Auto Text: “Insert Ellipse Oriented”

Triage

1. Orient the specimen: Identify the marking sutures and orient the specimen accordingly using anatomic position. If anatomic position is not known, orient using clock face.
2. Simple tongue resections are often oriented with sutures:
   • If sutures are labeled anterior or posterior AND right or left, the mucosa can be assumed to be superior/dorsal (unless the lesion is on the ventral tongue, then mucosa is inferior/ventral).
   • If sutures are labeled anterior or posterior AND superior or inferior, the mucosa can be assumed to be lateral.  Similarly, if a specimen is labeled “right” or “left” tongue resection with a single orienting stitch, the mucosa can be assumed to be lateral.
   • Anatomic orientation is preferred to clock face. If anatomic position is not known, orient using clock face.
3. Photograph fresh, intact specimen prior to sectioning.
4. Identify mucosa and deep soft tissue.  Measure the specimen in 3D (noting A-P, M-L, S-I).
5. Measure mucosal-based lesions and their distance to margins.
6. Identify and ink soft tissue resection margins.
   • Visually separate the specimen parallel to the long axis. Ink one half black and one half blue, meeting the colors in the middle. Be sure to include both the deep surface and peripheral edges in your ink. Ink should come all the way up to mucosa at the peripheral edge.
   • For complex excisions with angled tissue planes, you can consider inking each plane a different color.
   • NEVER HESITATE TO CALL THE ATTENDING FOR COMPLEX EXCISIONS.
7. Fix in formalin overnight. If the specimen is delicate at the mucosa is relatively flat, pin on wax. Please pin MUCOSAL SIDE DOWN. Ask attending if you have questions.

Gross

1. For simple excisions:
   • Amputate the polar margins, section perpendicular to the margin, and submit (submit all if small specimen, submit representative if large specimen).
   • Serially section the remainder of the specimen perpendicular to the ink. Slices should be numbered in order for ease of grossing and cassette summary.
   • Measure any mass lesions in 3D and distance to margins.
   • Photograph cut section, including deepest extent of tumor and nearest to margin.
   • If small, submit entirely and sequentially from pole to pole, placing no more than 1-2 pieces per cassette.
   • If large, submit representative sections of tumor (~1 per cm) including nearest margins, placing no more than one piece per cassette.

1. For complex excisions:
   • Please discuss with attending prior to grossing.
   • Think of the specimen as a 6-sided box with each tissue plane being a side (Anterior, Posterior, Superior, Inferior, Right, Left).
   • Be sure to adequately document tumor and involvement of all soft tissue planes / anatomic compartments / resection margins.

Updated 09-24-24 NAC