• Weigh and measure (three dimensions) the specimen.
• Examine the pleural surface for retraction, fibrosis, and adhesions.
• If infection is suspected, try to identify a mass lesion by palpation and external examination, wearing sterile gloves.
• If a mass is identified, use a sterile blade to take a piece from the mass through the pleural surface (not through the resection margin), then proceed as below.
• If no mass is identified, proceed as below but use a sterile blade to take a piece of the mass or other suspicious area after sectioning (expect bacterial contamination).
• Submit the tissue to microbiology for culture.  Discuss with the pathology attending whether to request special stains before reviewing the H&E sections.
• Dissect hilar lymph nodes (individually or as a group) and slice off the bronchial resection margin.
• Apply ink to the pleura overlying the mass, especially in areas of pleural retraction.
• Dissect the specimen in the unfixed state unless the attending pathologist requests formalin inflation (which involves filling the specimen with formalin through the bronchial tree and clamping it off) and overnight fixation prior to sectioning.
• Open all bronchi and their branches longitudinally with scissors, examining for lesions.  Serially section the lung.
• Describe any masses (size in three dimensions, color, consistency, necrosis, hemorrhage, cavitation, shape, borders).  Note their distances from the bronchial resection margin and the pleura.  Examine for involvement or invasion of bronchi.  If the specimen is a pneumonectomy, determine which lobes are involved by tumor and whether the tumor causes pleural adhesion between lobes.
• Describe the lung parenchyma away from the mass (color, emphysematous changes or bullae, fibrosis/scarring, consolidation).
• Take photographs.
• If rib is included, examine the external surface for evidence of tumor involvement.  Make a cross-section through any suspicious areas or through the center, if unremarkable.

• Mass:  three to five sections if infection suspected, minimum of five sections if neoplasia suspected.  Include adjacent uninvolved lung parenchyma, adjacent pleura, and adjacent bronchus in sections.
• Lung and pleura distant from mass:  three sections, including any additional lesions.
• Bronchial resection margin:  one complete cross section, en face.
• Lymph nodes:  entirely submit, designating specific location.
• Rib:  one complete cross-section for decal.
• If mesothelioma is suspected, a small portion (at least one dimension of individual piece should be <2 mm) of the specimen should be saved in glutaraldehyde for EM.

Internal use only

Received without fixative/in formalin, labeled _____ and “_____”, is a __ g, __ x __ x __ cm upper/middle/lower lobe of the left/right lung with a __ cm long bronchiovascular stump at the hilus and a ___ cm stapled linear margin coursing from ___ to ___.    The visceral pleura shows  ____ cm area of ___  (e.g. focally thickened, indurated, stellate fibrosis) in ___ (aspect) with a palpable mass below the area.  The main branch of the bronchus is opened to reveal _____ (e.g. intrabronchial nodule, mucosal ulcer, stricture, no abnormality) in ___ located ___ cm from the hilar bronchial margin.  Serial sections show a ____cm ____ (color, consistency, circumscription, centrally necrotic, hemorrhagic) mass in ___ (e.g. superior portion, peripheral protion, around ___ brounchus) with/without associated pleural puckering/extension.  The mass is located __ cm from the hilar bronchial margin.  The uninvolved lung has mild/focal/extensive _____ (consolidation, emphysematous changes, scarring, hemorrhage).  The uninvolved pleura is _____ (color, smooth vs. rough, thickened, adhesion-covered).  A few gray-black, soft lymph nodes ranging from __ to __ cm are identified in the hilar region.  Pleura overlying the mass is inked _____.  Photographs are taken.  Representative sections are submitted as follows:

#__ & #__ = hilar bronchiovascular resection margin; __ pieces.

#__ - #__ = hilar lymph nodes (e.g. 2 nodes bisected node or 3 possible intact nodes each cassette).

#__ & #__ = tumor mass (with adjacent bronchus if central OR with overlying inked pleura if peripheral); __ pieces in each.

#__ & #__ = tumor mass with adjacent lung parenchyma; __ pieces in each

#__ & #__ = uninvolved lung; __ pieces.

__ blocks, __ H&E, __FS