Pleura & peritoneum
General
Grossing & features to report


Topic Completed: 1 January 2014

Minor changes: 18 January 2021

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PubMed Search: Pleural gross mesothelial

Vaidehi Avadhani, M.D.
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Cite this page: Avadhani V. Grossing & features to report. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/pleuragrossing.html. Accessed January 22nd, 2021.
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
    1. Describe dimension and number of fragments, any lesions present
    2. Note if pleural plaques are seen; describe
    3. Tumor involvement of adjacent structures - lung, diaphragm, pericardium, skeletal muscle
    4. Ink margins in sections closest to tumor
    5. Tumor:
      • One section per cm of tumor
      • Extensive sampling if desmoplastic mesothelioma is suspected
    6. Additional sections of lung, if present (for asbestos fiber analysis):
      • Recommended - up to 5
    7. Sections for ancillary tests:
      • Electron microscopy, cytogenetics, etc., if necessary
    8. Lymph nodes
    9. 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

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