Tuesday, December 27, 2005

MULTIPLE SPECIMENS-SAME CASE

Multiple specimens for one patient
Frequently residents are confused how to handle multiple specimens from the same patient. They all have the same accession number because they are from the same case. However, the cassettes are labeled in succession as needed but with the suffix of letters, which is strictly an in-lab system. Each specimen must be designated the way the surgeon intended so that the surgeon can determine the diagnosis associated with each specimen from its anatomic designated location.
Example:
GROSS DESCRIPTION: Specimen #1, in formalin, labeled "right cheek" consists of one elliptical fragment measuring 9.5 mm x 5 mm x 3 mm in greatest dimensions. The external surface appears tan and irregular. There is a 3 mm pigmented area at one edge with numerous cilia. A slight depression is seen on the surface. The specimen was inked and bisected. Cut sections show diffuse pigment below the surface. The specimen was submitted in cassette A.

Specimen #2, in formalin, labeled "left cheek", consists of one fragment measuring 7 mm x 4 mm x 2 mm in greatest dimensions. The external surface appears irregular with a 3.5 mm papillomatous elevation. There are numerous cilia. The specimen was inked and bisected. The cut surface shows a pigmented line below the surface with numerous white nodules. The specimen was submitted in cassette B.

MICROSCOPIC: Sections of the specimen labeled "right cheek" show skin and dermal appendages with scattered pigmented melanocytes, melanophages, and extracellular dark brown to black pigment. There are numerous collections of histiocytes and lymphocytes in a perivascular distribution.

Sections of the specimen labeled "left cheek" show skin with nests of nevus cells in the dermis. The individual cells have round to oval shaped nuclei of uniform size and shape and are widely spaces. Rare cells contain fine granular pigment. Cells in the superficial dermis are larger than those seen in the deeper aspect of the dermis.

FINAL DIAGNOSIS: Skin, "right cheek" (excision) -extravasated foreign pigment consistent with tattoo
-chronic inflammation

FINAL DIAGNOSIS: Skin, "left cheek" (excision) -intradermal nevus

If the microscopic examination of two specimens are identical they can be combined but gross descriptions and diagnoses are always listed separately.

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