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Mastectomy, non-tumor

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IntroductionEdit

There are two scenarios for receiving a breast expected to be benign:

  • Resection of the contralateral breast in a patient with breast cancer on the other side.
  • Prophylactic bilateral mastectomy in a patient with a hereditary cancer syndrome (BRCA1, BRCA2 mutation)

You are not expecting to find a lesion, but should look for one with some routine sections.

Fresh HandlingEdit

  • Consult radiology reports and clinical history to determine the clinical scenario and guide your gross inspection.
  • Measure the breast, skin ellipse, nipple-areola complex and nipple.
  • Orient the breast using the surgeon’s sutures.
  • Ink the breast:
    • Anterosuperior: blue
    • Anteroinferior: green
    • Deep: black
  • Place the breast face-down on the table, oriented.
  • Section into quadrants using a Tissue-Tek knife, then section further in a pinwheel fashion (see diagram).
  • Look and palpate tissue for any lesions. If present, document.
  • Fix specimen in a large quantity of formalin.

Grossing InEdit

If the specimen was thoroughly described in the fresh state, then most of the work is already done.

  • Submit sections:
    • Contralateral breast from cancer patient:
      • 2 representative sections from each quadrant
      • 1 section of nipple
    • Prophylactic breast from BRCA patient:
      • 3 representative sections from each quadrant
      • 1 section of nipple

Submit the case in a bucket designated for “breast”, “fat”, or “16 hour” processing (all of these mean the same thing).


Review and SignoutEdit

1. Breast, right, mastectomy:

2. Breast, right, prophylactic mastectomy:

A. Breast, no carcinoma identified.
B. Non-proliferative fibrocystic changes.
C. ___ lymph nodes, no carcinoma identified (0/___).



Return to Breast Grossing

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