Optimal gross examination of mammary tissue includes inspection and palpation and may be aided by x-ray examination. It is advantageous to examine tissue in the fresh state, even if frozen section is not requested, because abnormalities are more evident and tissue can be preserved for special studies, as necessary.
However, some types of carcinoma, particularly mucinous and medullary carcinoma, have smooth, rounded outlines and a soft consistency. Infiltrating lobular carcinoma may be extremely diffuse and difficult to see on gross examination, and palpation may be more helpful than visual inspection.
The number of blocks submitted from specimens varies depending on circumstances. It is important, however, that tumors be sampled thoroughly because their microscopic appearance may vary from area to area. The center and periphery of tumors should be sampled, as well as the surrounding tissue, because malignant change may be far more extensive than is suspected on gross examination. If possible, a section of the largest full-cut face of a tumor should be submitted in one block. Because noninvasive carcinoma may be an incidental finding, it is important to sample apparently normal tissue, even that around an obviously benign lesion, with concentration on the nonfatty component and, as is discussed later, areas of mammographic abnormality. The fatty component is unlikely to contain significant pathologic changes that are not also present in the nonfatty component of the specimen.