SPECIMEN SUBMITTED: right base of tongue, right tonsil, additional right tonsillar biopsy.


Procedure date Tissue received Report Date Diagnosed by
05/29/2008 05/29/2008 06/03/2008 DR. L. B,DR. E. G/mrro



DIAGNOSIS:



1. Right base of tongue, biopsy (A):


Squamous epithelium with underlying lymphoid tissue, consistent with lingual tonsil, with no significant pathologic change.

2. Right tonsil, biopsy (B):


Squamous cell carcinoma in situ involving tonsillar crypts, no definitive invasion seen.

3. Additional tight tonsilar biopsy (C):


Squamous cell carcinoma, at least in situ, with foci highly suspicious for invasion.







Clinical: Metastatic squamous cell CA of the neck.
Gross:



The specimen is received fresh in three parts, all labeled with the patient's name "Craig" and the medical record number.



Part 1 is additionally labeled "right base of tongue" and consists of a 0.9 x 0.7 x 0.5 cm fragment of tan pink soft tissue which is entirely frozen. Frozen section diagnosis by Dr. B and T is "tongue, biopsy: squamous mucosa with mild atypia, final diagnosis pending permanent section." The specimen is submitted entirely in A.



Part 2 is additionally labeled "right tonsil" and consists of a 1.0 x 1.0 x 0.7 cm fragment of tan pink soft tissue which is entirely frozen. Frozen section diagnosis by Dr. B and T is "tonsil, biopsy, severely atypical squamous epithelium consistent with squamous cell carcinoma in situ final diagnosis pending permanent section." The specimen is submitted entirely in B.



Part 3 is additionally labeled "additional right tonsilar biopsy" and consists of a 1.5 x 1.3 x 0.4 cm aggregate of multiple tan pink soft tissue fragments submitted entirely in C.

That is the report from MAY 2008 and lasted with rehab until winter 2009,

Then in Feb 2013 I was diagnosed with Tongue cancer,,,,see below Stage 4

DIAGNOSIS: May 29 2013



1. Oral tongue, left lateral, biopsy #1 (A-B):


Invasive squamous cell carcinoma, moderately differentiated, invading into skeletal muscle and extending to tissue resection margins.



No lymphovascular invasion identified.

2. Oral tongue, left lateral, biopsy #2 (C-E):


Invasive squamous cell carcinoma, moderately differentiated, invading into skeletal muscle and extending to tissue resection margins.




No lymphovascular invasion identified.







Clinical: Possible left base tongue cancer.
Gross: The specimen is received from intraoperative consultation in two containers, each labeled with the patient's name, "Craig" and the medical record number.



Specimen 1 is additionally labeled "biopsy left lateral oral tongue". It consists of a piece of red tissue measuring 0.3 x 0.3 x 0.3 cm. The deep resection margin is inked green. The tissue was bisected and half frozen, with a frozen section diagnosis rendered by Dr. Y as: "Squamous hyperplasia with focus of small, irregularly shaped nest of squamous cells at the base-superficial dermis, highly suspicious for invasive carcinoma. Final diagnosis pending permanent sections." The frozen section remnant is submitted in cassette A and the remainder of the tissue is submitted in cassette B.



Specimen 2 is additionally labeled "left lateral oral tongue". It consists of two pieces of tissue. The first piece measures 0.3 x 0.3 cm and the second piece measures 0.5 x 0.3 x 0.3 designated by the surgeon as deep to the first piece. The deep resection margin is inked orange. Half of the first piece is frozen and the entire deep piece is frozen. The frozen section diagnosis rendered by Dr. Y is: "Invasive squamous cell carcinoma." The remnant of piece #1 is submitted in cassette C, the remnant of piece 2 is submitted in cassette D, and the remaining tissue is submitted in cassette E.