Neoplastic lesions include both osseous and chondroid tumors, and are usually primary, but occasionally they are metastatic (e.g., pathologic fracture).
If there is recent chemo-and/or radiotherapy, the extent of tumor response must be documented.
Take radiographs of the specimen before dissection if no recent radiograph is available, and use it to guide dissection and sampling.
Key element to observe: a) type of the tumor (chondroid, osseous or soft tissue); b) location of the tumor (extra- or intraosseous; epiphysis, metaphysis or diaphysis), its relationship to adjacent soft tissue, bone and amputation site (margin); and c) secondary changes such as necrosis, hemorrhage, or any periosteal reaction.
Produce a section map(i.e. picture of a complete longitudinal slice of the tumor indicating where sections are taken, labeling each section with the corresponding cassette number). This will be used to assess the magnitude of treatment response of tumor.
Received unfixed, labeled with the patient name, medical record number and “____”, is a ____ cm long right / left, upper / lower extremity amputated at _______ (e.g. ___ cm above the knee / mid lower leg / at ___ joint) with ___ cm ____ bone shaft protruding from the soft tissue margin. The specimen includes a ___ cm segment of ___ (e.g. upper arm, forearm) with a maximum diameter of __ cm, and a __ cm ___ (e.g. hand). There is a well-healed ___ cm linear scar / biopsy site on the skin at _______ aspect overlying a visible / palpable soft tissue / bone mass. Longitudinal sections of the limb reveal a __ x __ x __ cm intramedular / intracortical osseous / chondroid tumor in the ___ (e.g. metaphysis, diaphysis) of the radius / femur, ___ cm from the amputation margin. The tumor involves _____ (cortex, distal epiphyseal plate) and bulges out into adjacent soft tissue. The tumor cut surface is ____ (gray-tan, chondroid, hemorrhagic) with multiple foci of necrosis approximately __ cm in maximum diameter. The periosteum overlying the tumor is raised / thickened / intact. There are no / ___ separate satellite tumor nodules of ___ cm and ___cm in diameter in the soft tissue within ___ cm from the main tumor. A representative complete cross section of the tumor with adjacent cortex / epiphyseal plate is marked with labels, photographed and then orderly submitted in 12 cassettes (for assessment of tumor response to chemo-radiation therapy) along with representative sections from the margin and soft tissue as follows. Radiography is also performed.
#__ - #__ = soft tissue resection margin
#__ - #__ - proximal bone resection margin
#__ - #__ = upper anterior quadrant of the tumor, one piece in each (tumor with adjacent cortex in #__)
#__ - #__ = upper posterior quadrant of the tumor, one piece in each
#__ - #__ = lower anterior quadrant of the tumor, one piece in each (tumor with epiphyseal plate in #__)
#__ - #__ = low posterior quadrant of the tumor, one piece in each (tumor with adjacent soft tissue in #__)