GROSS DESCRIPTION:
Part 1:
Part 1 is labeled "tissue right deep neck". It consists of a 0.8
x 0.5 x 0.3 cm irregular segment of rubbery, pink and fibrotic,
soft tissue, with focal cautery artifact. The specimen is
entirely frozen. The remainder of the frozen tissue is totally
submitted labeled 1AFS.
INTRAOPERATIVE CONSULTATION: TISSUE FROM RIGHT DEEP NECK (Frozen section) -
BENIGN.
Part 2:
Part 2 is labeled "lymph node right posterior triangle". It
consists of a 1.0 x 0.6 x 0.3 cm irregular portion of pink to
tan and focally cauterized soft tissue. The specimen is entirely
frozen. The remainder of the frozen tissue is totally submitted
labeled 2AFS.
INTRAOPERATIVE CONSULTATION: LYMPH NODE FROM RIGHT POSTERIOR TRIANGLE (Frozen section) -
BENIGN.
Part 3:
Part 3 is received fresh labeled "right neck mass and
hemimandibulectomy". The specimen consists of a 12.0 x 9.0 x 7.5
cm segment of mandibular facial skin and soft tissue attached to
a resected right hemimandible that extends from the anterior of
the canine tooth to the superior ramus. The coronoid and
condylar process of the mandible are not included in this
resection. The mandibular segment has three teeth, one canine
and two premolars. Distal to the premolars there are no teeth.
On the facial skin of the specimen, a cotton drape is affixed
with metal staples. On removal of the cotton drape, an eruptive tumor is evident in the region of the mandibular
angle. The tumor measures 4.5 x 4.3 x 3.5 cm and has a central brown-
tan nodular appearance. The tumor
projects about 3.0 cm above the surface of the skin and shows
dependent wrinkling with hair at the inferior surface. The
surgical margins from the skin to mandible are inked black. At
the lingula of the mandible, the surgical margins of the lingual
musculature are inked black. The gingival mucosal margin is
inked black. Serially sectioning the tumor reveals a focus of
liquified necrosis in the posterior and deep aspect of the tumor.
Sections distal to the main tumor mass reveal a new tumor focus
that is 1.4 cm in greatest dimension and grossly separated from
the large tumor mass. Digital and photographic images of the
tumor are captured. Representative sections are submitted as
follows:
3A - Three sections of inferior margin
3B - Two sections of inferior anterior margin
3C - Anterior skin margin
3D and 3E - A deep section from surface skin to deep periosteum
is taken and divided into two cassettes; the skin surface is 3D,
the periosteal surface is in 3E. An additional deep surface is
taken in cassette 3F.
3G - New tumor focus at the posterior angle of the mandible
3H - Two sections through the distal aspect of the specimen
3I - Lingual gingival margins distal to the premolars
3J - One section of gingival mucosa at the level of the canine
3K - Distal gingival margins along mandibular ramus
3L - Lingual surfaces of muscle showing relationship of tumor
tracking beneath mandible
3M - Anterior bony resection margin
3N - Posterior bony resection margin