[Histonet] Cutting protocol for gender dysphoria

[Bob Richmond]

>
> Victoria Spooner at Bassett Healthcare in New York state asks:
>


> >>Does anyone have cutting protocols for mastectomies for gender dysphoria
> they would [share] with me? How many blocks are submitted per breast?<< How
> do they compare [to] mastectomies for tumor?<<
>

I don't know of any formal protocols. It would depend in part on the
patient's age. I'd think a rather small number would suffice, perhaps four
per breast. Cancer risk in such a patient should be low, because of
hormonal suppression.

About fifty years ago, when I was a resident at a large university
hospital,  I received bilateral simple mastectomy specimens from an older
individual. On dissection the rather small amount of rather fibrous breast
tissue was filled with numerous 5 to 10 mm cysts, all about the same size.
(I've never seen anything like it, before or since.)  I took some sections
at random, having no idea what was going on, and the slides were quite
unremarkable. I took the case to the senior pathologist, who was considered
a major authority on breast pathology, to sign out.

He swore me to lifelong secrecy (which I'll have to honor, since I've
forgotten the patient's name). The patient was a recently retired, quite
prominent local businessman, whose transgender status was a deeply guarded
secret. He'd been taking androgenic hormones for many years. After his
retirement, he had the long-put-off mastectomies performed.

Yes, such things went on fifty years ago.

Bob Richmond
Samurai Pathologist
Maryville TN