sections of a #Lumpectomy showing an ill-defined, pink-white | Figure 1

Pathologists' Assistant

Sections of a #Lumpectomy showing an ill-defined, pink-white, indurated mass. The 'S' and 'I' written are to keep orientation as to superior and inferior margins. On the far ends of the towel, 'M' and 'L' designate medial and lateral ends. In this case, because the lumpectomy is anteriorly surfaced by skin, we actually have 8 margins to measure distance of the tumor from: superior aspect of anterior soft tissue margin, skin margin, inferior aspect of anterior soft tissue margin, posterior margin, superior, inferior, medial, and lateral margins!

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Sagittal postcontrast CT image child with a closed head injury shows injury to the anterior portion of the superior sagittal sinus with extravasation of contrast (arrow) into the extracranial soft tissues and partial thrombus (arrowhead) of the anterior aspect of the superior sagittal sinus. The most common site of dural venous sinus injury is the anterior and middle third of the superior sagittal sinus. Because of the rich collateral venous drainage at this location, patients can be treated with sinus ligation. #NeuroWednesday

#Melanoma of the #Ear. Primary lesion not visible here but unfortunately has spread locally and involves many aspects of the margin. This patient will likely have to have a re-excision performed to assure clear margins.

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Here I present the gross pathology and microscopic diagnosis of a left distal femur specimen from a woman in her 30s. The patient underwent resection for a biopsy-proven Osteosarcoma, a highly aggressive tumor arising from bone. Osteosarcoma is the most common primary malignant bone tumor typically seen in younger patients under 40 years old. The first 2 pictures show the specimen before inking and sectioning. The soft tissue around the bone must be removed to attempt to get negative margins in case the tumor has extended beyond the bone. In the 3rd picture, we have a longitudinal cross section of the femur, showing the large (6.2 cm) white tumor circled in red. While this angle seems to support the tumor being confined to the bone, our 4th picture shows white, firm tumor tissue seemingly present at the black ink, representing the posterior soft tissue margin. The last picture is a full cross section of the mass, extending down to the black ink again. Unfortunately, the gross appearance of tumor at the posterior margin was confirmed microscopically and was considered a positive margin. The final diagnosis was: Osteosarcoma, Fibroblastic variant, Grade 2, present at the posterior soft tissue margin and 0.5 cm from the anterior soft tissue margin.

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