{"id":1032,"date":"2016-08-22T11:28:05","date_gmt":"2016-08-22T03:28:05","guid":{"rendered":"http:\/\/ww4.mywebsparks.com\/nus_pathweb\/?page_id=1032"},"modified":"2025-10-25T09:29:06","modified_gmt":"2025-10-25T01:29:06","slug":"where-to-start","status":"publish","type":"page","link":"https:\/\/medicine.nus.edu.sg\/pathweb\/pathology-demystified\/approach-to-gross-pathology\/where-to-start\/","title":{"rendered":"I. Where to Start"},"content":{"rendered":"\n\n\t<p><b>What <\/b><b>is a simple approach to describing gross pathology?<\/b><\/p>\n<p>When faced with a pathology specimen,\u00a0<b>don&#8217;t panic<\/b>\u00a0-&gt; just be systematic.<\/p>\n<p><strong>There are 5 steps. Here&#8217;s what to do: <\/strong>(click on each tab\u00a0<strong>to expand<\/strong>)<\/p>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-0\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-0\">1. Describe the ORGAN and the PLANE of sectioning<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-0\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p>Planes:<\/p>\n<ul>\n<li><strong>Sagittal:<\/strong> Plane that runs down through the body, dividing the body into left and right portions. Subsections of the sagittal plane include:\n<ul>\n<li><strong>Midsagittal<\/strong> runs through the median plane and divides along the line of symmetry<\/li>\n<li><strong>Parasagittal <\/strong>is parallel to midline but does not divide into equal left and right portions.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Coronal (frontal):<\/strong> Plane that runs perpendicular to the sagittal plane and divides the body into anterior and posterior (front and back) portions.<\/li>\n<li><strong>Transverse:<\/strong> Horizontal plane that divides the body into upper and lower portions; also called cross-section.<\/li>\n<\/ul>\n<table height=\"559\">\n<tbody>\n<tr>\n<td><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2016\/08\/liver-topws6.jpg\" alt=\"\" width=\"300\" height=\"569\" \/><\/td>\n<td>&nbsp;\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2016\/08\/01940-Brain-Hydrocephalus_01-19y5gj4-1024x683.jpg\" alt=\"\" width=\"700\" height=\"467\" \/><\/td>\n<td><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2016\/08\/03261-Bone-Giant-Cell-Tumour_01ed-1-11lsfk4-678x1024.jpg\" alt=\"\" width=\"450\" height=\"680\" \/><\/td>\n<\/tr>\n<tr>\n<td>Transverse section of liver<\/td>\n<td>Coronal section of brain<\/td>\n<td>Sagittal section of knee<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-0\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-0\">2. Describe the DISTRIBUTION of the abnormality: Localised vs Diffuse<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-0\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p>&#8211; The differential diagnoses (DDx) are quite distinct:<\/p>\n<ul>\n<li><strong>Diffuse<\/strong> process: the pathology affects the whole organ uniformly\n<ul>\n<li>Enlargement, change in colour, shrinkage\/atrophy<\/li>\n<li>Eg, fatty change in the liver, chronic venous congestion in the lung, diffuse hyperplasia in the thyroid gland<\/li>\n<li>DDx &#8211; Metabolic diseases, autoimmune conditions, haemodynamic disorders, sometimes infections etc.<\/li>\n<\/ul>\n<\/li>\n<li><strong>Localised\/focal <\/strong>process &#8211; the pathology is seen as one or several discrete lesions, while the rest of the organ appears grossly normal.\n<ul>\n<li>Mass, cyst, ulcer etc.<\/li>\n<li>DDx \u00a0&#8211; Neoplasms, cysts, abscesses, infarctions etc.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-0\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-0\">3. State the NATURE  and LOCATION of the abnormality<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-0\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p>Nature: <strong>mass, nodule, cyst, cavity, scar, focus of discoloration, <\/strong>etc<\/p>\n<p>For mucosal-lined organs eg, Gastrointestinal tract &#8211;<strong> ulcer, polyp, perforation<\/strong> etc.<\/p>\n<p>&#8220;There is a nodule in the upper lobe of the right lung.&#8221;<\/p>\n<p>Tip: Try to avoid the word &#8220;lesion&#8221; &#8211; this is entirely non-specific and non-descriptive.<\/p>\n<p>&#8220;There is a wedge-shaped, well demarcated area of pallor within the renal\u00a0 cortex in the upper pole of the kidney.&#8221;<\/p>\n<p>&#8220;The thyroid gland is diffusely enlarged and dark brownish in colour.&#8221;<\/p>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-0\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-0\">4. Describe the CHARACTERISITICS of the abnormality<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-0\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p>For localized lesions:<\/p>\n<ul>\n<li>Location &#8211; eg. middle lobe of right lung; upper pole of right thyroid lobe, colonic mucosa, subcapsular region of kidney etc.<\/li>\n<li>Size<\/li>\n<li>Shape &#8211; rounded (eg. benign neoplasms), ovoid, irregular, wedge-shaped (eg. infarcts)<\/li>\n<li>Number of lesions &#8211; solitary, multiple<\/li>\n<li>Cut surface &#8211; texture (solid\/cystic\/friable), colour (tan, pale, blackish, greenish, variegated), presence of necrosis (paler areas) or haemorrhage<\/li>\n<li>Edges of lesion<\/li>\n<li>Solid lesion &#8211; well defined vs ill-defined, infiltrative, enc<\/li>\n<li>Ulcer &#8211; regular, punched out, flat edges (favour benign) vs heaped edges, overhanging edges (favour malignant); describe base (necrotic; smooth; visible vessel etc.)<\/li>\n<\/ul>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-0\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-0\">5. Describe any visible CAUSE or EFFECT\/COMPLICATION of the disease<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-0\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p>Look for and describe the <strong>cause or complication<\/strong> of the disease if shown in the pot &#8211; e.g. myocardial infarction with coronary artery thrombus).<\/p>\n<p>In some specimen pots, you may be able to see not only the main pathology but also its cause or complications. Check out the example below.<\/p>\n\t<p><strong>Exercise:<\/strong> \u00a0Cause and effect &#8211; Below is a heart specimen with a <strong>myocardial infarct<\/strong>\u00a0in the left ventricle. Look carefully = <strong>can you spot the cause &#8211; the occluded coronary artery (left anterior descending artery)? <\/strong>If not, check out the video below.<\/p>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2016\/08\/Heart-fresh-infarct-close-up-1gojgd6.jpg\" alt=\"Heart-fresh-infarct-close-up-1gojgd6\" itemprop=\"image\" height=\"412\" width=\"533\" title=\"Heart-fresh-infarct-close-up-1gojgd6\" onerror=\"this.style.display='none'\"  \/>\n\t<iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/213508416\" width=\"640\" height=\"300\" frameborder=\"0\" webkitallowfullscreen mozallowfullscreen allowfullscreen><\/iframe>\n\t<p>If you can&#8217;t play the video, watch it here on YouTube: <a href=\"https:\/\/youtu.be\/iU_CGNQj7lA\" target=\"_blank\" rel=\"noopener\">https:\/\/youtu.be\/iU_CGNQj7lA<\/a><\/p>\n\t\t\t<a href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/pathology-demystified\/approach-to-gross-pathology\/where-to-start\/\" target=\"_self\" rel=\"noopener\">\n\t\t\t\t\t\t\tI. Where to Start?\n\t\t\t\t\t<\/a>\n\t\t\t<a href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/pathology-demystified\/approach-to-gross-pathology\/glossary-of-gross-terms\/\" target=\"_self\" rel=\"noopener\">\n\t\t\t\t\t\t\tII. Glossary of Terms\n\t\t\t\t\t<\/a>\n\t\t\t<a href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/pathology-demystified\/approach-to-gross-pathology\/practice\/\" target=\"_self\" rel=\"noopener\">\n\t\t\t\t\t\t\tIII. Approach to Gross Pathology: Practice!\n\t\t\t\t\t<\/a>\n\t\t\t<a href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/pathology-demystified\/approach-to-gross-pathology-quiz\/\" target=\"_self\" rel=\"noopener\">\n\t\t\t\t\t\t\tIV. Approach to Gross Pathology: Quiz\n\t\t\t\t\t<\/a>\n\t\t\t<a href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/pathology-demystified\/approach-to-gross-pathology\/approach-to-gross-pathology-one-page-summary\/\" target=\"_self\" rel=\"noopener\">\n\t\t\t\t\t\t\tApproach to Gross Pathology One Page Summary\n\t\t\t\t\t<\/a>\n\t\t\t<a href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/pathology-demystified\/approach-to-gross-pathology\/\" target=\"_self\" rel=\"noopener\">\n\t\t\t\t\t\t\tApproach to Gross Pathology Chapter Home\n\t\t\t\t\t<\/a>\n\t\t\t<a href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/pathology-demystified\/\" target=\"_self\" rel=\"noopener\">\n\t\t\t\t\t\t\tPathology Demystified\n\t\t\t\t\t<\/a>\n\n","protected":false},"excerpt":{"rendered":"<p>What is a simple approach to describing gross pathology? When faced with a pathology specimen,\u00a0don&#8217;t panic\u00a0-&gt; just be systematic. There are 5 steps. Here&#8217;s what to do: (click on each tab\u00a0to expand) 1. Describe the ORGAN and the PLANE of sectioning Expand Planes: Sagittal: Plane that runs down through the body, dividing the body into [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1025,"menu_order":0,"comment_status":"open","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-1032","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>NUS Pathweb<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/pathology-demystified\/approach-to-gross-pathology\/where-to-start\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:description\" content=\"What is a simple approach to describing gross pathology? 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