Wednesday, May 3, 2017

Gross Room

2:30 p.m.

Me: What? Who the heck is freezing testicle? I've never heard of such a thing.

Lin: I know. It's hard to freeze and gross, it's super fresh, I found a small lesion. Come look.

We normally fix testicles in formalin for a long time before we gross them. They are very squishy.

Me: That's so small. At least it seems clear of the margins. But a frozen? These tumors are so hard - we need stains to figure them out. Frozens ruins the tissue. At least we have the other half for permanents.

I looked through the microscope. Testicular tumors are so rare - we always need to pull out a book. I called Dr. Music for backup, and did just that - found the 1963 issue of male GU fascicle on the shelf and started to peruse. My best guess on first look was Leydig Cell tumor with extensive hyalinized stroma. But to call that on frozen? Pretty ballsy.

Dr. Music: I agree, this one is hard. But I think you love throwing the word testicle around.

Me: Isn't it fun? We get all the parts. Can you imagine a urologist throwing around the word breast, or vagina? They would be ostracized. But we can chant cervix, breast, penis, all day long.

Dr. Music: We can build a whole person. We can talk about every part. We look at it all. I agree. Suspicious for neoplasm, but we need stains.

Me: Thanks for your help. That's exactly where I was. I'll call the doc.

Of course the gross tech brings me his cell, because he has already left the OR. I'm a little incensed about the waste of the tissue for frozen. I explain to him nicely over the phone that we don't like to freeze these, because we need the tissue for immunostains. I think the message was lost.

Urologist: So it wasn't normal testes?

Me: Um, no. Not normal. I'm really worried about it. We need to do studies on the permanent sections to determine what it is.

I walked out of the reading room into the gross room. Told the techs if anyone ever decides to freeze a testicular mass they need to call me first, so I can try to talk them out of it.

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