grossing upper limb

EXTREMITIES – AMPUTATION FOR SOFT TISSUE TUMOR:

EXTREMITIES – AMPUTATION FOR SOFT TISSUE TUMOR

PROCEDURE:

PROCEDURE Review the X rays & CT scan taken before amputation Measure the length & circumference ( including the circumference at the level of the tumor) Determine the presence , position & dimensions of biopsy sites Search for the major lymph node groups, identify & place in the separate containers

PROCEDURE:

PROCEDURE Cut through the skin & carefully dissect the subcutaneous fat, muscles & major arteries, veins & nerves around the tumor, avoiding cutting through the latter. Try to determine as accurately as possible the relationship of the tumor with the following structures: skin, sub cutaneous fat, muscles, arteries, veins & nerves, periosteum & bone

PROCEDURE:

PROCEDURE As soon as all the margins of the tumor have been determined, remove the entire area with a good margin of normal tissues using scalpel & scissors.

PROCEDURE:

PROCEDURE Two options are available : Divide the tumor into slices with a large, sharp knife. Continue the dissection with the forceps, scissors & scalpel to determine the tumor relationship with the structures mentioned. Place several pieces from different areas in formalin, fix for several hours or overnight & trim it to place in cassettes.

PROCEDURE:

PROCEDURE 2. Place the entire specimen in a large pan containing formalin, cover with a towel, leave in fridge at 4◦ C overnight, & cut parallel slices with large, sharp knife. Take X ray & photographs.

PROCEDURE:

PROCEDURE Quickly dissect the soft tissues from the rest of the extremity, looking for other foci of tumor or other lesions. Cut the major bones of the extremity longitudinally with a band saw Make one of the sections through the area of the bone closest to the soft tissue tumor. Examine for tumor extension or other lesions. Open the major joints & examine them

DESCRIPTION:

DESCRIPTION Type of the amputation; side of the extremity Length & circumference of extremity, including circumference at the level of tumor Presence , position & dimensions of biopsy sites

DESCRIPTION:

DESCRIPTION 4. Tumor characteristics : Primary location: subcut fat, muscle compartment(specify which), fascial planes Tumor extension into & relation with the skin, subcutaneous fat , deep fascia, muscle, periosteum, bone, joint vessels & nerves: presence of obvious vascular or neural involvement by tumor If previous incision present, is there evidence of tumor extension along it

DESCRIPTION:

DESCRIPTION 4. Tumor characteristics : Size ( 3 dimensions), shape, color, borders(encapsulated?, pushing?, infiltrating?), consistency, secondary changes (cysts, necrosis?, hemorrhage?) Presence of myxoid changes, foci of calcification, cartilage, or bone Shortest distance of tumor from margin of resection

DESCRIPTION:

DESCRIPTION 5. Appearance of remaining extremity if abnormal; skin, subcutaneous fat, muscles, major vessels & nerves, bone( tumor invasion?, osteoporosis?, bone marrow?), joints(osteoarthritis?) 6. Appearance & approximate number of lymph nodes found.

GROSS PHOTOGRAPHS:

GROSS PHOTOGRAPHS Intra muscular myxoma Liposarcoma

GROSS PHOTOGRAPHS:

GROSS PHOTOGRAPHS Rhabdomyosarcoma Neurofibrosarcoma of sciatic nerve

GROSS PHOTOGRAPHS:

GROSS PHOTOGRAPHS Fibrosarcoma Sclerosing Epithelioid fibrosarcoma

GROSS PHOTOGRAPHS:

GROSS PHOTOGRAPHS Malignant fibrous histiocytoma Hyalinizing spindle cell tumor

GROSS PHOTOGRAPHS:

GROSS PHOTOGRAPHS Angiosarcoma of hip region Post mastectomy lymphangiosarcoma

GROSS PHOTOGRAPHS:

GROSS PHOTOGRAPHS Leiomyosarcoma Recurrent leiomyosarcoma

GROSS PHOTOGRAPHS:

GROSS PHOTOGRAPHS Alveolar rhabdomyosarcoma Myxoid chondrosarcoma

GROSS PHOTOGRAPHS:

GROSS PHOTOGRAPHS Synovial sarcoma Alveolar soft part sarcoma

Slide 22:

THANK YOU By : Dr ravi jain