Many of these grossing templates were made with generous help from Dr. Zarrin Hossein-Zadeh.  Others are based on templates from institutions I’ve practiced at.  For some, you’ll see that there are different versions/options. As with all templates, these must be customized for each case–no two cases are the same!

Amputation Digit

Received [fresh/in formalin], labeled with the patient’s name, medical record number and designated as “[….],” is/are [# of digits] [fingers/toes].
Dimensions: *** cm intact digit length, *** cm exposed bone, [3D] cm aggregate of soft tissue fragments
Resection margin, soft tissue: [Viable/Necrotic/Discolored yellow] Resection margin, bone: [PLEASE STATE WHETHER THE BONE MARGIN IS A CUT SURFACE OR AN ARTICULAR SURFACE] Skin: [Color] skin with [describe ulcers, sloughing, discoloration, mummification, etc] Nail: [Absent/Thickened/Yellow/Black] Bone: [Hard and uninvolved / Softened under ulcer] Other findings: ***
Gross photographs: [Yes or remove line]

Cassette Summary
***: Skin and soft tissue at resection margin, en face
***: [… skin lesion] ***: [Bone if involved, following decalcification] ***: [If your gross exam, clinical history, or radiology is suspicious for osteomyelitis: submit bone / bone marrow margin, following decalcification]

 

 

Amputation Revision

Received fresh, labeled with patient’s name, medical record number and designated as “***” is a [left/right] [above knee amputation/below knee amputation], revision of prior [below knee amputation/transmetatarsal amputation].
Dimensions: *** cm length, *** cm exposed bone
Distal amputation site: [Well-healed stump/Necrotic soft tissue and bone/Other] Proximal resection margin: [Viable/Necrotic/Discolored yellow] Skin: [Color] skin with [describe ulcers, sloughing, discoloration, etc] Bone: [Hard and uninvolved / Softening under ulcer] Femoral artery: [Patent / % stenosis / Occluded] Anterior tibial artery: [Patent / % stenosis / Occluded] Posterior tibial artery: [Patent / % stenosis / Occluded] Other findings: ***
Gross photographs: [Yes or remove line]

Cassette Summary
***: Skin and soft tissue at resection margin, en face
***: [… skin lesion] ***: [skin lesion OR bone if involved, following decalcification] ***: Femoral, anterior tibial and posterior tibial arteries

 

Above Knee Amputation (Benign Disease)

Received fresh, labeled with patient’s name, medical record number and designated as “***” is a [left/right] above knee amputation.
Dimensions: *** cm leg length, *** cm foot length, *** cm exposed femur
Resection margin: ***
Skin: [Color] skin with [describe ulcers, sloughing, discoloration, etc] Bone: [Hard and uninvolved / Softening under ulcer] Femoral artery: [Patent / % stenosis / Occluded] Anterior tibial artery: [Patent / % stenosis / Occluded] Posterior tibial artery: [Patent / % stenosis / Occluded] [Other findings: ……] Gross photographs: [Yes or remove line]

Cassette Summary
***: Skin and soft tissue at resection margin, en face
***: [… skin lesion] ***: [Skin lesion OR bone if involved, following decalcification] ***: Femoral, anterior tibial and posterior tibial arteries
***: [If your gross exam, clinical history, or radiology is suspicious for osteomyelitis: submit bone / bone marrow margin, following decalcification . IF NOT remove line]

 

Below Knee Amputation (Benign Disease)

Received fresh, labeled with patient’s name, medical record number and designated as “***” is a [left/right] below knee amputation.
Dimensions: *** cm leg from resection margin to heel, *** cm foot, *** cm exposed tibia, *** cm exposed fibula
Resection margin: [Viable/Necrotic/Discolored yellow] Skin: [Color] skin with [describe ulcers, sloughing, discoloration, etc] Bone: [Hard and uninvolved / Softening under ulcer] Anterior tibial artery: [Patent / % stenosis / Occluded] Posterior tibial artery: [Patent / % stenosis / Occluded] [Other findings: ……] Gross photographs: [Yes or remove line]

Cassette Summary
***: Skin and soft tissue at resection margin, en face
***: [… skin lesion] ***: [Skin lesion OR bone if involved, following decalcification] ***: Anterior and posterior tibial arteries
***: [If your gross exam, clinical history, or radiology is suspicious for osteomyelitis: submit bone / bone marrow margin, following decalcification. IF NOT remove line]

 

 

 

Above Knee Amputation (for Tumor)

Received fresh, labeled with the patient’s name, medical record number and designated “***” is a [right / left] above the knee amputation measuring ***cm from superior to inferior, *** cm from anterior to posterior, and *** cm from medial to lateral. The foot measures *** x*** x*** cm. The bony femoral stump extends *** cm from the soft tissue resection margin and appears [uninvolved / involved – provide gross features of involvement] by tumor. The soft tissue resection margins appear grossly [viable / non-viable – provide gross features and location of non-viable area (s)] and are [free of tumor grossly / involved by tumor grossly – provide gross features of involvement]. The soft tissue and bone margins are marked with black ink.
External examination of the leg displays [tan / brown / etc] skin and shows [no overt evidence of a tumor / evidence of a tumor]. IF PRESENT: The changes indicative of a tumor include [mass-effect changes which are disfiguring the leg / focal edema / diffuse edema / vascular-pattern marbling / skin ulceration / etc – provide features]. The epicenter of the above external changes is at the [lower leg just inferior to the knee / upper leg / lower leg just above the ankle / etc – provide anterior, posterior, medial, lateral relationships] and the diseased tissue spans over a distance of *** x*** x***cm. The changes extend to within *** cm of the margin. A skin scar [is not / is – provide measurements and location] identified.

On sectioning, the above changes are caused by a *** x*** x***cm tumor. The epicenter of the tumor is in the [metaphysis / epiphysis / diaphysis] of the [mid / proximal / distal] [tibia / femur / fibula]. The cut surfaces of the tumor are [firm / gritty / ossified / tan / tan – yellow] and the tumor has a [circumscribed / infiltrative] border. The tumor [does not display areas of necrosis, hemorrhage, and cavitation / displays areas of necrosis, hemorrhage, and cavitation / etc.]. IF PRESENT: These changes involve approximately *** % of the tumor. IF APPLICABLE: Grossly, while the epicenter of the tumor is at the [metaphysis / epiphysis / diaphysis] the tumor also [extends into / involves] the [metaphysis / diaphysis / epiphysis] of the bone. The tumor [does not involve / extends radially into – provide the anatomic location and extent of soft tissue involvement] the surrounding soft tissues. The tumor [does not extend to / extends to without breaching / breaches – provide extent of involvement of joint space and surrounding soft tissue and bone] the joint space. Satellite tumors [are not / are – provide gross features, location, relationship to primary tumor and margins] seen.
The soft tissue margin is [involved / free by *** cm]. And the bony margin is [involved / free by *** cm].
Lymph nodes [are not / are – provide location of nodes identified, size, and gross features].
Gross photographs [are / are not] taken.

Cassette summary:
***: Soft tissue resection margin , shave [place in several cassettes, providing anatomic orientation for each cassette; eg: anterior –lateral, posterior lateral, etc. If this margin is involved, take a longitudinal section showing the tumor at the margin].
***: Femoral resection margin, shave [unless involved, in which case a longitudinal section showing the tumor at the margin is preferred].
***: Sections demonstrating tumor with as labelled per specimen image [make sure to submit the areas with the most extensive involvement].
***: Lymph nodes

 

 

Below Knee Amputation (for Tumor)

Received fresh, labeled with the patient’s name, medical record number and “***” is a [right / left] below the knee amputation. The specimen measures *** x*** x*** cm in greatest dimension. The heel to fibula margin measures *** cm, and the heel to tibia margin measures *** cm. The foot measures *** x*** x*** cm. The bony tibia and fibula stumps extend *** cm and *** cm from the soft tissue resection margin respectively. The bone margins appear [uninvolved / involved – provide gross features of involvement] by tumor. The soft tissue resection margins appear grossly [viable / non-viable – provide gross features and location of non-viable area (s)] and are [free of tumor grossly / involved by tumor grossly – provide gross features of involvement]. The soft tissue and bone margins are marked with black ink.

External examination of the leg displays [tan / brown / etc] skin and shows [no overt evidence of a tumor / evidence of a tumor]. IF PRESENT: The changes indicative of a tumor include [mass-effect changes which are disfiguring the leg / focal edema / diffuse edema / vascular-pattern marbling / skin ulceration / etc – provide measurements of the features]. The epicenter of the above external changes is at the [lower leg just above the ankle / lower leg between the ankle and resection margin / etc – provide anterior, posterior, medial, lateral relationships] and the diseased tissue spans over a distance of *** x*** x***cm. The changes extend to within *** cm of the margin. A skin scar [is not / is – provide measurements and location] identified.

On sectioning, the above changes are caused by a *** x*** x*** cm tumor. The epicenter of the tumor is in the [metaphysis / epiphysis / diaphysis] of the [tibia / fibula]. The cut surfaces of the tumor are [firm / gritty / ossified / tan / tan – yellow] and the tumor has a [circumscribed / infiltrative] border. The tumor [does not display areas of necrosis, hemorrhage, and cavitation / displays areas of necrosis, hemorrhage, and cavitation / etc.]. IF PRESENT: These changes involve approximately *** % of the tumor. IF APPLICABLE: Grossly, while the epicenter of the tumor is at the [metaphysis / epiphysis / diaphysis] the tumor also extends into / involves the [metaphysis / diaphysis / epiphysis] of the bone. The tumor [does not involve / extends radially into – provide the anatomic location and extent of soft tissue involvement] the surrounding soft tissues. The tumor [does not extend to / extends to without breaching / breaches – provide extent of involvement of joint space and surrounding soft tissue and bone] the joint space of the ankle. Satellite tumors [are not / are – provide gross features, location, relationship to primary tumor and margins] seen.
The soft tissue margin is [involved / free by *** cm]. And the bony margin is [involved / free by *** cm].
Lymph nodes [are not / are – provide location of nodes identified, size, and gross features].
Gross photographs [are / are not] taken.

Cassette summary:
***: Soft tissue resection margin, shaved [place in several cassettes, providing anatomic orientation for each cassette; eg: anterior –lateral, posterior lateral, etc. If this margin is involved, take a longitudinal section showing the tumor at the margin] ***: Tibia resection margin, shaved [unless involved, in which case a longitudinal section showing the tumor at the margin is preferred] ***: Fibula resection margin, shaved [unless involved, in which case a longitudinal section showing the tumor at the margin is preferred] ***: Sections demonstrating tumor with as labelled per specimen image [make sure to submit the areas with the most extensive involvement] ***: Lymph nodes