Blocks for histology

In cases of neoplastic disease, the histology should represent the tumour, its relationship to its own capsule (if any), the capsule of the thyroid gland and adjacent structures (Figure 17.2). Focal abnormalities of the thyroid parenchyma need to be sampled as do adjacent lymph nodes and the parathyroid glands.

In inflammatory or diffuse reactive disease, representative samples of gland and capsule are required.

Macroscopically encapsulated neoplastic disease:

• for tumours up to 5 cm in diameter, submit total circumference, the blocks illustrating the interface of tumour, capsule and adjacent gland.

• for tumours greater than 5 cm in diameter, submit one additional block of tumour per centimetre diameter, blocks illustrating the interface of tumour, capsule and adjacent gland.

• closest surgical margin.

• samples of other lesions, e.g., nodules or fibrous areas.

• perithyroid lymph node(s).

number of tumour deposits. size, shape and colour. solid or cystic or both. encapsulated or infiltrative. present or absent. thick or thin. regular or irregular. intact or breached by tumour.

outer surface: smooth or roughened/breached by tumour.

colour and consistency.

presence or absence of nodules.

lymph nodes, neck dissection, parathyroid gland.

Figure 17.2. Total thyroidectomy specimen. a. Recommended block selection to include isthmus, pyramidal lobe and contralateral lobe if present. Tissue block composites depend on the size of the tumour. b. Small. c. Large. Include other nodules.

Macroscopically invasive neoplastic disease:

• three blocks of tumour to illustrate interface with adjacent normal tissues.

• three blocks of adjacent gland.

• closest surgical margin.

• samples of other lesions, e.g., nodules or fibrous areas.

• perithyroid lymph node(s).

Multinodular disease:

• one block from each nodule up to a maximum of five blocks.

• for dominant nodules, submit one additional block of tumour per centimetre diameter, the blocks illustrating the interface of nodule and adjacent gland.

Inflammatory disease:

• submit three representative blocks from each lobe and one block from the isthmus if present.

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