterogeneous no more than 1 section of necrotic tumor. most tumors require 12 sections or fewer, excluding margins
How many sections should you take for soft tissue tumors
One section per cm
PT1 of abdomen and thoracic visceral organs
Organ confined
Grossing the thyroid:
Orient the thyroid Weigh it Measure left lobe, right lobe, and isthmus Examine for parathyroids Indicate which ones are present and measure them Describe the capsule (intact or disrupted) Measure disruption and indicate where it is Ink the gland One color Differentially anterior/posterior Serially section superior to inferior Describe any lesions - size, color, consistency Well-circumscribed, encapsulated Infiltrative, papillary projections, cystic, hemorrhage If thyroid is for frozen, do touch prep on lesion Indicate where the lesion is located - superior/inferior pole, left/right Relationship of lesion to gland's capsule Describe remaining parenchyma Dark red, pale, nodular
What is a partial vulvectomy
Orientation by the surgeon is necessary Basically a large skin
what is the only true margin on a uterus specimen
Parametrium
What should be on your differential for ovary? Germ cell tumors
Teratoma, mature and immature Benign (mature) can be bilateral (10%-15%)=dermoid cyst Immature= may be malignant Unilocular cyst with hair and sebaceous material, tooth, calcifications Dysgerminoma-usually malignant same as seminoma Yolk sac tumor Mixed germ cell
What sections should you take on a uterus with atypical hyperplasia
The entire endometrium must be submitted + your regular sections
PT1 for endometrial tumor
Tumor confined to the corpus uteri, including endocervical glandular involvement
PT1 for nasopharynx
Tumor confined to the nasopharynx, or extension to the oropharynx and/or nasal cavity without parapharyngeal involvement
PT1 for vulva
Tumor confined to the vulva or perineum
PT2
Tumor confined to three adjacent vertebral segments
PT1 of vagina cancer
Tumor confined to vagina
PT1b
Tumor confined to vagina, >2.0cm
PT1a
Tumor confined to vagina, less than or equal to 2.0 cm
PT4b
Tumor encasement of external iliac vessels or presence of gross tumor thrombus in major pelvic vessels
PT3
Tumor extending to pelvic side wall and or causing hydronephrosis or nonfunctioning kidney
PT3
Tumor extending to the pelvic sidewall and or involving the lower third of the vagina and or causing hydronephrosis or nonfunctioning kidney
PT3b
Tumor extending to the pelvic wall and or causing hydronephrosis or nonfunctioning kidney
PT3 of the nasal cavity and ethmoid
Tumor extends to invade the medial wall or floor of the orbit, maxillary sinus, palate, or cribiform plate
PT2 ""
Tumor extends to supra glottis and/or sub glottis and/or with impaired vocal cord mobility
PT2 ""
Tumor extends to vocal cords with normal or impaired mobility
PT2
Tumor extension into tissue beyond organ
PT2a
Tumor greater than or equal to 8cm
PT3 of maxillary sinus
Tumor invades any of the following bone of the posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, ptreygoid fossa, ethmoid sinuses
PT2 ""
Tumor invades more than one subsite of hypo pharynx or an adjacent site, or measures larger than 2 cm but not larger than 4cm in greatest dimension without fixation of hemilarynx
PT2 ""
Tumor invades mucosa of more than one adjacent subsite of supraglottis (Mucosa of BOT, vallecula, medial wall of pyriform sinus) without fixation of the larynx.
PT4
Tumor invades the bladder mucosa and or bowel mucosa (bullous edema is not sufficient to classify as t4)
PT4
Tumor invading mucosa of the bladder or rectum and or extending beyond the true pelvis
PT1b
Tumor invading one half or more of the myometrium (>50%)
PT2
Tumor invading paravaginal tissues but not to pelvic sidewall
PT2a
Tumor invading paravaginal tissues but not to pelvic wall, less than or equal to 2cm
PT2b
Tumor invading paravaginal tissues, but not to pelvic wall, >2 cm
PT4
Tumor invading the mucosa of the bladder or rectum and or extending beyond the true pelvis
PT2
Tumor invading the stroll connective tissue of the cervix but not extending beyond the uterus. this does NOT include endocervical glandular involvement
PT2 of the nasal cavity and ethmoid
Tumor invading two subsites in a single region or extending to involve an adjacent region within the nasoethmoidal complex, with or without bony invasion
PT1b ""
Tumor involves both vocal cords
PT2
Tumor involves one or both ovaries or Fallopian tubes with pelvic extension below pelvic brim or primary peritoneal cancer
PT3
Tumor involves one or both ovaries or Fallopian tubes; or primary peritoneal cancer with microscopically confirmed peritoneal mets outside the pelvis and or mets to retroperitoneal lymph nodes
PT4a
Tumor involves sacroiliac joint and extends medial to the sacral neuroforamen
PT3a
Tumor involves serosa and or adnexa (direct extension or metastasis)
PT3a
Tumor involving lower third of the vagina but not extending to the pelvic wall
PT3
Tumor involving the serosa, adnexa, vagina, or parametrium
PT1 of maxillary sinus
Tumor is limited to maxillary sinus mucosa with no erosion or destruction
PT2 ""
Tumor larger than 2 cm but no larger than 4 cm in greatest dimension
PT2 ""
Tumor larger than 2 cm but not larger than 4 cm in greatest dimension without extraparenchymal extension
PT2 ""
Tumor larger than 2 cm, but not larger than 4 cm in greatest dimension
PT3 ""
Tumor larger than 4 cm and/or tumor having extraparenchymal extension
PT3 ""
Tumor larger than 4 cm in greatest dimension or extension to lingual surface of epiglottis
PT1a ""
Tumor less than or equal to 1 cm in greatest dimension limited to the thyroid
PT1
Tumor less than or equal to 2 cm
PT1 for papillary, follicular, poorly differentiated, hurthle cell and anaplastic thyroid carcinoma
Tumor less than or equal to 2 cm in greatest dimension, limited to the thyroid
PT2 ""
Tumor less than or equal to 2 cm, DOI greater than 5 mm and less than or equal to 10 mm or tumor greater than 2 cm but less than or equal to 4 cm and less than or equal to 10 mm DOI
PT1 for cancer of the lip and oral cavity
Tumor less than or equal to 2 cm, less than or equal to 5 mm DOI
PT1 for appendicular skeleton, trunk, skull, and facial bones
Tumor less than or equal to 8 cm in greatest dimension
PT3a
Tumor less than or equal to 8cm
PT1a
Tumor less than or equal to 8cm in greatest extension
PT1b
Tumor limited to both ovaries (capsules intact) or Fallopian tubes, no tumor on ovarian or Fallopian tube surface and no malignant cells In ascites or peritoneal washings
PT3 ""
Tumor limited to larynx with vocal cord fixation and/or invasion of paraglottic space and/or inner cortex of thyroid cartilage
PT1c
Tumor limited to one or both ovaries or Fallopian tubes with any of the following
PT1a
Tumor limited to one ovary (capsule intact) or Fallopian tube, no tumor on ovarian or Fallopian tube surface; no malignant cells in ascites or peritoneal washings
PT1 for hypopharynx
Tumor limited to one subsite of hypopharynx and/or 2 cm or smaller in greatest dimension
PT1 for the supraglottis
Tumor limited to one subsite of supraglottis with normal vocal cord mobility
PT1a ""
Tumor limited to one vocal cord
PT1 for the sub glottis
Tumor limited to subglottis
PT1a
Tumor limited to the endometrium or invading less than half the myometrium (<50%)
PT3 ""
Tumor limited to the larynx with vocal cord fixation and/or invades any of the following: postcricoid area, pre epiglottic space, paraglottic space, and/or inner cortex of thyroid cartilage
PT3 ""
Tumor limited to the larynx with vocal cord fixation and/or invasion of paraglottic space and/or inner cortex of thyroid cartilage
PT1 for ovary
Tumor limited to the ovaries (one or both) or fallopian tube(s)
PT1 for the glottis
Tumor limited to the vocal cords (may involve anterior or posterior commissure) with normal mobility
PT3 ""
Tumor measures larger than 4 cm in greatest dimension or with fixation of hemilarynx or extension to esophagus
PT3 ""
Tumor more than 4 cm in greatest dimension or extension to lingual surface of epiglottis
PT2
Tumor of any size with extension to adjacent perineal structures (lower/distal third of urethra, lower/distal third of vagina, anal involvement)
PT3
Tumor of any size with extension to any of the following: upper/proximal 2/3 of the urethra, upper/proximal 2/3 of the vagina, bladder mucosa, or rectal mucosa, or fixed to pelvic bone
What are excrescences
Tumor on surface of ovary
PT1 of the nasal cavity and ethmoid
Tumor restricted to any one subsite, with or without bone invasion
PT4
Tumor spanning 3 pelvic segments or crossing the sacroiliac joint
PT3
Tumor spanning two pelvic segments with extraosseous extension
PT4b
Tumor with brain parenchymal invasion, carotid artery encasement, pre vertebral muscle invasion, or CNS involvement via perineural spread
PT2 ""
Tumor with extension to parapharyngeal space, and or adjacent soft tissue involvement (medial pterygoid, lateral pterygoid, pre vertebral muscles)
PT3 ""
Tumor with infiltration of bony structures at skull base, cervical vertebra, pterygoid structures, and/or paranasal sinuses
PT4 ""
Tumor with intracranial extension, involvement of cranial nerves, hypo pharynx, orbit, parotid gland, and/or extensive soft tissue infiltration beyond the lateral surface of the lateral pterygoid muscle
PT4
Tumor with invasion of adjoining structures
PT4a
Tumor with orbital invasion, skull base/dural invasion, invasion of central compartment viscera, involvement of facial skeleton, or invasion of pterygoid muscles
PT2b
Tumor with parametrial invasion
PT2a
Tumor without parametrial invasion
What needs to be included in your gross for a pharynx?
Type of procedure Tumor site (oropharynx, nasopharynx, hypo pharynx) Tumor laterality Tumor Focality Tumor size _x_x_ Margins Lymph nodes
is it ok to use CT or MRI measurments of the tumor for Pt (staging) if the specimen is fragmented and an accurate measurement cannot be obtained?
Yes
Is describing the fluid in the cysts important?
Yes it is, is it sticky or gelatinous
PT1b
lesions more than 2 cm or any size with stromal invasion more than 1.0 mm, confined to the vulva and/ or perineum
What is placenta increta
penetration of villi into the myometrium
What is placenta accreta
penetration of villi through decidua basalis up to myometrium
Should you map out Ewing sarcoma
yes
is it important to snap freeze a small portion of tissue whenever possible?
yes
should you check the pt hx for radiology reports
yes
how to gross an ovary
-Weight -Overall measurement -Describe the outer surface Incidental and unremarkable: outer surface is generally pink-white and bosselated Some malignancies may involve the surface -Open carefully, describe fluid Serous, mucinous, sebaceous Can collect fluid -Examine the lining inside Do not rub the surface Smooth or papillary excrescences -Describe any solid areas Identify any remaining ovarian stroma Corpus luteum, corpus albicans -One section per centimeter -Gross fallopian tube if attached
What are the 5 types of neck dissections you could receive with a larynx?
1. Radical 2. Modified radical- Internal jugular vein and/or sternocleidomastoid muscle spared 3. Selective Neck dissection (SND)- Less than the 5 traditional levels 4. Superselective neck dissection (SSND)- 2 levels or less 5. Extended radical neck dissection.
What is transglottic
1.0 cm above the false cord down to the cricoid cartilage
What are the most common tumors of the endometrium
Adenocarcinoma (most common) MMMT-Big and bulky Serous carcinoma P53, most aggressive
Anaplastic carcinoma
Aggressive, mortality rate of 100% within 1yr Rapid enlarging, bulky Generally already spread throughout the neck
Segmental/wide resection
An intracompartmental resection. a single piece of bone is resected. including the lesion and a cuff of normal bone
Follicular carcinoma
Areas with dietary iodine deficiency (25% to 40%) Single nodules, well circumscribed or infiltrative Difficult to distinguish from follicular adenoma on gross Most frequently a "cold" nodule on scintigram (hyperfunctional nodules are "warm")
Papillary carcinoma
Associated with ionizing radiation Solitary or multifocal Some well circumscribed with intact capsule, others infiltrative Cut surface can have papillary projections, be cystic or calcified Microscopically "Orphan Annie eye nuclei" Concentric calcifications are psammoma bodies
What should be on your differential for ovary? transitional cell
Brenner tumor Cells resemble urothelium Solid or cystic, unilateral,
PT1 Cervix
Cervical carcinoma confined to the uterus (extension to corpus should be disregarded
PT2
Cervical carcinoma invading beyond the uterus but not to the pelvic wall or to lower third of the vagina
What is the most important thing to do before grossing a uterus?
Check the patients HX
What should be on your differential for bone tumors
Chondrosarcoma Osteosarcoma Fibrosarcoma Myeloma Angiosarcoma Leiomyosarcoma Liposarcoma Ewing sarcoma
PT2a1
Clinically visible lesion 4.0 cm or less
PT1b1
Clinically visible lesion 4.0 cm or less in greatest dimension
PT1b
Clinically visible lesion confined to the cervix or microscopic lesion greater than t1a1 and 2
PT1b2
Clinically visible lesion more than 4.0 cm
PT2a2
Clinically visible lesion more than 4.0 cm
What is a radical vulvectomy
Complicated with numerous resection margins Photos are beneficial Soft tissue and skin margins need to be inked If theres attached fat, search for lymph nodes and separate L and R
What falls under a bone bx
Core needle curettage excisional bx
Tumor thickness/DOI
DOI (PLUM LINE) is the microscopic measurement and is a valuable parameter for predicting nodal involvement and survival. it is measured from the adjacent basement membrane down.
PT3 ""
Discontinuous tumors in the primary bone site
Margins
It has been recommended that for all margins <2cm, the distance of the tumor from the margin be reported in CM. Recommend specifying the location of all margins <2cm. Margins from bone tumors should be taken perpendicular. if the tumor is >2cm from the margin, the marrow can be scooped out and submitted as margin
What is the waldeyer ring?
It is formed by a ring or group of extranodal lymphoid tissues about the upper end of the pharynx which consists of the: -Palatine tonsils -pharyngeal tonsils -base of tongue/lingual tonsils -adjacent submucosal lymphatics
What is an intralesional resection?
Leaving gross tumor behind. partial debulking or curettage
PT1a
Lesions 2 cm or less, confined to the vulva and or perineum, and with stromal invasion of 1.0 mm or less
Why do you get vulva specimens?
Lichen sclerosis (hyperkeratosis) HPV infection, syphilis Squamous dysplasia and neoplasia Vulvar biopsies Vulvectomies Only done if Invasive squamous carcinoma or Carcinoma in-situ
What should be on your differential for soft tissue tumors?
Liposarcoma Fibrosarcoma Leiomyosarcoma Rhabdomyosarcoma angiosarcoma (Kaposi sarcoma) MPNST Chondrosarcoma osteosarcoma synovial sarcoma
PT3b
Macroscopic peritoneal mets beyond pelvis 2 cm or less with or without mets to retroperitoneal lymph nodes
PT3c
Macroscopic peritoneal mets beyond pelvis more than 2 cm with or without mets to the retro lymph nodes (includes extension of tumor to capsule of liver and spleen without parenchymal involvement of either organ)
PT1c3
Malignant cells in ascites or peritoneal washings
PT1a1
Measured stromal invasion of 3.0mm or less in depth and 7.0 mm or less in horizontal spread
PT3a
Microscopic extra pelvic peritoneal involvement with or without positive retroperitoneal lymph nodes
PT4a ""
Moderately advanced disease. Tumor invades cricoid or thyroid cartilage and/or invades tissues beyond the larynx (trachea, soft tissues of the neck including deep extrinsic muscles of the tongue, strap muscles, thyroid, or esophagus)
PT4a ""
Moderately advanced disease. tumor invades skin, mandible, ear canal, and/or facial nerve.
PT4a:
Moderately advanced disease. tumor invades the larynx, extrinsic muscle of tongue, medial pterygoid, hard palate, or mandible
PT4a ""
Moderately advanced disease: tumor of any size with gross extrathyroidal extension into the nearby tissues of the neck, including subcutaneous soft tissue, larynx, trachea, esophagus, or recurrent laryngeal nerve
PT4a ""
Moderately advanced local disease Lip: Tumor invades through cortical bone or involves the inferior alveolar nerve, floor of mouth, or skin of face (chin or nose) Oral cavity: Tumor invades adjacent structures only (through cortical bone of the mandible or maxilla, or involves the maxillary sinus or skin of the face)
PT4a of maxillary sinus
Moderately advanced local disease. Tumor invades any of the following: anterior orbital contents, skin of nose or cheek, minimal extension to anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses.
PT4 ""
Moderately advanced local disease. Tumor invades larynx, extrinsic muscle of tongue, medial pterygoid muscles, hard palate, or mandible or beyond
PT4a ""
Moderately advanced local disease. Tumor invades the larynx, extrinsic muscle of the tongue, medial pterygoid, hard palate, or mandible
PT4a ""
Moderately advanced local disease. Tumor invades through the outer cortex of thyroid cartilage and/or invades tissues beyond the larynx (trachea, soft tissues of neck including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus)
PT4a of the nasal cavity and ethmoid
Moderately advanced local disease. tumor invades any of the following: anterior orbital contents, skin of nose or cheek, minimal extension to anterior cranial fossa, ptreygoid plates, sphenoid or frontal sinuses.
PT4a
Moderately advanced local disease. tumor invades through the outer cortex of the thyroid cartilage and/or invades tissues beyond the larynx (trachea, cricoid cartilage, soft tissues of neck including deep extrinsic muscles of the tongue, strap muscles, thyroid, or esophagus)
PT4 of maxillary sinus
Moderately advanced or very advanced local disease
PT1a2
More than 3.0mm and not more than 5.0mm, with a horizontal spread of 7.0mm or less
PT4c
More than 5 sites
Example of a uterus dictation
Part A is received fresh labeled "Blah" and "uterus." It consists of a 400g uterus which is 11.5 cm from fundus to cervix, 7.0 cm cornu to cornu, and 5.0 cm anterior to posterior. The serosa is tan-pink and contains adhesions on the posterior aspect. The 3.0 x 3.0 cm tan-white exocervix contains a 0.5 cm slit-like os. The 4.5 x 4.0 cm triangular endometrial cavity is tan and focally hemorrhagic. The endometrium is 0.2 cm thick. The 2.8 cm thick myometrium is tan and trabeculated. There are four intramural white whorled nodules in the myometrium on the anterior side ranging from 0.5 x 0.4 x 0.4 cm to 3.5 x 2.0 x 1.5 cm. The endocervical canal is tan and corrugated. Representative sections are submitted as follows: Sections: A1: Anterior cervix (or endo-ectocervix) A2: Posterior cervix (or endo-ectocervix) A3: Anterior endomyometrium to include intramural nodule A4: Posterior endomyometrium A5: Serosal adhesions If adnexa was present: A6: Right fallopian tube A7: Right ovary A8: Left fallopian tube A9: Left ovary
Example of ovary dictation
Part A is received fresh labeled "blah" and "right ovary and fallopian tube." It consists of a 50g, 25.0 x 20.5 x 20.0 cm cyst with attached 5.0 x 0.5 cm fimbriated fallopian tube. The outer surface is smooth. The cyst is filled with tan, serous fluid. The inner surface contains focal areas of papillary excrescences. No residual ovarian stroma is identified. The fallopian tube is tan-pink with multiple paratubal cysts ranging from 0.3 cm to 0.5 cm. Sectioning reveals a pinpoint stellate lumen. Representative sections are submitted as follows: A1-A6: Cyst to include papillary excrescences A7: Fallopian tube
Example of a thyroid gross
Part A is received fresh labeled with the patient's name, "Crawley, Mary" and "total thyroid." It consists of a 75g total thyroid with a 6.5 x 4.0 x 3.5 cm right lobe, 7.0 x 5.5 x 3.5 cm left thyroid, and a 3.0 x 2.5 c 2.0 cm isthmus. The specimen is inked black and sectioned from superior to inferior to reveal a 3.5 x 3.0 x 2.0 cm tan, well circumscribed, encapsulated nodule in the right superior pole which abuts the thyroid capsule. The remaining parenchyma is dark red and unremarkable. There is a 0.4 x 0.3 x 0.3 cm tan, ovoid nodule adherent to the right inferior pole of the thyroid that is consistent with a parathyroid. Representative sections are submitted as follows: A1- A2: Nodule to thyroid capsule; A3-A4: Remainder of nodule in its entirety; Evaluating the lesion's capsule will determine adenoma vs. carcinoma A5: Uninvolved right lobe; A6: Isthmus; A7: Left lobe; A8: Possible parathyroid
What is placenta percreta
Penetration of villi through the myometrium, into and through the serosa
What should be on your differential for Salivary gland tumors
Pleomorphic Adenoma (most common) Warthin tumor (second most common) Mucoepidermoid carcinoma Adenoid cystic carcinoma
What parts of the cap protocol should be included in your gross?
Procedure Tumor site Tumor laterality Tumor locality Tumor size _X_X_ Margins: Involved or uninvolved and distance Lymph nodes
What needs to be included in your gross for a bone resection?
Procedure Tumor site Tumor location Tumor size _x_x_ % necrosis margins Mass to closest margin extent of mass decalcification
What should be included in your gross for cancers of the lip and oral cavity?
Procedure Tumor site (lip/oral) Tumor laterality Tumor focality Tumor size __x__x__ Tumor DOI ___mm Tumor extension (if any) Margins Nodes if any
What should be included in your gross?
Procedure Tumor site (supraglottis,glottis, transglottic) Tumor laterality Tumor focality Tumor size Tumor extension Margins Lymph nodes (if present) -could also include vocal cord integrity
What needs to be included In your bone bx gross?
Procedure tumor site (appendicular, spine, pelvis) Tumor location (epiphysis, metaphysis, diaphysis, cortex, medullary cavity, surface, joint, soft tissue) Necrosis % Tumor size if possible decalcification
What should be included in your gross for ovary and tube
Procedure type Hysterectomy type Specimen integrity Tumor site ovarian surface involvement/Fallopian tube surface Tumor size _x_x_ Implants other tissues/organs involved
What should be included in your gross of a cervix
Procedure type Hysterectomy type tumor size _x_x_ Tumor site (clock face) Stromal invasion Other tissue/organ involvement Margins Differentially ink (anterior blue, posterior black. maybe an orange dot at 12) Open at 12 DOI
What should be included in your gross for a thyroid gland?
Procedure type Tumor focality Tumor site Tumor size _x_x_ margins (superficial and deep surface) Whether there are parathyroid glands present Lymph nodes Extrathyroidal extension
What should be included in your gross?
Procedure type Tumor site Tumor size _x_x_ % necrosis Margins and how close the tumor is to each Lymph nodes if present
What needs to be included in your gross for salivary glands?
Procedure type Tumor site (parotid, submandibular, sublingual) Tumor laterality Tumor focality Tumor size _x_x_ Weight Tumor extension Margins Lymph nodes
What needs to be included in your gross of a vagina resection
Procedure type Tumor site (upper, middle, lower third) Tumor size Other tissue involvement margins nodes
What should be included in your gross for a vulvectomy
Procedure type tumor site (right vulva, left vulva, clitoris) Tumor size _x_x_ Tumor focality DOI in mm Tumor border (pushing or infiltrating) Other tissues involved Margins
Upper alveolar ridge
Refers to the mucosa overlying the alveolar process of the maxilla, which extends from the line of attachment of mucosa in the upper gingival buccal gutter to the junction of the hard palate. its posterior margin is the upper end of the pterygopalatine arch
What is a marginal resection?
Removing the tumor and its pseudo capsule with a relatively small amount of adjacent tissue. there is no gross tumor at the margin; however, microscopic tumor may be present. note that occasionally, a surgeon will perform an "excisional" Bx, which effectively accomplishes the same thing
What should be on your differential for cancers of the lip and oral cavity?
SCC
What should be on your differential for nasal cavity and sinusoidal tumors?
SCC
What should be on your differential for tumors of the Larynx?
SCC
What should be on your differential for vagina carcinoma
SCC
What should be on your differential?
SCC Mucinous carcinoma Endocervical adenocarcinoma
What should be on your differential for vulva cases
SCC Adenocarcinoma
What should be on your differential for cancers of the pharynx?
SCC (hpv positive or negative)
PT1- PT3b medullary thyroid carcinoma
Same as the PT1-PT3b as papillary, follicular,
How are tumors of the nasal cavity and ethmoid sinus staged?
Same as the maxillary. it is all dependent on extent into other tissues
Hard Palate
Semilunar area between the upper alveolar ridge and the mucous membrane covering the palatine process of the maxillary palatine bones. it extends from the inner surface of the superior alveolar ridge to the posterior edge of the palatine bone
What sections should you take for thyroid for goiter
Should include any encapsulated nodules Depending on size and amount of nodules At least one section of each nodule (up to five nodules) if homogeneous Always sample nodules with different appearances If parenchyma is diffusely nodular, may submit 2-3 sections per lobe, plus sections from isthmus Sample any nodules that have had an FNA
Ovary 3 general appearances
Simple cyst: thin-walled, no solid areas; mostly benign Complex cyst: may or may not have solid component Solid tumors: predominantly solid with some cystic areas Before popping, weigh it. You section 1 section per cm. if its 30 cm You can take 30 sections. 3 sections per cassette for 10 cassettes
What is important for staging lip and oral cavity cancers?
Size (2->4cm) DOI (5->10mm) extent into other structures
PT1c1
Surgical spill
What is hypopharynx
The hypopharynx is the portion of the pharynx extending from the plane of the superior border of the hyoid bone (or floor of the vallecula) to the plane corresponding to the lower border of the cricoid cartilage. the contents of the hypopharynx include: -piriform sinus (right and left)- represents part of the hypopharynx which extends bilaterally and forward around the sides of the larynx and lies between the larynx and the thyroid cartilage. -lateral and posterior hypopharyngeal walls -postcricoid region extending from the level of the arytenoid cartilage and connecting folds to the inferior border of the cricoid cartilage. It connects the 2 piriform sinuses, thereby forming the anterior wall of the hypopharynx
Mucosal lip
The lip begins at the junction of the vermillion border with the skin and includes only the vermilion surface or that portion of the lip that comes in contact with the opposing lip. it is well defined into an upper and lower lip joined at the commissures of the mouth
What is most important in staging of thyroid cancers?
The most important thing is the capsule integrity, invasion, and size of the mass. if the tumor extends beyond the capsule you end up with a higher stage.
What is nasopharynx?
The nasopharynx is situated behind the nasal cavity and above the soft palate. it begins anteriorly at the posterior choana and extends along the plane of the airway to the level of the free border of the soft palate. the contents of the nasopharynx include: -nasopharyngeal tonsils (adenoids) lie along the posterior and lateral of the nasopharynx -orifice of Eustachian tube lies along the lateral aspects of the nasopharyngeal wall -fossa of rosenmuller (pharyngeal recess)
What is the oropharynx?
The oropharynx is the portion of the continuity of the pharynx extending from the plane of the superior surface of the soft palate to the superior surface of the hyoid bone or floor of the vallecula. the contents of the oropharynx include: -Soft palate -Palatine tonsils -Anterior and posterior tonsil pillars -Tonsillar fossa and tonsillar (faucial) pillars -Uvula -Base of tongue, including the lingual tonsils -vallecula -posterior oropharyngeal wall
Radical resection
The removal of an entire bond, or the excision of the adjacent muscle groups if the tumor is extra compartmental
How do you orient a uterus with adnexa?
The serosa should be shorter on the front due to the bladder The round ligament will be most anterior The ovary will be most posterior
How are Maxillary sinus tumors staged?
The staging is based off extent of the tumor and whether it extends into adjacent structures
How are tumors of the Larynx staged?
They're staged based off of extent into other organs/tissues
Buccal mucosa (inner cheek)
This includes all the membrane lining of the inner surface of the cheeks and lips from the line of contact of the opposing lips to the line of attachment of mucosa of the alveolar ridge and pterygomandibular raphe
What is a uterine cervix excision?
This is going to be the cone or Leep specimens
Retromolar gingiva (retromolar trigone)
This is the attached mucosa overlying the ascending ramus of the mandible from the level of the posterior surface of the last molar tooth and the apex superiorly. adjacent to the tuberosity of the maxilla
Anterior 2/3 of the tongue (oral tongue)
This is the freely mobile portion of the tongue that extends anteriorly from the line of circumvallate papillae to the undersurface of the tongue at the junction of the floor of the mouth. it is composed of 4 areas: the tip, the lateral borders, the dorsum, and the undersurface (nonvillous ventral surface of the tongue).
Lower alveolar ridge
This refers to the mucosa overlying the alveolar process of the mandible, which extends from the line of attachment of mucosa in the buccal gutter to the line of free mucosa of the floor of the mouth. posteriorly it extends to the ascending ramus of the mandible.
What is a TAHBSO
Total abdominal hysterectomy bilateral salpingo oophorectomy
What is a total vulvectomy
Total vulvectomy Includes everything surrounding the vagina Orient Inguinal fat (superior on either side) Clitoris (superior, midline) Labia majora (laterally) Treat like a skin case Can ink one color or do L/R Margins= soft tissue and skin
PT1 for HPV negative oropharynx
Tumor 2 cm or smaller in greatest dimension
PT1 for HPV-Mediated (positive) oropharynx
Tumor 2 cm or smaller in greatest dimension
PT1 for salivary gland tumors
Tumor 2 cm or smaller in greatest dimension without extraparenchymal extension
PT1 of retroperitoneum tumors
Tumor 5 cm or less
PT1 for trunk and extremities
Tumor 5 cm or less in greatest dimension
PT3
Tumor >10 cm and less than or equal to 15 cm
PT3
Tumor >10cm but less than or equal to 15
PT4
Tumor >15 cm
PT1b ""
Tumor >1cm but less than or equal to 2 cm in greatest dimension, limited to the thyroid
PT2
Tumor >2 cm to less than or equal to 4 cm
PT2 ""
Tumor >2cm but less than or equal to 4 cm limited to the thyroid
PT3
Tumor >4 cm
PT3 ""
Tumor >4 cm or any tumor > 10 mm DOI
PT3 ""
Tumor >4cm limited to the thyroid, or gross extra thyroidal extension invading only strap muscles
PT3a ""
Tumor >4cm limited to thyroid
PT2
Tumor >5 cm and less than or equal to 10 cm
PT2
Tumor >5cm but less than or equal to 10
PT2b
Tumor >8 cm
PT3b
Tumor >8cm
PT1b
Tumor >8cm in greatest dimension
PT2 ""
Tumor >8cm in greatest dimension
PT2 of maxillary sinus
Tumor causing bone erosion or destruction including extension into the hard palate and/or middle nasal meatus, except extension to posterior wall of maxillary sinus and ptreygoid plates
PT3
Tumor confined to four or more adjacent vertebral segments or any nonadjacent vertebral segments
PT2
Tumor confined to one pelvic segment with extraosseous extension or 2 segments without extraosseoms extension
PT1 pelvis
Tumor confined to one pelvic segment with no extraosseoms extension
PT1 Spine
Tumor confined to one vertebral segment or two adjacent vertebral segments
PT3b
Vaginal involvement (direct extension or metastasis) or parametrial involvement
What is glottic?
Ventricle to 0.5-1.0 cm below the free level of the true vocal cords. this includes Ant. and Post. commissures and the true cords
PT4b ""
Very advanced disease. tumor invades skull base and/or pterygoid plates and/or encases carotid artery.
PT4b ""
Very advanced disease: tumor of any size with extension toward the spine or into nearby large blood vessels, gross extra thyroidal extension invading the pre vertebral fascia, or encasing the carotid artery or mediastinal vessels
PT4b of the nasal cavity and ethmoid
Very advanced local disease. Tumor invades any of the following: Orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division or trigeminal nerve (V2), nasopharynx, or clivus
PT4b of maxillary sinus
Very advanced local disease. Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus
PT4b ""
Very advanced local disease. Tumor invades masticator space, ptreygoid plates, or skull base, and/or encases the internal carotid artery.
PT4b ""
Very advanced local disease. Tumor invades pre vertebral space, encases carotid artery, or invades mediastinal structures.
PT4b
Very advanced local disease. tumor invades lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, or skull base or encases carotid artery.
PT4b
Very advanced local disease. tumor invades lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, or skull of base or encases carotid artery
PT4b ""
Very advanced local disease. tumor invades pre vertebral space, encase carotid artery, or invades mediastinal structures.
PT4b ""
Very advanced local disease. tumor invades pre vertebral space, encases carotid artery or invades mediastinal structures.
What is VIN associated with?
Vulvar intraepithelial neoplasia Is associated with high risk HPV (16>18) and tends to be multifocal and more common in younger women Positive with P16
What needs to be included in your gross for a uterus
Weight Procedure type Type of hysterectomy performed Specimen integrity Tumor site Tumor size_x_x__ myometrial invasion in mm Adenomyosis-if present Uterine serosa involvement Lower uterine segment involvement Cervical ströma involvement Other tissues involved Margins- only if cervix or parametrium are involved by carcinoma Lymph nodes
What should be on your differential for ovary? Epithelial
Well the fall under benign, borderline, and malignant Epithelial -Serous (cystadenoma, adenocarcinoma) Describes the fluid Multicystic, may or may not have papillary projections, commonly bilateral, borderline and malignant tumors involve the surface of the ovary -Mucinous (cystadenoma, adenomcarcinoma) Fluid is sticky, gelatinous Produce larger cystic masses, mulitloculated, only 5% of benign and malignant mucinous tumors are bilateral -Endometrioid Arise from endometriosis
Floor of mouth
this is a semilunar space over the myelohyoid and hypoglossus muscles, extending from the inner surface of the lower alveolar ridge to the undersurface of the tongue. its posterior boundary is the base of the anterior pillar of the tonsil. it is divided into 2 sides of the submaxillary and sublingual salivary glands