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United States Government Work, uncopyrighted, public-domain,
DRAFT COPY ONLY. This document does not necessarily represent the views
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PRINCIPLE OF THE TEST.
A thyroidectomy is performed for known or suspected cancer, or other
clinical indication, and received in surgical pathology for evaluation.
The specimen should be oriented, evaluated grossly, surgical margins inked,
and any gross abnormalities described thoroughly. The final report
should reflect an adequate sampling of tissue, and should include
the size and TNM stage of any tumor.
SPECIMEN REQUIRED.
Tissue Specimen and filled-out
Tissue Examination Form (USSF515).
REAGENTS, INSTRUMENTATION.
1. Dissection Instruments.
STEP-BY-STEP DESCRIPTION.
1. Orient the thyroid gland by identifying the inferiorly-placed
isthmus, and the concavity of the posterior aspect of the lateral lobes.
2. Some thyroid glands have an upwardly pointed pyramidal lobe,
arising from the isthmus.
3. Ink the outer surface of the thyroid gland.
4. In a hemithyroidectomy, shave and submit
the isthmus surgical margin.
5. Serially section each thyroid lobe transversely,
along the short axis, and maintain the proper orientation of the slices.
6. Submit sections to demonstrate normal parenchyma, any identifiable
lymph nodes, parathyroid glands if present, juxtaposition of tumor
and thyroid parenchyma, and juxtaposition of tumor and capsule.
7. Completely submit the tumor, in a manner to demonstrate
the relation between the tumor capsule and surrounding parenchyma.
FIGURE 173.001.0. Thyroidectomy specimen.
8. TNM STAGING.
TUMOR STAGING:
T1 ... <1 cm, limited to thyroid.
T2 ... 1-4 cm, limited to thyroid.
T3 ... >4 cm, limited to thyroid.
T4 ... Extension beyond thyroid capsule.
NODAL STAGING:
N0 ... No regional nodes.
N1 ... Positive regional nodes.
N1a ... Ipsilateral cervical nodes.
N1b ... Bilateral or contralateral.
METASTASIS STAGING:
M0 ... No metastases.
M1 ... Distant metastases (includes pelvic lymph nodes).
REFERENCES.
1. Rosai J.
Rosai and Ackerman's Surgical Pathology. Ninth Edition.
St Louis: C.V. Mosby. 2004;:.
ISBN: 0323013422, 3080 pages.
2. Mills SE, Carter D, Greenson JK, Oberman HA,
Reuter VE, Stoler MH, eds.
Sternberg's Diagnostic Surgical Pathology. Fourth Edition.
New York: Lippincott Williams & Wilkins. 2004;:.
ISBN: 0781740517, 3089 pages.
3. Westra WH, Hruban RH, Phelps TH, Isacson C.
Surgical Pathology Dissection. An Illustrated Guide.
Second Edition. With a Forward by Askin FB.
New York: Springer. 2002.
ISBN 0-387-95559-3, 258 pages.
4. Lester SC.
Manual of Surgical Pathology.
New York: Churchill Livingstone.
A Harcourt Health Sciences Company. 2001.
ISBN 0-443-07918-8, 336 pages.
5. Sinard JH.
Outlines in Pathology.
Philadelphia: W.B.Saunders Company.
A Harcourt Health Sciences Company. 1996.
ISBN 0-7216-6341-9, 229 pages.
6. American Joint Committee on Cancer.
AJCC Cancer Staging Manual. Sixth Edition.
New York: Springer. 2002.
ISBN 0-387-95271-3, 421 pages.