Initial procedure

• palpate to locate tumour or areas of abnormality.

• specify which lung or lobe.

• record the weight (g) and dimensions (cm). Ink the pleura overlying the tumour.

• remove the bronchial margin by sectioning transversely, before inflation fixation (Figure 38.3). Sample the hilar nodes.

2. Slice open coronally or parasagitally depending on tumour location and using the partially opened airways as a guide

Sample tumour in relation to airways and vessels

Sample tumour in relation to airways and vessels

Sample hilar lymph nodes and transverse section proximal bronchial and vascular limits

2. Slice open coronally or parasagitally depending on tumour location and using the partially opened airways as a guide

Sample tumour in relation to pleura and parenchyma

Figure 38.3. Blocking a pneumonectomy specimen.

inflation: if the specimen is intact instil fixative from a height of about 25 cm via tubing that terminates in a nozzle wedged into the supply bronchus or bronchi. Continue until the pleural surface is smooth. Immerse in a container of fixative overnight with a covering of lint or filter paper to prevent drying. If the specimen is not intact inflate with a syringe. Remember to culture, if appropriate, before fixation.

• to access airways open from the hilum, pass a probe down to the tumour and then cut along it.

• serially slice the tumour at 3 mm intervals in the plane that best demonstrates its relationship to the anatomical structures. In general, mid-zone and peripheral lesions are sliced parasagitally, hilar lesions coronally.

• with vascular lesions such as pulmonary emboli, approach laterally within fissures cutting towards the hilum until the pulmonary artery is entered.

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