The decalcification section is more comprehensive and detail oriented in our book Grossing Bones: Principles, Techniques, and Instruments available now on Amazon.com.
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