Determine which components are present, laterality (left vs right), and whether the midline is included. Each specimen is different, so consult with the pathology attending regarding the best way to approach the specimen and how margins should be submitted (on edge vs. en face), if not already submitted for frozen section.
Marginal mandibulectomy: removes a portion of the mandible (usually the alveolus and the medial plate) without disrupting continuity of the bone.
Segmental mandibulectomy: removes an entire segment of the mandible, disrupting continuity of the bone.
Measure the overall specimen and the individual components (three dimensions).
Take photographs before and after sectioning. Take X-rays as needed.
Ink the surgical margins.
Determine whether the tumor is primarily in the bone or in the mucosa/soft tissue. This will guide your approach.
Bone tumors: serially section the specimen with a saw at 0.5 cm intervals, then submerge in formalin overnight. Place the sections in decalcification solution until they can be cut with a sharp knife. Remember decalcification has adverse effect on morphology and antigenicity, should you choose to leave any attached to the bone.
Mucosa/soft tissue tumors: carefully dissect the soft tissue off the bone, maintaining its orientation and avoiding excessive shredding. The bone can be processed as above.
Measure the lesion (three dimensions if mass, two dimensions if flat) and its distance from the various resection margins. Determine the type of lesion (mass, ulcer, plaque) and describe it (color, shape, borders, circumscription, necrosis, hemorrhage). Evaluate for invasion of bone or other adjacent structures and measure depth of invasion.
See Lymph Nodes: Radical Neck Dissection if applicable.
Mucosa/soft tissue without tumor: at least two sections, including additional lesions if present.
Bone: one or two sections to demonstrate involvement by tumor if not already included with other sections.
Lymph nodes, if applicable: submit entirely. If a node is large and obviously replaced by tumor, submit two or three representative sections from areas with the greatest degree of suspected extranodal extension (see Lymph Nodes: Radical Neck Dissection).
Received without fixative/in formalin, labeled _____ and "_____ ", is a __ x __ x __ cm right/left/midline marginal mandibulectomy/segmental mandibulectomy specimen with/without the ramus with attached _____ (__ x __ x __ cm floor of mouth, __ x __ x __ cm radical neck dissection). There are __ (#) (incisor, cuspid, bicuspid, molar) in situ/extracted teeth which appear _____ (carious, structurally normal, involved by tumor). A _____ (color, configuration, necrotic) mass with surface dimensions of __ x __ cm primarily involves the _____, with total thickness of __cm (__cm exophytic component and __ cm depth of invasion into the _____). The nearest margins are _____ (__ cm) and _____ (__ cm). Other margins are at least __ cm away. The oral/lingual mucosa has a _____ (color, diffuse vs. localized, circumscription) _____ (ulcer, plaque, area of leukoplakia) __ x __ cm associated/not associated with the mass. The specimen is inked as follows: blue = superior _____ margin; green = inferior _____ margin; red = medial _____ margin; yellow = lateral _____ margin; black = posterior _____ margin. The specimen is photographed before and after sectioning.
#__ - #__ = mass and nearest mucosal margins (#__ = medial, #__ = lateral, #__ = anterior)