TUGAS 1

Small bowel, Soft Tissue,

and Thyroid Gland
 Small Bowel-Biopsy
 Procedure

1. The specimen usually received

attached to a piece of filter paper
or gealfoam, mucosal side up; let
it fix well before processing.
2. Examine with dissecting
microscope and determine
mucosal pattern; avoid drying of
the specimen and traumatizing
the mucosa during this procedure
 Small Bowel-Biopsy
Performance of this step has lost
some of popularity it had years
ago, but it still retains some
usefulness as a quick predictor of
the histologic appearance and as
an aid for proper orientation of the
specimen.
 Small-Bowel Excision
Description
1. Size and color of specimen
2. Mucosal pattern with dissecting
microscope (see accompanying
drawings)
Small-Bowel Biopsy
 Small-Bowel Biopsy
Section for Histology
1. The entire specimen is submitted.
It is essential for it to be oriented
on edge.
2. If the specimen comes attached to
gealfoam, the latter can be
processed together with the
specimen.
 Small-Bowel Excision

Small bowel resection vary a great

deal in length and location
depending on the characteristics of
the lesion. They include the
regional mesentery and are usually
followed by an end to end
anastomosis
 Small-Bowel Excision
Procedure
1. Two option are available
depending on the length of the
bowel and the type of pathology
present.
a. Cut longitudinally trough the
antimesenteric bodres, pin on
coackboard, and fix overnight
 Small-Bowel Excision
b. Wash out content gently with
formalin or saline solution (not
with water), tie one end, fill the
lumen with formalin and tie the
other end. Fix overnight and open
longitudinally along the
mesenteric border.
 Small-Bowel Excision
Description
1. Length and diameter of the
specimen
2. Mucosa : appearance;
edema;?hemorrage?ulcerations?t
umor?(size, location,
circumferential involvment?depth
of invasion)
3. Wall : thickness, abnormalities
 Small-Bowel Excision
Description
4. Serosa : fibrosis,
peritonitis,adhesions
5. Lymph Nodes : size and
appearance
6. Mesentery ; mesenteric blood
vessels.
 Small-Bowel Excision
Section for Histology
1. Depends on pathology present.
2. In cases of infarct : several cross-
sections of mesenteric vessel.
THYROID GLAND
 Thyroid Gland
• Operations on the thyroid gland include
nodulectomy (a procedure largely abandoned
that consists of enucleation of a thyroid
nodule), lobectomy (often combined for
cosmetic reasons with removal of the isthmus),
subtotal hyroidectomy (in which the posterior
capsule and a small portion of thyroid tissue –
1–2 g – are left on the side opposite to the
lesion), and total thyroidectomy (in which the
entire gland – including the posterior capsule –
is removed).
 Thyroid Gland
• Description
1. Type of specimen: lobectomy, isthmectomy,
subtotal
thyroidectomy, total thyroidectomy
2. Weight, shape, color, and consistency of
specimen
3. Cut surface: smooth or nodular? if nodular:
number, size, and appearance of nodules
(cystic? calcified? hemorrhagic? necrotic?);
encapsulated or invasive? distance to line of
resection
 Thyroid Gland
• Sections for histology
1. For diffuse and/or inflammatory lesions: three
sections from each lobe and on from isthmus
2. For a solitary encapsulated nodule measuring
up to 5 cm: entire circumference; take one
additional section for each additional
centimeter in diameter. Most of these sections
should include the tumor capsule and adjacent
thyroid tissue, if present.
 Thyroid Gland
Sections for histology
3. For multinodular thyroid glands: one
section of each nodule (up to five nodules),
including rim and adjacent normal gland;
more than one section for larger nodules
4. For papillary carcinoma: block entire
thyroid gland and (separately) line of
resection
 Thyroid Gland
Sections for histology
5. For grossly invasive carcinoma other than
papillary: three sections of tumor, three of
non-neoplastic gland, and one from line of
resection
6. For all cases: submit parathyroid glands if
found on gross inspection
 KELENJAR TIROID, PARATIROID, KISTA
TIROGLOSUS, KEL. SUPRARENAL
1. Ukuran : …… x …… cm
2. Warna luar :
3. Bentuk permukaan : luar : □ rata □
berbenjol □ Lain-lain, jelaskan!
4. a. Perkapuran : □ ada □ tidak
ada
b. Nekrosis : □ ada □ tidak
ada
c. Perdarahan : □ ada □ tidak
ada
 KELENJAR TIROID, PARATIROID, KISTA
TIROGLOSUS, KEL. SUPRARENAL
5. Perubahan bentuk : - tumor : Ukuran :
….x…… cm
- Bentuk : □ tonjolan □ Invasi
- buat potongan dari simpai yang melekat
dengan tumor minimal 4 kup
- Kista : - besar : ……. - Isi kista - Permukaan
dalam
6. Lain – lain : Jelaskan !
Sumber : Surgical PathologyDissection : An Illustrated
Guide, Second Edition “William H. Westra, M.D.,et all
SPRINGER Hal.203
Sumber : Surgical PathologyDissection : An Illustrated Guide, Second Edition
“William H. Westra, M.D.,et all SPRINGER Hal.203
SOFT TISSUE
 SOFT TISSUE –RESECTION FOR
TUMOR
• Procedure
1. Review any imaging studies (CT scans, MRIs)
that may have been taken before amputation
2. Measure the length and circumference of the
extremity, Including a measure of the
circumference at the level of the tumor
3. Determine the presence, position, and
dimensions of biopsy sites
 SOFT TISSUE –RESECTION FOR
TUMOR
• Procedure
4. Search for the major lymph node groups and
identify and place in separate containers
5. Cut through the skin and carefully dissect the
subcutaneous fat, muscles, and major arteries,
veins, and nerves around the tumor, avoiding
cutting through the latter. Use an anatomy
atlas as a guide, if necessary.
 SOFT TISSUE –RESECTION FOR
TUMOR
• Procedure
Try to determine as accurately as possible the
relationship of the tumor with the following
structures: skin, subcutaneous fat, and specific
muscles; arteries, veins, and nerves; and
periosteum and bone. Mark some of the
major anatomic landmarks with tags, if
indicated
 SOFT TISSUE –RESECTION FOR
TUMOR
6. As soon as all the margins of the tumor have
been determined, remove the entire area with
a good margin of normal tissues using a
scalpel and scissors
7. Two options, outlined later, are available for
studying the specimen thus obtained. The first
is used in most instances, but the second is
preferable in selected cases.
 SOFT TISSUE –RESECTION FOR
TUMOR
• In either case, if a previous incision site is
present, take a sample for histology at this
time along the entire course of the incision
a. Divide the tumor into slices with a large, sharp
knife. Continue the dissection with the
forceps, scissors, and scalpel to determine the
tumor relationship with the structures
previously mentioned. Place several pieces
from different areas in formalin, fix for several
hours or overnight, and trim to place in
 SOFT TISSUE –RESECTION FOR
TUMOR
cassettes
b. Place the entire specimen in a large pan
containingf ormalin, cover with a towel, leave
in the refrigerator at 4°C overnight, and cut
parallel slices with a large sharp knife. Take x-
ray studies, if pertinent. Take photographs or
photocopies, and identify in one of them the
site of the sections to be taken
 SOFT TISSUE –RESECTION FOR
TUMOR
8. Quickly dissect the soft tissues from the
rest of the extremity, looking for other foci
of tumor or other lesions
9. Cut the major bones of the extremities
longitudinally with a band saw. Make one
of the sections through the area of bone
closest to the soft tissue tumor. Examine
for tumor extension Other lesions
10. Open the major joints and examine them.
 SOFT TISSUE –RESECTION FOR
TUMOR
Description
1. Type of amputation; side of extremity
2. Length and circumference of extremity,
including circumference at level of tumor
3. Presence, position, and dimensions of biopsy
sites
4. Tumor characteristics:
a. Primary location: subcutaneous fat; muscle
compartment(s) (specify which); fascial
planes
 SOFT TISSUE –RESECTION FOR
TUMOR
Description
d. Size (three dimension), shape, color, borders
(encapsulated? pushing? infiltrating?),
consistency, secondary changes (cysts? necrosis?
hemorrhage?)
e. Presence of myxoid changes, foci of calcification,
cartilage, or bone
f. Shortest distance of tumor from margin of
resection
 SOFT TISSUE –RESECTION FOR
TUMOR
Description
5. Appearance of remaining extremity, if
abnormal (if not, so state); skin, subcutaneous
fat, muscles, major vessels and nerves, bone
(tumor invasion? osteoporosis? bone marrow),
joints (osteoarthritis?)
6. Appearance and approximate number of
lymph nodes found
 SOFT TISSUE –RESECTION FOR
TUMOR
Sections for histology
1. Tumor: four sections or more, depending on
size and extent. All grossly dissimilar areas
should be sampled. Whenever possible,
sections should be taken to include the
periphery of the tumor and adjacent fat,
muscle, skin, periosteum, vessels,and/or
nerves
2. Previous incision site, if present, taken all
along its course
 SOFT TISSUE –RESECTION FOR
TUMOR
Sections for histology
3. Lymph nodes: if grossly normal, only
representative ones; if grossly abnormal or if
clinical suspicion or metastases, all of them
4. Proximal margins of resection: subcutaneous
fat and muscle (plus skin and bone, if
indicated)
 JARINGAN LUNAK

OTOT
• Potongan : - memanjang - melintang
• Sedapat mungkin tidak dicetak semua,
karena mungkin diperlukan
pewarnaan/penanganan khusus; misalnya
untuk lemak.
 JARINGAN LUNAK

• Neoplasma.
– Jelaskan secara makroskopik: ukuran, warna,
penampang. konsistensi, bersimpai atau tidak

– Apabila klinik didiagnosis ganas, dan

makroskopik mengarah ganas, selain dibuat
potongan dari tumor, juga dibuat potongan
pada batas-batas sayatan.
 JARINGAN LUNAK

• Neoplasma.
– Apabila massa tumor cukup besar, dibuat
beberapa potongan (3 -6 kup) dari bagian-
bagian yang terpisah
– Untuk sediaan yang kecil, sedapat mungkin
tidak dicetak semua karena mungkin
diperlukan pewarnaan untuk lemak