Determine which components are present. Each specimen is different, so consult with the attending pathologist regarding the best way to approach the specimen and how margins should be submitted (perpendicular vs. en face), if not previously submitted for frozen section.
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.
Remove the soft tissue surgical margins and place them in labeled cassettes.
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.
Received without fixative/in formalin, labeled _____ and “_____”, is a __ x __ x __ cm left/right maxillectomy specimen consisting of _____ (hard and soft palate with __ teeth; turbinates; nasal septum; bones/muscles – which ones?, paranasal sinuses, orbital contents) [give measurements of each component]. There is a __ x __ x __ cm _____ (color, consistency, circumscription, borders) mass located within the _____ which invades/extends into _____. It is __ cm from the anterior margin, __ cm from the posterior margin, __ cm from the superior margin, __ cm from the medial margin, and __ cm from the lateral margin. The adjacent uninvolved mucosa is _____. A fistula tract extends from the _____ to the _____ for a distance of __ cm. The margins are inked as follows: blue = superior _____ margin; green = anterior _____ margin; red = medial _____ margin; yellow = lateral _____ margin; black = posterior _____ margin. Photographs are taken. Representatively submitted as follows:
#__ - #__ = superior bone margin and mass, perpendicular, for decal
#__ = anterior bone margin, en face, for decal; __ pieces.
#__ = posterior bone margin, en face, for decal; __ pieces.
#__ = medial bone margin, en face, for decal; __ pieces.
#__ = medial soft tissue margin, en face; __ pieces.
#__ = lateral bone margin, en face, for decal; __ pieces.
#__ = lateral soft tissue margin, en face
#__ - #__ = mass (#__ = deepest invasion of bone, for decal); __ pieces in each.