Resection Specimens

Pleurectomy (Figure 39.1)

• record the number of fragments.

• measure the dimensions (cm) of the fragments unless there are more than three, then note dimensions of the smallest and largest, weigh the fragments (g).

• describe any lesions - colour, consistency and sizes.

• record the presence of other structures such as muscle, pericardium or fat and any involvement of these by tumour.

• ink margins and note the distances (cm) of any lesion from them.

• submit one section for each cm of tumour to include the margins.

Extrapleural Pneumonectomy

• tissue may be taken for electron microscopy before fixation.

• weigh the specimen (g) and record its dimensions (cm).

• take the bronchial margin and remove hilar lymph nodes (number/size).

• examine the pleura - determine the percentage involvement by tumour.

• examine the pericardium for tumour.

• ink margins close to the tumour.

• serially section the specimen coronally at 1 cm intervals.

• describe involvement of the diaphragm by tumour - distance from the anterior, posterior, medial and lateral margins, depth of invasion into diaphragm, involvement of the peritoneal surface of the diaphragm.

• describe involvement of visceral pleura - extent of fusion of visceral pleura to parietal, size of nodules of tumour.

pT1 Tumour limited to ipsilateral parietal and/or visceral pleura pT1 Tumour limited to ipsilateral parietal and/or visceral pleura

Figure 39.2. Pleural and interlobar spread of malignant mesothelioma. Reproduced from Hermanek P, Hutter RVP, Sobin LH, Wagner G, Wittekind Ch (eds.). TNM Atlas: illustrated guide to the TNM/pTNM classification of malignant tumours, 4th edition. Springer-Verlag: Berlin and Heidelberg, 1997.

• invasion of lung - usually tumour invades along interlobar fissures (Figure 39.2). Describe parenchymal disease such as pneumonia or fibrosis.

• if rib is attached describe the dimensions, and any tumour involvement seen. If lesions are seen in the ribs, X-ray.

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