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