Gross pathology

Gross pathology, also simply gross, refers to the macroscopic pathology, and the macroscopic assessment of pathology specimens. It may include preparation of tissue for a microscopic examination. It is an essential part of pathologic assessments.

The process of cutting up specimens is known as grossing (North American term), cut-up or macroscopic cut-up (Australian term).

Specimen opening

Usually referred to simply as opening.

May go by the term freshing.

• The first part of a gross pathologic assessment.

Components

1. Orient the specimen.
2. Paint with ink - if applicable.
   • A good general rule is: ink before you think.
3. Cut open for fixation - if not immediately blocked.

Gross only

Which specimens are "gross only" typically depends on institutional policy.

Common gross only specimens

• Teeth.
• Foreign bodies.
• Femoral head with osteoarthritis - no fracture & no history of cancer.
• Calcific aortic stenosis.

Gross spot diagnosis

Heart

Heart valve:

• Infective endocarditis.
• Bicuspid aortic valve.
• Nonbacterial thrombotic endocarditis - non-distructive.
• Rheumatic heart disease - fish mouth valve, thick cordae tendinae.
• Calcific aortic stenosis.

Heart - other:

• Fibrinous pericarditis.
• Hypertrophic cardiomyopathy - septal thickness > free wall thickness.
• Cardiac hypertrophy.
• Dilated cardiomyopathy.
• Arrhythmogenic right ventricular cardiomyopathy.
• Atrial septal defect.
• Ventricular septal defect.
• Patent foramen ovale.

Cardiovascular

• Aortic dissection.
• Aortic rupture.
• Cerebral saccular aneurysm.

Lungs

• Pulmonary thromboembolism.
• Pulmonary infarct.
• Lung abscess.
• Lung tumour (primary).
• Metatstatic tumour lung - usu. multiple and peripheral.
• Malignant mesothelioma.
• Pleural plaques.
• Emphysema.
• Pneumothorax.
• Hemothorax.
• Hypoplasia secondary to diaphragmatic hernia.

Gastrointestinal pathology

Esophagus:

• Squamous cell carcinoma of the esophagus - classically mid esophagus.
• Adenocarcinoma of the esophagus - usually distal esophagus.
• Barrett's esophagus.
• Esophageal varices.
• Esophageal perforation.

Stomach:

• Malignant gastric ulcer.
• Peptic ulcer.
• Gastric antral vascular ectasia.
• Leopard spots - seen in hypothermia.
• GIST.

Duodenum:

• Peptic ulcer.
• Duodenal adenocarcinoma - classically assoc. with FAP.

Liver:

• Cirrhosis.
• Hydatid cyst.
• Hepatocellular carcinoma - in the context of cirrhosis.
• Metastases.
• Hemangioma.
• Focal nodular hyperplasia.
• Hepatic adenoma.
• Cholangiocarcinoma.
• Congestive hepatopathy (nutmeg liver) - seen in congestive heart failure.
• Hepatic infarct - classically at the periphery, red and wedge-shaped.

Gallbladder:

• Cholelithiasis.
• Cholesterolosis of the gallbladder.
• Gallbladder polyp.

Pancreas:

• Solid pseudopapillary neoplasm - with age & sex provided.
• Pancreatic adenocarcinoma.
• Neuroendocrine tumour.
• Chronic pancreatitis.

Small bowel:

• Ischemic small bowel.
• Meckel's diverticulum.
• Intussusception.
• Neuroendocrine tumour - if on section.
• GIST.
• Incarcerated hernia.

Appendix:

• Acute appendicitis.
• Neuroendocrine tumour of the appendix.
• Mucinous tumour of the appendix.

Large bowel:

• Colorectal adenocarcinoma.
• Bowel infarction.
• Ulcerative colitis - no skip lesions, no wall thickening.
• Crohn's disease - creeping fat, cobble stone pattern, skip lesions, fistulas.
• Pseudomembranous colitis.

Gynecologic pathology

Ovary:

• Mucinous tumour.
• Mature teratoma.
• Serous cystadenoma.
• Fibroma.
• Brenner tumour - may be yellow, typically solid.
• Endometrioma.

Uterine tube:

• Ectopic pregnancy.
• Tubal abscess.
• Adenomatoid tumour.

Uterus:

• Adenomyosis.
• Leiomyoma - multiple.
• Endometrial carcinoma.
• Leiomyosarcoma - friable, solitary, fish flesh.
• Bicornuate uterus.
• Uterus didelphys.
• Sarcoma botryoides (embryonal rhabdomyosarcoma).

Uterine cervix:

• Nabothian cyst.
• Cervical polyp.
• Cervical carcinoma.

Dermatopathology

Tumour:

• Basal cell carcinoma.
• Squamous cell carcinoma.
• Malignant melanoma.

Possible syndromic:

• Seborrheic keratosis - Leser–Trélat sign
• Neurofibroma - neurofibromatosis.
• Angiofibroma - Fabry disease.

Neuropathology

Bleeds:

• Epidural hematoma
• Subdural hematoma.
• Subarachnoid hematoma - berry aneurysm.
• Intracerebral hematoma - hypertensive, usu. thalamus.
  • Lobar hemorrhage - periphery of cortex.
• Duret hemorrhage - pontine hemorrhage.

Tumours:

• Meningioma - intradural, extramedullary.
• Glioma.
• Schwannoma - cerebellopontine angle.
• Myxopapillary ependymoma - filum terminale.

Non-tumour:

• Diffuse axonal injury - classically corpus callosum.
• Fat embolism.
• Cerebral contusion.
  • Plaque jaune.
• Cerebral infarction - classically MCA territory.

Neurodegenerative:

• Alzheimer disease - atrophy spares occipital lobe.
• Frontotemporal dementia.
• Huntington disease - young, caudate nucleus missing.

Genitourinary pathology

Kidney:

• Clear cell renal cell carcinoma - yellow.
• Papillary renal cell carcinoma - friable.
• Chromophobe renal cell carcinoma - brown +/-hemorrhage, no central scar.
• Renal oncocytoma - brown, central scar.
• Autosomal dominant polycystic kidney disease.
• Angiomyolipoma - fat.

Testis:

• Seminoma - solid.
• Mixed germ cell tumour - cystic (often teratoma) & solid.
• Leydig cell tumour - brown.
• Testicular torsion.

Paratesticular:

• Liposarcoma.

Placenta

Membranes:

• Marginal inserion - normal.
• Circumvallate placenta.
• Circummarginate placenta.

Disc:

• Retroplacental blood clot - suggestive of placental abruption.
• Chorangioma - big red intraparenchymal.
• Placental infarct - white = old, red = recent.
• Twin-to-twin transfusion syndrome - one side beefy red the other pale.
• Meconium staining/chorioamnionitis.
• Amnion nodosum.
• Squamous metaplasia of the amnion.
• Succenturiate placenta (placenta with accessory lobe(s)).
• Bilobate placenta.

Cord:

• Two vessel umbilical cord.
• False knot.
• True knot.
• Membranous insertion (AKA velamentous insertion).
• Furcate insertion - vessels separate before inserting.

Fetal

• Amniotic rupture sequence - includes amniotic band syndrome.
• Twin-to-twin transfusion syndrome (TTTS).

Genetic:

• Down syndrome.
• Edwards syndrome.
• Patau syndrome.
• Turner syndrome.

See also

• Basics.
• EIT.
• Tissue loss.

External links

• Old (black & white) gross pathology (artandmedicine.com).
• Cut-up manual from the RCPA (rcpa.edu.au).