This video demonstrates the detailed grossing procedure for an unoriented cervical cone/LEEP biopsy specimen presenting with carcinoma in situ, grade two. The systematic handling protocol prioritizes precise sequential sectioning and margin identification crucial for pathological diagnosis.
The specimen is first measured (1.8 x 1.6 x 0.7 cm) and then marked using a dual-color inking technique: blue ink identifies the inner, endocervical margin, and black ink identifies the outer, ectocervical margin. The annular tissue is serially sectioned clockwise into 12 narrow segments, with the specialized decision to submit only one piece per cassette to eliminate potential orientation errors during histology processing. The goal is ensuring every section captures all three diagnostic components: the ectocervical margin (black), the endocervical margin (blue), and the mucosa/lesion itself. Best practices for assisting the histotechnician, such as labeling embedding instructions ("on edge"), are also outlined.
Grossing an Unoriented Cervical Cone/LEEP Biopsy
0:08 Case Introduction: The video focuses on the grossing of an unoriented cervical cone or LEEP biopsy diagnosed with carcinoma in situ, grade 2.
0:50 Cassette Protocol: The specimen is handled by placing only one piece of tissue per cassette (totaling 12 cassettes for the whole specimen) to ensure strict orientation and sequential tracking, contrasting with common practices that might put multiple sections in one cassette.
1:20 Specimen Details: The formal dictation notes the specimen dimensions (1.8 x 1.6 x 0.7 cm) and the central os size (1.0 x 0.7 cm).
2:26 Dual-Color Inking: The crucial inking process involves applying blue ink to the inner, endocervical aspect and black ink to the outer, ectocervical aspect to mark the resection margins.
3:49 Sectioning Goal: The symmetrical specimen is serially sectioned in a clockwise manner, aiming for 12 total sections, with the goal that each piece contains the blue margin, the black margin, and the mucosa/lesion.
5:14 Sectioning Technique: The specimen is first cut perfectly in half, resulting in two semi-annular pieces, which are then systematically cut into six sections each.
6:18 Aiding Histology: To assist the histotechnologist, the technician writes the number of pieces (always '1' for LEEP sections) on the side of the cassette and includes a note instructing the piece to be embedded "on edge" to ensure the proper margin planes are visualized.