• Common soft tissue tumor of extremities include: malignant fibrohistiocytomas (MFH), malignant peripheral nerve sheath tumor, angiosarcoma, and occasionally giant cell tumor of the bone.

• Key elements to note: size and location of the tumor, relationship to adjacent neurovascular structures and bone, involvement of these structures, and lymph node status. Review recent imaging (x-ray/CT/MRI) results to guide the dissection.

• Measure the length and circumference (including the circumference at the level of the tumor)
• Carefully dissect the subcutaneous fat, muscles, and major arteries, veins, and nerves around the tumor
• Once the extent of the tumor is determined, remove the entire area with a good margin of normal tissues.
• Use blunt dissection to determine the tumor relationship with the structures previously mentioned.
• Orderly sample the tumor so that the extent of tumor and relationship with neurovascular structure can be correlated microscopically later.
• Quickly dissect the soft tissues from the rest of the extremity, looking for other foci of tumor or other lesions
• Cut the major bones of the extremities longitudinally with a band saw to examine the tumor extension.

• Tumor:  One section for each cm of the tumor; whenever possible, include the periphery of the tumor and adjacent fat, muscle, skin, periosteum, vessels, and/or nerves.
• All grossly dissimilar areas should be sampled. 
• Previous incision site (if present) taken all along its course.
• Lymph nodes:  if grossly normal, only representative ones; if grossly abnormal or if clinical suspicion of metastases, all of them.
• Proximal margins of resection:  subcutaneous fat and muscle (plus skin and/or bone if indicated).
• Vascular margin or resection.
• Nerve margin of resection in cases of malignant peripheral nerve sheath tumors.

Received unfixed, labeled with the patient name, medical record number and “____”, is a ____ cm long right / left, upper / lower extremity amputated at _______ (e.g. ___ cm above the knee / mid lower leg  / at ___ joint) with ___ cm ____ (i.e., tibia) bone shaft protruding from the soft tissue margin. The specimen includes a ___ cm segment of ___ (e.g. upper arm, forearm) with a maximum diameter of __ cm, and a __ cm ___ (e.g. hand).  There is a well-healed ___ cm linear scar / biopsy site on the skin at _______ aspect overlying a visible / palpable soft tissue / bone mass. A large ___ (deeply seated / superficial) ___ (firm, fluctuant / soft) mass is palpable in _____ .  A longitudinal incision is made and the blunt dissection reveals a __ x __ x __ cm, ___ (round / oval ) ___ (solid / cystic) ___ (cutaneous / subcutaneous / intramuscular) mass in the ____ (mid portion of the extremity) approximately __ cm from the closest proximal resection margin.  The tumor is ___ (encasing / infiltrating into / in juxtaposition to / __ cm from) a nearby neurovascular bundle (or adjacent bone).  The cut surface is _____ with ____ (punctuated necrosis / hemorrhage / cystic changes). Invasion of a large ____ (vessel) is noted. There are no / ___ separate satellite tumor nodules of ___ cm and ___cm in diameter in the soft tissue within ___ cm from the main tumor.  Longitudinal slice of the _____ bone reveals ____ (changes) bone cortex and ____ (color, trabeculae) marrow.  The ___ joint is ___.  Representative sections are submitted as follows:

#__ - #__ = proximal soft tissue resection margin including vascular margin

#__ - #__ = proximal bone resection margin

#__ - #__ = tumor with adjacent neurovascular bundles (tumor with adjacent cortex in #__)

#__ - #__ = tumor with adjacent ____ (skin / muscle / bone)

#__ - #__ = satellite nodules

#__ - #__ = scar and previous biopsy (procedural) site

#__ - #__ = multiple lymph nodes, ____ (location)

#__ - #__ = uninvolved soft tissues

___ blocks, ___ H&E, __ decal