Bones in the Surgical Pathology Grossing Room

Dispersed on this website in separate entries,  our book Grossing Bones: Principles, Techniques, and Instruments (available now on Amazon.com) summarizes specific techniques applied on different bone specimens, including tumors. The decalcification section is more comprehensive and detail oriented.the book summarizes specific techniques applied on different bone specimens, including tumors. The decalcification section is more comprehensive and detail oriented.

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Table of Contents

Preface………………………………………………………………………………………………….6

General principles of bone grossing ……………………………………………… 9

Bone gross composition …………………………………………………………………… 10

Grossing technology terminology ………………………………………………………14

Preservation ………………………………………………………………………………………15

Fixation vs. in the fresh state………………………………………………………………16

Fixation………………………………………………………………………………………………18

Section ……………………………………………………………………………………………… 21

Grossing techniques and instruments………………………………………..24

Orientation for gross section………………………………………………………………25

Immobilization ………………………………………………………………………………….28

Hard-pressed cardboard packing cartons ……………………………………….30

Other immobilization devices………………………………………………………….35

The “third hand” principle in immobilization ………………………………….36

Holding instruments……………………………………………………………………………39

Saws……………………………………………………………………………………………………40

Hand saws………………………………………………………………………………………41

Power saws …………………………………………………………………………………. 45

Reflections on hand vs. mechanical saws ………………………………………51

Summarization of bone grossing section manual technique………….53

Other instruments…………………………………………………………………………….55

Wrong practices …………………………………………………………………………………58

Untested challenges …………………………………………………………………………….59

Decalcification ………………………………………………………………………………….61

General consideration ……………………………………………………………………….62

Methods of decalcification ………………………………………………………………. 63

Decalcification reagents ……………………………………………………………………64

Simultaneous fixation and decalcification ………………………………………….66

EDTA considerations ………………………………………………………………………….67

Decalcification and advanced histology studies …………………………………68

Reflections on the choice of a decalcifier ………………………………………….69

End point of decalcification……………………………………………………………….70

Methods of end point determination………………………………………….71

Radiography…………………………………….…………………………………………72

Chemical method……………………………………………………………………….72

Physical methods (bending, probing, others) …….………………………74

Some technical details of decalcification process………………………………76

Agitation …………………………………………………………………………………….76

Rinsing…………………………………………………………………………………………77

Microwave decalcification …………………………………………………………………78

Decalcification on the block, or surface decalcification ……………………..79

Some recommendations from surgical pathology practice…………………80

Teeth, Nails, and Gout specimens ………………………………………………………83

Grossing techniques for selected bone specimens ………………………85

Femoral head ………………………………………………………………………………………86

Degenerative bone disease (osteoarthritis)….. ………………………………….87

Avascular necrosis……………………………………………………………………………..89

Fracture…………………………………………………………………………………………….92

Fragile bones……………………………………………………………………………………….94

Rib…………………………………………………………………………………………………….95

Miscellaneous fragile bones ……………………………………………………………..98

Bone section from larynx ………………………………………………………………..100

Maxillofacial surgery…………………………………………………………………….102

Nose resection ……………………………………………………………………………….102

Maxillary bone ……………………………………………………………………………….102

Mandible bone……………………………………………………………………………….108

Bone tumors………………………………………………………………………………….114

General principles of grossing bone tumor specimens ……………………114

Sampling plan of bone tumor grossing …………………………………………..115

Bone tumor specimen grossing techniques     …………………………………117

Bone tumor specimen dissection    ………………………………………………….118

The choice of a saw and immobilization    ……………………………………….119

Examples of grossing bone tumor specimens………….………………………….121

Femoral bone tumor    ………….………………………………………………………….121

Pelvic tumor    ……………………….…………………………………………………………127

Sampling bone tumor after chemotherapy …………….…….………………… .129

Amputations ……………………………………….…………………………………………….132

Small bones …….………………………………….…………………………………………… 135

Small bone fragments …………………………………………………………………….137

Bone biopsy. ……………………………………………………………………………………139

Bone marrow biopsy   …………………………………………………………………….140

Bone and cartilage………………………………………………………………………………142

Grossing for undemineralized bone processing ……………………….143

The sample size for undemineralized bone processing………………………144

Sampling techniques …………………………………………………………………………144

Safety issues in grossing bones …………………………………………………… 148

Personal protection equipment ……………………………………………………… 150

The protection mask   ……………………………………………………………………….151

The special place for bone specimen processing ………………………………153

Mechanical injury ……………………………………………………………………………154

Grossing station for bones ……………………………………………………………155

Specialized Bone Grossing Table      ………………………………………………….157

Addendum ……………………………………………………………………………………162

Special stains and immunohistochemistry (IHC) ………………….…162

Special stains…………………………………………………………………………………… 164

Immunohistochemistry (IHC) …………………………………………………………  162

Embedding -Microtomy sectioning rationale ………………………… 169

Afterword ………………………………………………………………………………… 175

 

 

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