How should large specimens (limb-sparing surgery, amputations) be sent over to diagnostic lab?

• A. Send whole and chilled to diagnostic lab; do NOT fix in formalin initially; do NOT freeze if avoidable
• B. Send fixed in formalin initially
• C. Freeze immediately
• D. Send only small biopsy samples

Answer: (A)

Large surgical specimens such as limb-sparing resections or amputations need to be evaluated by the pathologist while still fresh so that margins and architecture can be assessed accurately. Delivering the whole specimen unfixed and chilled to the diagnostic lab allows the pathologist to perform a careful gross examination, orient the tissue, ink the margins, and select representative sections from key areas, including margins, before any fixation. Fixing before grossing can obscure tissue detail and hinder margin assessment, and freezing can create artifacts that degrade histology. Sending only small biopsy samples is often not representative of the entire specimen, especially for margin status. Therefore, the best approach is to send the entire specimen fresh and cooled, without initial formalin fixation or freezing, to enable proper grossing and histologic processing.