Pleura & peritoneum
General
Grossing & features to report
Author: Vaidehi Avadhani, M.D.
Last author update: 1 January 2014
Last staff update: 18 January 2021
Copyright: 2003-2023, PathologyOutlines.com, Inc.
PubMed Search: Pleural gross mesothelial
Table of Contents
Types of specimen | Surgical procedures definition | Grossing - biopsy | Grossing pleurectomy | Features to reportCite this page: Avadhani V. Grossing & features to report. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/pleuragrossing.html. Accessed May 29th, 2023.
Types of specimen
- Biopsy
- Pleurectomy
Surgical procedures definition
- Pleurectomy / decortication with mediastinal lymph node sampling:
- Complete removal of pleura and all gross tumor
- Extrapleural pneumonectomy:
- En bloc resection of pleura, lung, ipsilateral diaphragm; may include pericardium
Grossing - biopsy
- If received for frozen section, ensure enough lesional tissue is present
- Ask for additional tissue if tissue submitted needs to be entirely frozen
- Important because immunohistochemistry may be unreliable on previously frozen tissue
- May need to send for special studies including electron microscopy and cytogenetics
Grossing pleurectomy
- Describe dimension and number of fragments, any lesions present
- Note if pleural plaques are seen; describe
- Tumor involvement of adjacent structures - lung, diaphragm, pericardium, skeletal muscle
- Ink margins in sections closest to tumor
- Tumor:
- One section per cm of tumor
- Extensive sampling if desmoplastic mesothelioma is suspected
- Additional sections of lung, if present (for asbestos fiber analysis):
- Recommended - up to 5
- Sections for ancillary tests:
- Electron microscopy, cytogenetics, etc., if necessary
- Lymph nodes
- References: NCCN: NCCN Guidelines [Accessed 23 March 2018], Lester: Manual of Surgical Pathology, 3rd Edition, 2010
Features to report
- Tumor size and location
- Histologic type
- Extent of invasion
- Surgical resection margins
- Involvement of pleura, pulmonary vessels, bronchus, mediastinal structures, diaphragm, chest wall, other
- Lymph nodes: total examined, number involved by tumor, extracapsular extension
- Presence of pleural plaques, ferruginous bodies, pulmonary interstitial fibrosis, other significant findings
