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    Soft tissue tumour

    Background

    Soft tissue tumours are difficult to assess clinically and histological examination is necessary to distinguish benign and malignant tumours facilitating their management and prognosis.1


    Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

    • No
      • Non-routine fixation (not formalin), describe.
    • Yes
      • Special studies required, describe.
      • Ensure samples are taken prior to fixation.
        • Cytogenetics
        • Electron microscopy
        • Biobanking
        • Frozen tissue storage
    • Not performed
    • Performed, describe type and result
      • Frozen section
      • Imprints
      • Other, describe

    See general information for more detail on specimen handling procedures.

    Inspect the specimen and dictate a macroscopic description.


    External Inspection

    Orientate and identify any specific anatomical features of the specimen.

    Record additional orientation or designation provided by operating clinician:

    • Absent
    • Present
      • Method of designation (e.g. suture, incision)
      • Featured denoted

    Photograph the intact specimen if required.

    Describe the following features of the specimen:

    Procedure/specimen type

    Record as stated by the clinician.

    • Needle biopsy
    • Wide local excision
    • Radical excision
    • Pelvic exenteration
    • Amputation, specify type
    • Other, describe

    Neoadjuvant therapy

    • No
    • Yes
    • Not known

    Anatomical components included (more than one may apply) and specimen dimensions (mm)

    Describe and measure the anatomical components present.

    • Total specimen, in three dimensions
    • Skin
    • Skeletal muscle, specify muscle if known
    • Large nerves or vessels
    • Subcutis
    • Fascia
    • Other, describe

    Weight (g) if applicable

    • Record the specimen weight

    Evidence of previous biopsy or surgery (if present)

    • Needle track
    • Cutaneous scar
    • Sutures
    • Other, specify

    Dissection

    Needle core biopsies do not require dissection.

    Paint the relevant surgical margins with ink and record the colours applied.

    Serially section the specimen (usually transversely sections perpendicular to the longitudinal axis at 5-10mm intervals).2 This allows sampling of fresh tissue for special studies and penetration of the fixative.

    After sampling, the specimen should be placed in an adequately-sized container of formalin for 24-48 hours fixation.


    Internal Inspection

    Describe the internal or cut surface appearance including the following items:

    Tumour

    • Absent
    • Present
      • Number; if more than one tumour, designate and describe each tumour separately

    Tumour size (mm)

    • In three dimensions

    Tumour location2

    (more than one may apply)

    • Cutaneous
    • Subcutaneous tissue
    • Intramuscular
    • Adipose tissue
    • Subfascial
    • Fascial
    • Other, describe

    Distance of tumour to margins (mm)3

    • Distance of tumour to closest margin (mm), specify margin
    • Distance of tumour to other margins (mm), specify margin(s)

    Type of tissue between tumour and closest margin3

    • Fat
    • Muscle
    • Fascia

    Appearance of the tumour's cut surface3

    Describe the following features of the tumour.

    Consistency/matrix

    • Solid
      • Fibrotic
      • Rubbery
      • Friable
    • Cystic
      • Size in maximum dimensions (mm)
      • Contents, describe
    • Myxoid
    • Fibrous
    • Fatty

    Colour

    • Uniform
    • Variegated
    • Describe

    Growth front (nature of tumour interface with normal tissue)3

    • Infiltrative
    • Lobulated
    • Well-circumscribed
    • Encapsulated
    • Other, describe

    Tumour necrosis3

    • Not identified
    • Present
      • Percentage of tumour volume, estimated (%)

    Percentage of necrosis is an important factor in establishing the grade of the tumour.3

    Tumour haemorrhage3

    • Absent
    • Present, describe (e.g. focal)

    Retrieved from resection specimen

    • Describe site(s)
    • Number retrieved

    Separately submitted

    • For each specimen container, record specimen number and designation
    • Collective size of tissue in three dimensions (mm)
    • Number of grossly identified lymph nodes submitted
    • Maximum diameter of each (mm)

    Photograph the dissected specimen.

    Note photographs taken, diagrams recorded and markings used for identification.


    Processing

    Submit all tissue transferred directly into cassettes for processing. Some institutions may submit cores in separate cassettes to maximise tissue for immunhistochemical investigations. Lens paper, biopsy pads or similar are required to prevent loss of tissue during processing.

    Dissect the specimen further and submit sections for processing according to the illustration provided.

    Submit representative sections:

    • At least one block per 10mm of maximum tumour dimension.3 If the lesion is small, submission of the entire lesion should be considered due to the histological variability of some soft tissue tumours.

    Submit representative sections of

    • Tumour, at least one block per 10mm of maximum tumour dimension3 or  where practicable, submit an entire full face of tumour
    • Sample any heterogeneous areas or areas suspicious for necrosis or dedifferentiation3
    • At least one section demonstrating the relationship with adjacent normal parenchyma
    • Surgical margins, composite longitudinal sections to margins where <10mm
    • Biopsy tract if included
    • Additional tumour nodules

    Areas suspicious for necrosis (soft, friable areas) and varying differentiation (firm, white areas) should be sampled to identify dedifferentiation in a well-differentiated liposarcoma and a possible round cell component in myxoid liposarcoma which may affect prognosis and grading.3

    Submit all lymph nodes and identify the site of each.3

    Record details of each cassette.

    An illustrated block key similar to the one provided may be useful.

    Block allocation key

    Cassette id Site No. of pieces
    A Soft tissue biopsy  
    Cassette id Site No. of pieces
    A-D Surgical margins  
    E Tumour, full face  
    F-G Tumour, one block per 10mm, demonstrating interface with normal tissue  
    H-I Heterogeneous areas, if present  
    E-F Necrotic or dedifferentiated areas, if present  

     

    Acknowledgements

    Associate Professor Fiona Bonar for her contribution in reviewing and editing this protocol.


    References

    1. Freemont AJ, Denton J and Mangham DC. Tissue pathways for bone and soft tissue pathology, The Royal College of Pathologists, London, 2011.
    2. Fisher C. Dataset for cancer histopathology reports on soft tissue sarcomas, The Royal College of Pathologists, London, 2014.
    3. Hemmings C, Miles C, Slavin J, Bonar F, Graf N, Thomas D, Desai J, Austen L and Barry P. Soft tissue resection structured reporting protocol, The Royal College of Pathologists of Australasia, Surry Hills, NSW, 2011.

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      Soft tissue tumour 1

      Deep soft tissue sarcoma excision specimen

      Soft tissue tumour 2

      Deep soft tissue sarcoma demonstrating serial dissection lines

      Soft tissue tumour 3

      Deep soft tissue sarcoma, block allocation. Note some tumour heterogeneity in block D.

      Soft tissue tumour 4

      Superficial sarcoma excision specimen

      Soft tissue tumour 5

      Superficial sarcoma, block allocation

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      27-Mar-2019
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