Auto Text: “Insert Soft Tissue Oriented” or “Soft Tissue Unoriented”

Triage

1. Take photographs of all resections in the intact (and later, cut) state.
2. Weigh and measure in 3-dimensions.
3. Measure skin and associated scar, if applicable.
4. In order to evaluate margins:
   • Examine the outer surface/capsule for anatomic structures (nerves, bone, skin, vasculature).
   • Ink the resection margin: The outer surface can be friable / moveable, so make sure the ink is on a true margin (ask an attending for help if unsure). If unoriented, use 1 color. If oriented, two or more colors can be used as discussed with attending.
5. For ALL pediatric resections and for unusual adult soft tissue tumors:
   • Consult with an attending pathologist or PA. Many patients are consented for combined research/diagnostic protocols and it is important to collect/freeze fresh tissue if possible.  This process should be facilitated by a PA while consulting with the case attending.
   • Snap Freeze (in liquid nitrogen) – for potential genetic studies. See Snap Freeze page for instructions.
   • Consider taking tissue for Electron Microscopy (in glutaraldehyde) – for ultrastructural studies. If unsure, check with the attending pathologist. Tissue must be viable and 1 mm cubed, 3-4 pieces per vial. See EM page for instructions.
   • Some pediatric neuroblastomas come labeled as soft tissue resections – please see the Neuroblastoma page in the Peds section.
6. Serially section the specimen in 0.5 – 1.0 cm increments. Do NOT maintain “bookends” – please section completely. If you fear loss of orientations, slices can be re-approximated and wrapped in paper or gauze.
7. Photograph representative cut-section(s).
8. Measure the size of tumor in 3D and closest extent to margin.
9. Identify relationship to surrounding anatomic structures; if bone is present and tumor invades into the bone, the bone will have to be sectioned as well.
10. Fix overnight.
11. 

Gross

1. If not already done, measure the specimen in 3-dimensions.
2. Describe type of procedure and presence of pertinent anatomic structures (skin, nerve, bone).
3. Measure tumor size in 3D, noting closest extent to margins and proximity to anatomic structures (if present).
4. If necessary, map out the resection on paper to show where sections were taken (using MacroPath software).
5. Submit the following sections:
   • Representative perpendicular margins with closest extent of tumor to ink.
   • Tumor – at least one section per centimeter of greatest dimension; including sections with variable appearance (differences in color, consistency), edges/capsules and proximity to different anatomic structures.
   • Normal anatomic structures and grossly uninvolved tissue.
6. If the specimen is a RE-excision for close margins and you do NOT see any definite residual tumor, submit the entire area of scar / prior biopsy site. Submit representative normal tissue on either side of the surgical site. Depending on the size of the tissue, your attending may want the entire specimen submitted – please consult the attending if you are considering submitting the entire specimen.