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Operative Report Example 3

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Path. No.: S91-0100

Name: Phineas Feltbad
Reg. No.: 000040

Age: 79
Sex: Male
Race: White
Location: _____
Date: 05/23/91

Address:________________________
Occupation:________________

Pre-operative Diagnosis: Cancer of left floor of mouth

Operative Findings: Cancer of left floor of mouth

Post-operative Diagnosis: Same


Surgical Pathology Section

Gross:

The specimen is received in three parts, all fresh.

Part #1 which is labeled "? metastatic tumor in jugular vein lymph node" consists of an elliptical fragment of light whitish-tan tissue which measures approximately 0.3 x 0.2 x 0.2 cm. The specimen is examined by the frozen section technique, and the diagnosis is "ganglion". The remainder of part #1 of the specimen is submitted as frozen section control #1.

Part #2 is labeled "resection of floor of mouth continuous with tongue and mandible plus left radical neck dissection". As received in the frozen section room, the specimen consists of a grossly identifiable left radical neck dissection and also the entire left ascending ramus of the mandible, the posterior three-fourths of the left mandible proper, the left lateral portion of the tongue, and the submental and submaxillary salivary glands. The main lesion is identified on the left side of the floor by the mouth. There is a craterform lesion which measures approximately 1.2 x 0.5 cm in greatest dimensions. With the assistance of Dr. U. No Whoo, the specimen is properly oriented. Two areas of interest are defined. The first of these is the anterior tongue margin. The second of these is the medial tongue margin. Fragments from each of these areas are examined by the frozen section technique. The diagnosis on frozen section #2 (anterior tongue margin) is "no tumor seen" and on frozen section #3 (medial tongue margin) is "no tumor seen". Two additional areas of special interest are identified. The first of these is that portion of the left radical neck dissection which was nearest to the carotoid artery. A fragment of tissue from this area is excised and submitted for sectioning labeled "CM". The second area of interest is that portion of the left radical neck dissection which bordered upon the anterior aspect of the vertebral column. A fragment of tissue is excised from this area and submitted for sectioning labeled "VM". After having been photographed in several positions, the specimen is blocked further. A section is taken through the main tumor mass and submitted for sectioning labeled "T POST". Attention is directed to the left radical neck dissection proper. This part of the specimen is divided into the appropriate five levels. Each level is examined for lymph nodes which are dissected free and submitted in their entirety for sectioning. The remainder of the specimen is saved.

Part #3 of the specimen, labeled "anterior margin of inferior mandible" consists of an irregular fragment of fibrous connective and skeletal muscular tissues and measures approximately 1.0 x 0.5 x 0.2 cm. The specimen is submitted in its entirety for sectioning on three levels.

Microscopic Description:

Microscopic examination of frozen section control #1 confirms the original frozen section diagnosis of "ganglion".

Microscopic examination of frozen section control #2 confirms the original frozen section diagnosis of "no tumor seen".

Microscopic examination of frozen section control #3 confirms the original frozen section diagnosis of "no tumor seen".

Microscopic examination of part #2 of the specimen reveals foci of moderately well differentiated squamous cell carcinoma in the floor of the left side of the mouth. The residual tumor is surrounded by large amounts of dense fibrous connective tissue. Microscopic examination of the section labeled CM which represents the carotoid margin reveals squamous cell carcinoma extending to within 0.1 cm of the surgical margin.

Microscopic examination of section labeled VM representing the vertebral margin fails to reveal evidence of tumor in this location. Microscopic examination of the tissue in level I reveals section of fibrotic and atrophic submaxillary salivary gland. There is also one lymph node in level I which is negative for metastatic tumor. Microscopic examination of the tissue in level II reveals sections of 11 lymph nodes none of which contains numerous foci of squamous cell carcinoma. Microscopic examination of the tissue in level IV reveals sections of 6 lymph nodes, none of which contains metastatic tumor. Microscopic examination of the tissue in level V reveals 1 lymph node which is negative for metastatic tumor.

Diagnosis:

  1. Squamous cell carcinoma, left floor of mouth
  2. Squamous cell carcinoma, in extranodal connective tissue of neck at level III
  3. Nineteen cervical lymph nodes, no pathologic diagnosis.

Largo Grossman, MD
Pathologist