This page is for pleural mesothelioma. For peritoneal mesothelioma, refer here.
Auto text: “Insert Pleura Biopsy” or “Insert Pleura Resection”
Triage
- Pleural specimens may come with or without lung.
- Weigh and measure in 3 dimensions.
- Measure volume (for pleura-only specimens): There is a graduated cylinder in the gross room, that can be filled with water to a designated volume. Submerge the specimen, and record the amount of water displacement.
- Photograph each case.
- Orient the specimen. The requisition and/or specimen container often mention sutures and what site(s) they mark.
- Measure attached diaphragm and, if present, peritoneum attached to abdominal surface of diaphragm.
- Measure attached pericardium, if present.
- If lung is present, take bronchial/resection margin, vascular margins, and hilar lymph nodes.
- Ink as follows: pericardial surface – blue, abdominal surface of diaphragm – black, chest wall surface-violet.
- If lung is present, ink outer surface of lung another color and slice sagitally into ~3 slices. Take gross photographs of each slice. Print these out so that you can map where you take your sections.
- In all cases, measure thickness of pleura (range) and any discrete nodules (state maximum thickness measurement), and estimate what percent of pleura is involved (is the tumor a discrete focus or diffuse entity).
- If unfused, measure thickness of visceral and parietal pleura separately. If fused, measure thickness together.
- Measure thickness of pericardium and abdominal peritoneum, if present.
- Fix in formalin overnight.
Gross
- Describe tumor extent:
- Involvement of parietal and visceral pleura.
- Extension into or through diaphragm.
- Extension into or through pericardium.
- If lung is present,tracking of tumor down interlobar fissures and extension into lung parenchyma.
- If oriented, take sections of pleura where the tumor is closest to the:
- Apex
- Anterior surface
- Posterior surface
- Lateral surface
- Medial surface
- Take sections of tumor (no more than a total of 20 cassettes per case) to show invasion into:
- Pericardium
- Diaphragm
- Lung parenchyma
- Bronchi
- Mediastinal fat
- Interlobar fissure
- Chest wall soft tissue
- Submit ALL lymph nodes