• Measure the specimen (three dimensions).
• Dissect out the lymph nodes from the fat.  Measure the smallest and largest lymph nodes.  Examine the external surfaces for tumor and capsular defects.
• Serially section the lymph nodes at 2-3 mm intervals across the short axis (see below) if lymphoma is suspected or needs to be ruled out.  It is acceptable to section lymph nodes longitudinally if metastatic carcinoma is suspected.
• The first priority is good formalin-fixed, paraffin-embedded, and H&E-stained sections.  Frozen sections subsequently processed in formalin usually show cellular distortion and are not useful for diagnosis.  If insufficient tissue is present (i.e., less than two blocks of tissue) do not freeze the tissue or send it for special studies.  Perform touch preps (see below) and submit all the tissue in formalin for processing.
• If the lymph node is received without fixative, determine whether the specimen is submitted for an infection work-up, a lymphoma work-up, both, or neither.
• Touch-preps:  for all cases.
• Gently blot the cut surface of one of the slices, in order to remove blood or saline.  Press a clean slide to the cut surface of the slice, at least 2-3 times on adjacent areas of the slide.  Prepare a total of four slides in this manner.  Fix two slides in alcohol and stain with hematoxylin-eosin or other stain as requested by the attending pathologist.  Air-dry the other two slides and stain with DiffQuik stain.
• If the imprints are low in cellularity, you may gently scrape the cut surface of the slice with a sharp blade, then smear out the scraped material onto a clean slide and stain as above.
• Infection work-up:  if infection is suspected clinically, following frozen section, or on gross examination.
• Microbiologic culture:
• Ideally, tissue for culture should be sent to microbiology directly from the operating room so that the tissue remains sterile until cultured.  Remind the surgeon of this when you pick up the fresh tissue if he/she is suspecting an infectious process.
• If you must submit tissue from pathology for culture, use sterile technique.  Take a small piece of tissue unless the specimen is very large.  Indicate on the request form which studies (i.e. bacteria, fungi, AFB) are to be performed.
• Special stains:  consult with the attending pathologist whether to pre-order unstained slides or request special stains.
• Lymphoma work-up:  if leukemia or lymphoma is suspected clinically, following frozen section, or on gross examination.  See Lymphoma Work-Up.
• Fix the remainder of the specimen in formalin.  If the specimen will sit in formalin before going into cassettes, it may be helpful to place each individual slice on a small piece of paper or paper towel to minimize curling.  Discard the paper before submitting the tissue.
• If the specimen is received in formalin, do not request special studies (exception:  unstained slides or special stains).

• One to five sections, depending on the size of the lymph node.  Include the capsule.  Avoid submitting excessive fat.
• Request thin H&E sections (3 µm-thick).
• Request special stains and unstained slides depending on the case.

Internal use only

Received without fixative/in formalin, labeled _____ and “_____”, is a __ x __ x __ cm portion of yellow fibroadipose tissue containing __ (number) discrete/matted lymph nodes.  The lymph node capsules are _____ (intact, inapparent).  Each lymph node has a _____ (color, fleshy, bulging, soft, firm, multinodular, necrotic, hemorrhagic) cut surface.  __ (number) touch preps are prepared and stained with _____ stain.  A portion of the specimen is submitted for microbiologic culture and flow cytometry, and is held for possible gene rearrangement studies.  Representatively submitted for routine histology in cassette #__ -__.

__ blocks, __ H&E, __ touch preps (__ Diff-Quik, __ H&E)