Main differential diagnoses / indications: lung mass (neoplasm, infection, esp. tuberculosis), and interstitial lung diseases. Occasionally, therapeutic for large bullae.
Measure the specimen (three dimensions). Measure the length of the stapled margin, if present. Remove the staples and ink the cut surface.
Examine the pleural surface for retraction, fibrosis, and adhesions.
If interstitial lung disease is suspected, inflate the specimen by injecting fixative (formalin) using a syringe and a fine needle, even if the specimen is partially opened. Let the specimen fixed for > 15 minutes before sectioning.
Apply ink to the pleural surface overlying any palpable mass or area of pleural retraction.
Determine whether a mass lesion is present by palpation and external examination:
If infection cannot be safely excluded, use sterile technique to take a piece from the mass through the pleural surface (not through the resection margin), and submit the tissue to microbiology for culture.
If a mass is identified, sample the mass or other suspicious area after sectioning.
Discuss with the pathology attending whether to request special stains before reviewing the H&E sections.
Serially section the specimen perpendicular to the inked cut surface (stapled line).
Describe any masses (size in three dimensions, color, consistency, necrosis, hemorrhage, cavitation, shape, borders). Note their distances from the inked cut surface and the pleura.
Describe the rest of the lung parenchyma (color, emphysematous changes or bullae, fibrosis/scarring, consolidation).
Entirely submit if seven cassettes or fewer or if clinically suspected mass is not grossly apparent.
If more than seven cassettes: three to five sections of lesions and two to three sections of lung without lesions. Include nearest resection margin, adjacent uninvolved lung, and pleura in sections of lesions.
Received without fixative/in formalin, labeled _____ and “_____”, is a __ x __ x __ cm wedge resection of lung with a __ cm staple line. The pleura is _____ (color, texture, adhesion-covered, fibrotic, retracted). The exposed surface after removal of the staple line is free of lesions/involved by tumor and is inked _____. There is a __ x __ x __ cm mass with a _____ (color, consistency, necrosis) cut surface, located __ cm from the resection margin and __ cm from the pleura. There is a __ x __ x __ cm unilocular/ multiloculated bulla with _____ (fibrotic, ruptured) walls located __ cm from the resection margin. A portion of the mass is submitted to microbiology for culture. Entirely submitted as follows:
#__ = Frozen section remnant - mass with inked surface immediately distal to staple line; __ pieces.
#__ & #__ = remainder of mass with adjacent lung, pleura, and inked surface immediately distal staple line; __ pieces in each.
#__ = walls of bulla; __ pieces.
#__ & #__ = remainder of specimen; __ pieces in each.