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.

Triage

1. Weigh and measure in 3-dimensions.
2. Measure skin and associated scar, if applicable.
3. Examine the outer surface/capsule for anatomic structures (nerves, bone, skin, vasculature).
4. Ink the resection margin. If oriented, two or more colors can be used as discussed with attending.
5. Check with the PAs – we have an unlinked protocol to bank tissue from malignant and benign nerve sheath tumors.
6. Serially section the specimen in 0.5 – 1.0 cm increments. Do NOT maintain “bookends” – please section completely.
7. Look for enlarged or tortuous nerves.  Plexiform neurofibroma often resembles a “bag of worms.”
8. Photograph representative cut section(s), especially if potentially plexiform.
9. Measure the size of tumor in 3D and closest extent to margin.
10. Identify relationship to surrounding anatomic structures.
11. Fix overnight if large.
12. Can gross fresh if small.

Gross

1. Confirm tumor size in 3D, noting closest extent to margins and proximity to anatomic structures (if present).
2. Describe outer surface/capsule.
3. Describe the edges of the tumor (well-circumscribed vs infiltrative) and the cut surfaces (tan-white, gelatinous, solid vs cystic, etc).
4. Describe any plexiform components: Look for enlarged or tortuous nerves.  Plexiform neurofibroma often resembles a “bag of worms.”
5. Submit the following sections:
   1. 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.
   2. You do NOT need to separately submit “tips” on the small, routine neurofibromas.
   3. If suspicion of malignant transformation, be careful to submit fleshy, dense, solid, necrotic, opaque areas.
   4. If the tumor is larger than 10 cm, submit 2 sections per cassette (for example, for a 12 cm tumor: 12 sections, 6 cassettes.
   5. If small, your attending may want the entire specimen submitted – please consult the attending if you are considering submitting the entire specimen.
   6. Always submit flanking grossly normal-appearing tissue (often the neurofibroma is microscopically infiltrative into adjacent tissue).
   7. Submit representative adjacent anatomic structures (skin, nerves, bone, etc).