Auto text: “Insert soft tissue oriented” or “Insert soft tissue unoriented”
Please check the clinical history in Epic to determine if the patient has known Neurofibromatosis, or if there is a clinical/radiographic suspicion for malignant transformation of the neurofibroma.
- Weigh and measure in 3-dimensions.
- Measure skin and associated scar, if applicable.
- Examine the outer surface/capsule for anatomic structures (nerves, bone, skin, vasculature).
- Ink the resection margin. If oriented, two or more colors can be used as discussed with attending.
- Check with the PAs – we have an unlinked protocol to bank tissue from malignant and benign nerve sheath tumors.
- Serially section the specimen in 0.5 – 1.0 cm increments. Do NOT maintain “bookends” – please section completely.
- Look for enlarged or tortuous nerves. Plexiform neurofibroma often resembles a “bag of worms.”
- Photograph representative cut section(s), especially if potentially plexiform.
- Measure the size of tumor in 3D and closest extent to margin.
- Identify relationship to surrounding anatomic structures.
- Fix overnight if large.
- Can gross fresh if small.
- Confirm tumor size in 3D, noting closest extent to margins and proximity to anatomic structures (if present).
- Describe outer surface/capsule.
- Describe the edges of the tumor (well-circumscribed vs infiltrative) and the cut surfaces (tan-white, gelatinous, solid vs cystic, etc).
- Describe any plexiform components: Look for enlarged or tortuous nerves. Plexiform neurofibroma often resembles a “bag of worms.”
- Submit the following sections:
- Tumor – submit 1 section per centimeter; including sections with variable appearance (differences in color, consistency), proximity to inked margins, and proximity to different anatomic structures.
- You do NOT need to separately submit “tips” on the small, routine neurofibromas.
- If suspicion of malignant transformation, be careful to submit fleshy, dense, solid, necrotic, opaque areas.
- If the tumor is larger than 10 cm, submit 2 sections per cassette (for example, for a 12 cm tumor: 12 sections, 6 cassettes.
- If small, your attending may want the entire specimen submitted – please consult the attending if you are considering submitting the entire specimen.
- Always submit flanking grossly normal-appearing tissue (often the neurofibroma is microscopically infiltrative into adjacent tissue).
- Submit representative adjacent anatomic structures (skin, nerves, bone, etc).