Grossing Olympics

Grossing Olympics

February 23, 2026

February 2026

Start

Events

Thyroid Figure Skating

Lung Bobsled

Prostate Alpine Skiing

Stomach Curling

Lip Luge

Closing ceremony

Thyroid - Figure Skating

The judges (attendings) have recently revised the standards for this event. Before we begin, let's review the changes. You can also review the new policy in Policy Stat

Thyroid - Figure Skating

Qualifying Round

short stitch - right superior long stitch - left inferior

right thyroid lobe

isthmus margin

Three nodules: Levels 3-4 Levels 5-6 Levels 6-11

Thyroid - Figure Skating

Medal Round

Review of Staging

short stitch - right superior long stitch - left inferior

The specimen is labeled " total thyroid." Received fresh and transferred to formalin is a 56.4 g asymmetrical thyroid gland. The specimen is oriented as follows: Short stitch = right superior, long stitch = left inferior. The right lobe is 5.4 x 3.7 x 3.2 cm, the left lobe is 3.8 x 3.0 x 2.2 cm, and the isthmus and pyramidal lobe are 3.4 x 2.0 x 0.8 cm. The external surface is smooth red-pink and intact. The specimen is marked with blue ink on the superficial surface, marked with black ink on the deep surface. The lobes are serially sectioned from superior to inferior into 13 levels (right lobe) and 9 levels (left lobe). The isthmus is sectioned from right to left into 4 levels. Sectioning reveals multiple separate nodules. Nodule #1 is 2.4 x 2.2 x 1.5 cm with a thinly encapsulated pale-tan solid cut surface within levels 4-9 of the left lobe. Nodule #1 abuts the inked outer surface. Nodule #2 is 0.5 x 0.3 x 0.3 cm with a tan-pink encapsulated pale-tan solid cut surface within levels 5-6 of the left lobe, 0.3 cm from nodule #1. Nodule #2 is less than 0.1 cm from the inked outer surface. Nodule #3 is 1.9 x 1.8 x 1.2 cm with a glistening tan-pink thinly encapsulated solid cut surface within levels 1-3 of the right lobe. Nodule #3 abuts the inked outer surface. Nodule #4 is 0.3 x 0.3 x 0.3 cm with a tan-pink thinly encapsulated solid cut surface and level 2 of the right lobe, 0.5 cm from nodule #3 and 0.1 cm from the outer surface. Nodule #5 is 4.0 x 3.1 x 2.4 cm thinly encapsulated, solid, glistening, tan-pink cut surface in levels 5-13 of the right lobe. Nodule #5 is 0.4 cm from nodule #3 and abuts the inked outer surface. The nodules grossly spare the thyroid capsule. The uninvolved thyroid parenchyma is red-brown with a faint nodular background.

Cassette Designation: A1: Level 2, left lobe, uninvolved thyroid parenchyma A2: Representative level 4 with nodule #1, left lobe A3: Representative level 6 with nodule #1 to nodule #2, left lobe A4: Level 8 with nodule #1, left lobe A5: Level 1, isthmus, uninvolved thyroid parenchyma A6: Level 2 with nodule #3 to nodule #4, right lobe A7: Level 3 with nodule #3, right lobe A8: Level 4, right lobe, uninvolved thyroid parenchyma between nodules A9: Representative level 5 with nodule #5, right lobe A10: Representative level 8 with nodule #5, right lobe A11: Representative level 10 with nodule #5, right lobe A12: Representative level 12 with nodule #5, right lobe

Final Score

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Lung - Bobsled

Bobsled requires carefully navigating around corners...just like the margins in this specimen

pericardium margin - yellow cardiac tissue margin - red bronchial margin - orange posterior perihilar pleural disruption - blue perihilar soft tissue margin - black

The specimen is labeled "left pneumonectomy." Received fresh and transferred to formalin is a 540.3 g, 17.3 x 12.4 x 5.4 cm left pneumonectomy. Gross photographs are taken. The pleura is diffusely tan-pink and shaggy, with multifocal areas of severe red-purple adhesions. The horizontal fissure is partially fused on the anterior surface. The majority of the pleura is absent on the posterior surface of the upper lobe. There is a 5.7 x 4.8 cm area of ragged disruption adjacent to the hilum on the superior surface of the lower lobe from which protrudes tan-pink, hemorrhagic friable tissue. This area of disruption is inked blue. Additionally, there is a 5.8 x 3.0 cm area of ragged disruption on the diaphragmatic surface. Adjacent to the area of disruption is a 6.5 x 1.8 cm adherent portion of diaphragm tissue and muscle. At the hilum intervening between the area of disruption and the mainstem bronchus is a 4.5 x 2.2 x 1.2 cm firmly adherent portion of ragged perihilar tan-pink soft tissue having an irregular roughened margin that is inked black. On the anterior perihilar surface is a 3.5 x 2.8 cm circular portion of adherent smooth fibromembranous pericardial sac tissue having a circumferential margin that is inked yellow. Intervening between the adherent pericardial sac and the mainstem bronchus is a 1.5 cm in diameter pulmonary vein encircled by a 2.5 x 2.0 cm rim of cardiac muscle that has a roughened circumferential margin that is inked red. The bronchus is markedly enlarged and bulky, protruding 4.5 cm beyond the hilar soft tissue. The staple lines of the bronchus and pulmonary artery are removed and the true margins on the staple lines are inked green. The underlying bronchial surface is inked orange. Gross photographs are taken of the inked specimen.

The specimen is sectioned longitudinally from medial to lateral to reveal a 5.5 x 4.6 x 3.8 cm fairly well-circumscribed, infiltrative, tan-white firm, centrally friable and partially necrotic mass (gross necrosis accounting for approximately 25% of the overall mass). The mass is centered within the hilum with extension into both the upper and lower lobes. The mass abuts the blue inked area of posterior perihilar pleural disruption, abuts the black inked perihilar soft tissue margin, abuts the yellow inked pericardial sac margin and abuts the pericardial sac surface surface. The mass extensively grossly invades into and partially obliterates the bronchus, coming to within 0.4 cm of the bronchial margin. The mass grossly invades into the walls of the pulmonary artery and pulmonary vein, coming to within 0.7 cm of the pulmonary artery margin, and abuts the pulmonary vein margin. The mass grossly invades into the cardiac muscle surrounding the pulmonary vein, abutting the red inked cardiac margin. The mass directly invades into multiple perihilar possible lymph nodes and extensively invades into the surrounding parenchyma. A central full-thickness cross-section of the mass displaying the greatest dimension is removed, photographed, and submitted. The pulmonary parenchyma radiating from the mass exhibits areas of tan-yellow firm consolidation and grey-pink softening exuding gray-pink purulent fluid. Additionally, there are scattered areas of tan-yellow ill-defined nodularity primarily within both lobes independent of the mass, 0.3 to 1.2 cm in greatest dimension. These areas of irregular parenchyma primarily extend into the lower lobe with slight extension into the upper lobe. The remaining uninvolved parenchyma is soft red-pink and spongy with scattered fine lacelike anthracotic pigmentation. Multiple perihilar possible lymph nodes are identified, 0.3 to 1.5 cm in greatest dimension. The majority of the possible lymph nodes have gray-black firm cut surfaces with areas of patchy tan-white discoloration (grossly positive).

B1: Pulmonary artery margin, en face B2-B4: Mass with entire pulmonary vein margin including entire adjacent cardiac muscle margin, perpendicular B5-B7: Mass with closest pericardial sac margin and possible surface involvement B8: Mass with closest bronchial margin, perpendicular B9-B10: Mass with closest perihilar soft tissue margin B11-B12: Mass with area of disruption B13-B22: Central full-thickness composite cross-section of mass displaying the greatest dimension with bronchial, pulmonary artery, and pulmonary vein involvement, multiple involved possible lymph nodes (see associated photograph for cassette map) B23-B24: Irregular pulmonary parenchyma from upper and lower lobes, respectively B25-B26: Uninvolved pulmonary parenchyma from upper and lower lobes, respectively B27-B28: Representative areas of nodularity B29: Adherent diaphragmatic tissue B30: Six possible lymph nodes (one half of each, the other half of each is in the composite section) B31: One bisected possible lymph node B32: One trisected possible lymph node B33-B34: One serially sectioned possible lymph node

Review of Staging

Final Score

B. Left Lung, pneumonectomy: - Squamous cell carcinoma, keratinizing (5.5 cm) - Tumor invades walls of pulmonary artery and pulmonary vein, perihilar soft tissue and cardiac muscle - Pulmonary vein margin and perihilar soft tissue margin positive for carcinoma - Post-obstructive pneumonia with areas of necrosis - Metastatic carcinoma in six hilar lymph nodes out of eleven (6/11) - Pathologic Stage (AJCC 8th ed.): ypT4N1

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Prostate - Alpine Skiing

In Alpine Skiing you navigate through each gate systematically, like the system for grossing a prostate. But how do you adjust when a gate is moved unexpectedly?

Review of Anatomy

Posterior view

Review of Staging

The specimen is labeled “ prostate”. Received in formalin is a 66.5 g, 4.4 cm right to left by 3.9 cm apex to base by 3.6 cm anterior to posterior prostate with attached intact seminal vesicles and segments of vas deferens. The right seminal vesicle is 2.9 x 1.5 x 1.1 cm and the left seminal vesicle is 2.5 x 1.6 x 1.5 cm. The right vas deferens is in 3.2 cm in length, the left vas deferens is 2.7 cm in length, and each are 0.4 cm in diameter. The external surface is smooth tan-pink with focal areas of cautery artifact and a 3.2 x 2.7 x 2.2 cm bulging nodule at the left posterior lateral surface of the prostate. The right side of the specimen is inked black, the left side of the specimen is inked blue, and a yellow stripe is placed along the postero-inferior surface. The apex and base margins are shaved, and the remaining prostate is serially sectioned from apex to base into 12 levels (levels 10-12 only nodule). Sectioning reveals diffuse glistening tan-pink nodular prostatic parenchyma, however a discrete mass or lesion is not grossly identified. Upon sectioning the previously described nodule does not grossly involve the prostate and displays a rubbery lobular tan-white circumscribed cut surface with a foci of opaque yellow possible necrosis. The cut surfaces of the bilateral seminal vesicles and vasa deferentia are grossly unremarkable. A gross photograph is taken.

Representative sections to include every other level of the prostate are submitted as follows: Cassette Designation: A1-A2: Right apical margin, radially sectioned A3-A4: Left apical margin, radially sectioned A5: Right base/bladder neck margin, radially sectioned A6: Left base/bladder neck margin, radially sectioned A7: Level 1, right A8: Level 1, left A9: Level 3, right anterior A10: Level 3, right posterior A11: Level 3, left anterior A12: Level 3, left posterior A13: Level 5, right anterior A14: Level 5, right posterior A15: Level 5, left anterior A16: Level 5, left posterior A17: Level 7, right anterior A18: Level 7, right posterior A19: Level 7, left anterior A20: Level 7, left posterior A21: Level 7, Junction of prostate and nodule A22: Level 9, right prostate with junction of right seminal vesicle A23: Level 9, left prostate with junction of left seminal vesicle A24-A25: Level 9, nodule (A24 including possible necrosis) A26: Level 11, nodule A27: Right and left vas deferens margins, shaved A28: Right seminal vesicle and vas deferens A29: Left seminal vesicle and vas deferens

Final Score

A. Prostate and Seminal Vesicles, Radical Prostatectomy and Vesiculectomy; Pelvic Mass, Resection: Prostatic adenocarcinoma, Gleason Grade 3+4 (Score =7, Grade Group 2). - Resection margin is focally positive for tumor, left apical margin (limited). - NEGATIVE for extraprostatic extension. - Bilateral seminal vesicles and vasa deferentia are NEGATIVE for tumor. - Pathologic Stage (AJCC 8th ed.): pT2 N0. - Please see Template. Leiomyosarcoma - Histologic grade (FNCLCC): G2, total differentiation, mitotic count and necrosis score 4 or 5. - POSITIVE margin (circumferential margin, focal). - Pathologic Stage (AJCC 8th ed.): pT1 N0. - Please see Template.

sarcoma staging

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Stomach - Curling

Curling is a game of precision and planning ahead, much like grossing this specimen

C. The specimen is labeled " partial gastrectomy with greater omentum." Received fresh and transferred to formalin is a 10.8 x 4.3 x 4.0 cm portion of stomach, with an 26.0 x 22.5 x 1.4 portion of omentum. The serosal surface is tan-pink, smooth, and glistening. The surrounding perigastric adipose tissue and omentum contains an abundance of tan-pink, smooth, and well-circumscribed nodules, which coalesce with one another, ranging from 0.2 to 1.5 cm in greatest dimension, and comprising roughly 80% of the specimen. The specimen consists of a single 10.8 cm in length staple line. The staple line is removed, and the underlying margin is inked black. The specimen is opened longitudinally to reveal a 7.5 x 7.4 x 3.5 cm tan-pink to yellow, homogenous, and exophytic mass, which comes within 0.2 cm from resection margin. The base of the mass exhibits an area of pink-red, mucosal ulceration. Sectioning through the mass reveals infiltration through the gastric wall, with involvement into the surrounding perigastric adipose tissue, and involvement of the gastric mucosa. Centrally located within the mass is a 2.2 x 1.7 x 1.5 cm area of tan-brown, ill-defined, and softened tissue consistent with necrosis. The stomach exhibits a circumference of 5.3 cm. The wall thickness cannot be grossly appreciated. The remainder of the mucosa is tan-brown and somewhat flattened. Uninvolved perigastric adipose tissue is not grossly identified. Gross photographs of the intact specimen and cut surface are taken. Representative sections are submitted as follows: Cassette Designation: C1-C3: Representative resection margin, closest approach to mass, perpendicular C4-C5: Mass with area of mucosal ulceration C6-C7: Mass with invasion into surrounding perigastric adipose tissue C8-C9: Mass with adjacent serosa C10-C11: Mass with possible area of necrosis C12-C13: Representative sections of omentum

Review of Staging

Final Score

A. Falciform ligament, Resection: - Involved by gastrointestinal stromal tumor (GIST). B. Lesser omentum, Resection: - Involved by gastrointestinal stromal tumor (GIST). C. Stomach with greater omentum, Partial gastrectomy: - Gastric gastrointestinal stromal tumor (GIST), predominantly spindle cell type (ypT3 pM1). - Gastric resection margin is focally positive for tumor. - Omentum with numerous tumor deposits. - Please see synoptic report.

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Lip- Luge

Luge is a fast slide down a slippery slope, much like the shape of this next specimen

Review of Anatomy

Review of Staging

Oral cavity SCC

Cutaneous carcinoma of head and neck

E. Gross the specimen is labeled " lower lip resection." Received fresh and transferred to formalin is a 3.3 x 3.0 x 1.6 cm wedge-shaped portion of pink-tan soft tissue. The specimen is oriented with a suture at the 6:00 inferior tip. The superior portion of the specimen is partially covered by pink-tan mucosa. The inferior portion is partially covered by tan skin. A yellow-tan to red-tan resection margin is present on the posterior surface and extends to the right and left lateral surfaces. At the junction of the skin and mucosal surfaces on the anterior surface of the specimen there is a 2.8 x 2.4 x 0.4 cm slightly raised, nodular, pink-tan to red lesion. The lesion mostly involves the mucosal surface, and focally extends onto the skin surface. The lesion is 0.4 cm from the left lateral mucosal margin, 0.5 cm from the right lateral mucosal margin, 0.5 cm from the superior mucosal margin, and 1.0 cm from the inferior skin margin. The resection margin is inked as follows: Superior half blue, inferior half green. The specimen is sectioned from right to left into 7 levels. The lesion is present in all levels, and has a depth of invasion of 0.8 cm. The lesion comes to 0.7 cm from the posterior soft tissue resection margin. The specimen is entirely submitted as follows: Cassette Designation: E1-E2: Level 1, right lateral margin perpendicular sections E3: Level 2 E4: Level 3 E5: Level 4 E6: Level 5 E7: Level 6 E8-E9: Level 7, left lateral margin perpendicular sections

Final Score

E. Lower lip resection: - Invasive squamous cell carcinoma, well differentiated, keratinizing subtype. - Tumor size: 2.8 cm. - Depth of invasion: 8 mm. - Muscle invasion: Present. - Minor salivary gland invasion: Present. - Perineural invasion: Present (greater than 0.1 mm diameter). - Lymphovascular invasion: Not identified. - Margins: Negative. - AJCC (8th ed) TNM for cutaneous carcinoma: pT3. Note (E): Although the carcinoma involves the entire lip vermilion, the bulk of the tumor appears to involve the dry vermilion which should be staged as a cutaneous squamous cell carcinoma.

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Closing Ceremony

The Winter Olympics are about preparation, accuracy, and performance under pressure. Grossing is no different

Grossing is the Gold standard, and every specimen is an "event."