Lymph nodes & spleen, nonlymphoid
Lymph nodes-general
Grossing-lymph nodes

Topic Completed: 1 December 2010

Minor changes: 4 July 2020

Copyright: 2001-2020,, Inc.

PubMed Search: lymph node grossing

Nikhil Sangle, M.D.
Page views in 2019: 437
Page views in 2020 to date: 561
Cite this page: Sangle N., Depond W. Grossing-lymph nodes. website. Accessed October 24th, 2020.
Grossing for diagnosis
  • Cut perpendicular to long axis if possible
  • Avoid squeezing nodes, which may alter histology
  • For culture (if clinically indicated) or for flow cytometry, use end of lymph node
  • For touch imprints, fix in ethanol, stain with H&E, Wright stain or use for immunocytochemistry
  • Use scrapes / cell suspension for flow cytometry, cytogenetics, molecular gene rearrangement studies, FISH
  • Sections for formalin or B5 fixation should be 3 - 4 mm thick to allow for proper fixation; B5 (mercury containing fixative) provides best morphologic details
  • Snap freezing is best for research, some immunohistochemistry, future molecular studies
  • Formalin fixation is best for PCR
  • EM is helpful only rarely to diagnose Langerhans histiocytosis or occasionally metastatic tumors
  • Include extranodal fat (infiltration implies malignant process)
  • Note: the most important slides to obtain are sufficient H&E for diagnosis
  • Frozen sections may confirm involvement of node by a disease process, but do not use to obtain a specific diagnosis because freezing artifacts may hinder diagnosis
Grossing for staging
  • Most lymph nodes are near the wall of the organ
  • Be aware of minimal number of nodes required for staging some carcinomas
  • May want to fix first overnight - lymph nodes stand out as white nodules
  • Carnoy solution helps clear the fat
  • Clearing solutions (such as ethanol, diethyl ether, glacial acetic acid and formalin) may help identify additional lymph nodes (Am J Surg Pathol 1997;21:1387, Arch Pathol Lab Med 2003;127:1552, Arch Pathol Lab Med 2001;125:642)
  • For each anatomic group, describe the number of nodes, the size of the largest node and any gross features
  • Submit all lymph nodes for histology; section node if 5 mm or greater in diameter
  • For large nodes grossly involved by tumor, only one section needs to be submitted to demonstrate tumor and possible extranodal extension but save remainder for resampling if necessary
  • For other large nodes, submission of entire node detects additional metastases in some cases (Am J Clin Pathol 1998;109:571)
  • Describe number of nodes in each cassette and whether whole or sectioned
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