Intestine with tumor: Difference between revisions

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==Gross examination==

[[File:Gross pathology of minimally invasive colorectal surgery of tubulovillous adenoma.jpg|thumb|150px|There is a separate article for the '''[[Grossing of minimally invasive colorectal surgery]]'''.]]

*'''Orientation''': Determine the proximal (oral) and distal (aboral) parts of the specimen if possible.<ref name=Stora>Unless otherwise specified, reference is: {{Stora utskärningen}}</ref>

*Measure the '''length''' of the entire specimen.<ref name=Stora/> ~~Optionally, also~~ measure diameter.

*Measure the '''length''' of the entire specimen.<ref name=Stora/> {{Moderate-begin}}Also measure diameter.{{Moderate-end}}

*Surfaces that appear to overlie a tumor ~~can be~~ '''inked'''{{~~Ink note~~}}.

*For extraperitoneal segments such as the distal and posterior rectum, rate the completeness of the attached '''mesocolon''', with following example for mesorectal excisions:<ref name="Delibegovic2017">{{cite journal|last1=Delibegovic|first1=Samir|title=Introduction to Total Mesorectal Excision|journal=Medical Archives|volume=71|issue=6|year=2017|pages=434|issn=0350-199X|doi=10.5455/medarh.2017.71.434-438}}</ref>

*'''Initial ~~cutting~~''' can be:

{|class=wikitable

! !! Volume !! Defects !! Cone shape<ref group=notes>A cone shape is a tapered distal end, generally by removed mesorectum. It is applicable mainly to low anterior resection (LAR) specimens.</ref> !! Circumferential resection margin

|-

! Complete

| Smooth, intact || Less than 5 mm || No || Smooth, regular

|-

! Almost complete

| Moderate volume || There is no visible muscularis propria || Moderate || Irregular

|-

! Incomplete

| Small volume || Up to the muscularis propria || Yes || irregular

|}

*{{Moderate-begin}}Surfaces that appear to overlie a known or suspected tumor are preferably '''[[inked]]''', even for serosal surfaces.{{Moderate-end}} {{Moderate-begin}}Also take a '''photo''' of surfaces overlying a tumor.{{Moderate-end}}

*Describe the '''serosa''', and whether there are any suspected tumor breakthroughs hereof.<ref name=Stora/>

*'''Initial intestinal opening''' can be:

:*A ''longitudinal'' cut opposite to the tumor if it is relatively demarcated (by sight and/or palpation).

:*''Transverse'' (cross-sectional) slicing, until reacing the tumor, particularly for circumferential tumors.

*Measure the '''distances''' proximal and distal ~~to the tumor~~.<ref name=Stora/>

*Measure the '''distances''' to the proximal and distal surgical margins.<ref name=Stora/>

*Note any accompanying '''polyps'''.<ref name=Stora/> ''See [[Colorectal polyp]]''

*Describe the '''serosa''', and whether there are any suspected tumor breakthroughs hereof.<ref name=Stora/>

*Evaluate the following either before or after slicing it up:<ref name=Stora/>

:*Tumor '''size'''

:*The proportion of the '''circumference''' involved

:*Any significant '''stricture''' of the lumen

*'''~~Slice~~''' the tumor, either by transverse or longitudinal ~~slicing~~.<ref name=Stora/>

*'''Serially section''' the tumor, either by transverse or longitudinal sectioning.<ref name=Stora/>

*Review each slice and note the '''depth''' (in terms of anatomic layer, possibly with rough percentage thereof) and distance to the serosa or transverse resection margin for any tumor invasion and/or infiltration.<ref name=Stora/>

File:Gross pathology of small intestinal adenocarcinoma, serosal view.jpg|Gross pathology of small intestine with adenocarcinoma, serosal view, showing cancer with infiltrative growth (in this case an adenocarcinoma), causing stenosis.

File:Gross pathology of small intestinal adenocarcinoma, luminal view.jpg|Luminal view, showing the stenotic infiltrative growth across the entire intestinal wall.

File:Edges and margins in intestinal tumor.svg|Margins that need to be determined.

</gallery>

*Carefully go through included '''mesentery''' for lymph nodes. A consensus standard is to find at least 12 lymph nodes from colon specimens.<ref name="pmid19461921">{{cite journal| author=Wong SL| title=Lymph node counts and survival rates after resection for colon and rectal cancer. | journal=Gastrointest Cancer Res | year= 2009 | volume= 3 | issue= 2 Suppl | pages= S33-5 | pmid=19461921 | doi= | pmc=2684729 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19461921 }} </ref> {{Further|Lymph nodes}}

===Tissue selection===

[[File:Gross pathology of metastatic melanoma to small intestine.jpg|thumb|240px|For presumable '''metastases''' to the colon (melanoma pictured), one slice from each deposit is enough (or from representative deposits if there are many of them). For presumably primary tumors, generally sample one slice per centimeter of tumor.]]

Should include:<ref name=Stora/>

*The tumor slices that show the deepest penetration. The slices should include tumor relation to the serosa or resection margin, as well as adjacent normal mucosa.

*The tumor slices that show the '''deepest penetration'''. The slices should include tumor relation to the serosa or resection margin, as well as adjacent normal mucosa. If transported or processed together with other cases, put the tumor slices in thin-mesh cassettes or tissue bags to limit contamination.<ref group=note>Colorectal adenocarcinoma (the most common colon tumor) is a promiscuous contaminant of other tissues. - {{cite journal| author=Carll T, Fuja C, Antic T, Lastra R, Pytel P| title=Tissue Contamination During Transportation of Formalin-Fixed, Paraffin-Embedded Blocks. | journal=Am J Clin Pathol | year= 2022 | volume= 158 | issue= 1 | pages= 96-104 | pmid=35195717 | doi=10.1093/ajcp/aqac014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35195717 }} </ref>

*Proximal and distal resection margin, respectively. Take transverse slices except if the tumor is ~~critically close to~~ the margin, in which case it is advisable to take slices perpendicular to that margin, including both the tumor border and the resection margin.

*Proximal and distal '''resection margin''', respectively. Take transverse slices except if the tumor is within 2 cm from the margin, in which case it is advisable to take slices perpendicular to that margin, including both the tumor border and the resection margin. [[Ink]] the margins when taking perpendicular sections{{Moderate-begin}}, but this is optional when taking transverse slices.{{Moderate-end}}

*Take slices of any other suspicious findings

*Take slices of any '''other suspicious''' findings

*Take a slice of the normal intestinal wall

*Take a slice of the '''normal''' intestinal wall

*Take slices from any adherent structures and/or organ parts

*Take slices from any '''adherent''' structures and/or organ parts

*~~Carefully go through included mesentery for lymph~~ nodes~~, and cut each in two parts~~.

*'''[[Lymph nodes]]'''.

===Gross report===

~~Should~~ include:<ref name=Stora/>

Legend:

*Dimensions of entire sample, as well as for the tumor

<< Decision needed between alternatives separated by / signs >>

*Distance to proximal and distal resection margins

{{Finding-begin}}Common findings / In case of findings{{Finding-end}}

*Depth of tumor invasion and/or infiltration. It can include a "macroscopic staging" as per the [[#Staging]] section below.

'''Organs''' or '''important regions''' are in bold in the report example, but does not need to be in an actual report.

The gross report include:<ref name=Stora/>

*'''Dimensions''' of entire sample, as well as for the tumor

*Distance to proximal and distal '''resection margins'''

*'''Depth''' of tumor invasion and/or infiltration, preferably with distance to circumferential margin. It can include a "macroscopic staging" as per the [[#Staging]] section below.

*Completeness of the attached '''mesocolon''' for extraperitoneal segments.

Minimal reporting example:

{|class="wikitable"

| 11.5 cm long intestinal sample. 23 mm from distal margin is a polypoid irregular brown tumor, measuring 58 x 39 x 28 mm. 18 mm to circumferential margin.

|}

Comprehensive example for a rectal resection:

{|class=wikitable

|

* The specimen is received in <<fresh / in formalin>> and consists of a low anterior, total mesorectal resection specimen {{Finding-begin}}which includes:__{{Finding-end}}.

*The bowel measures __ cm in length and ranges from __cm to __cm in diameter.

*The serosa is __.

*The anterior peritoneal reflection is __cm from the distal surgical margin.

*The mesorectal envelope is <<complete / nearly complete / incomplete>>

*The anterior mesorectum is inked __ and the posterior mesorectum __.

*The specimen is opened longitudinally.

*The mucosa displays a _ x_ x _ cm tumor.

*The tumor is located __ cm from the proximal surgical margin, _cm from the distal surgical margin, _cm from the nearest radial mesorectal margin {{Finding-begin}} and ___ cm from the dentate line{{Finding-end}}.

*On sectioning the tumor has a maximum thickness of __cm and grossly extends into the __.

*The tumor is <<at / __cm above / __cm below) the anterior peritoneal reflection.

*The tumor occupies approximately __% of the circumference of the lumen, which is <<patent / partially obstructed / completely obstructed>>.

*The wall measures up to __cm in thickness.

*The attached mesorectum measures from _cm up to _cm in thickness.

*Within the mesorectum there are __ possible lymph nodes measuring up to _cm in greatest dimension.

*Representative sections are submitted for microscopic examination in __cassettes.

|}

==Microscopic evaluation==

==Microscopic evaluation of colorectal tumors==

Determine tumor type and differentiation.

[[File:Relative incidence of colorectal cancers.svg|thumb|230px|The vast majority of colorectal cancers are adenocarcinomas.<ref>{{cite journal|last1=Kang|first1=Hakjung|last2=O’Connell|first2=Jessica B.|last3=Leonardi|first3=Michael J.|last4=Maggard|first4=Melinda A.|last5=McGory|first5=Marcia L.|last6=Ko|first6=Clifford Y.|title=Rare tumors of the colon and rectum: a national review|journal=International Journal of Colorectal Disease|volume=22|issue=2|year=2006|pages=183–189|issn=0179-1958|doi=10.1007/s00384-006-0145-2}}</ref>]]

[[File:Pie chart of colorectal carcinoma etiologies.svg|thumb|250px|Relative incidences of colorectal carcinomas.]]

Intestinal tumors are generally colorectal carcinomas, specifically [[colorectal adenocarcinoma]], so each evaluation can primarily focus on whether such is the case. ''Other cancer types are displayed in section on small intestinal tumors below''

[[File:Colorectal adenocarcinoma, not otherwise specified.jpg|thumb|250px|Colorectal adenocarcinoma, not otherwise specified]]

''Further reading: [[Colorectal adenocarcinoma]]''

===Staging===

Determine depth of growth and/or infiltration. In case of cancer, stage by the AJCC or TNM system:

==Microscopic evaluation of small intestinal tumors==

[[File:Small intestinal cancers by incidence and prognosis.jpg|thumb|330px|Relative incidences of small intestinal cancers.<ref>{{cite journal|last1=Qubaiah|first1=O.|last2=Devesa|first2=S. S.|last3=Platz|first3=C. E.|last4=Huycke|first4=M. M.|last5=Dores|first5=G. M.|title=Small Intestinal Cancer: a Population-Based Study of Incidence and Survival Patterns in the United States, 1992 to 2006|journal=Cancer Epidemiology Biomarkers & Prevention|volume=19|issue=8|year=2010|pages=1908–1918|issn=1055-9965|doi=10.1158/1055-9965.EPI-10-0328}}</ref>]]

Consider mainly the most common tumors:

*'''Malignant''' small intestinal tumors (60% of cases)<ref>{{cite|url=https://radiopaedia.org/articles/tumours-of-the-small-intestine?lang=us|title=Tumors of the small intestine|author=Dr Matt A. Morgan and Dr Erik Ranschaert et al.|website=Radiopaedia|accessdate=2020-12-23}}</ref>, see diagram.

*'''Leiomyoma''', approximately 15%, generally evaluated as a '''[[Spindle-cell tumors of the midgut]]'''.<ref name=Rodriguez-Vigil2006>{{cite web|url=https://www.diagnosticimaging.com/view/small-bowel-findings-reveal-tumor-spectrum|title=Small bowel findings reveal tumor spectrum|author=Beatriz Rodriguez-Vigil, MD , Manuel Lamas, MD , Arturo Alvarez-luque, MD|date=2006-06-03|website=diagnosticimaging.com}}</ref>

*'''Adenoma''', approximately 7%.<ref name=Rodriguez-Vigil2006/>

*'''Lipoma''', approximately 5%.<ref name=Rodriguez-Vigil2006/>

{|class="wikitable"

! Type !! Evaluation !! Image

|-

! [[Adenocarcinoma]]

| As per colorectal cancer in previous section || [[File:Light microscopy of small intestinal adenocarcinoma.jpg|190px]]

|-

! [[Neuroendocrine tumors of the midgut]]

| || [[File:Histopathology of small intestinal well-differentiated grade 1 (G1) carcinoid.jpg|190px]]

|-

! [[Spindle-cell tumors of the midgut]]

| Generally perform c-Kit immunohistochemistry to detect any [[gastrointestinal stromal tumor]].<ref name="LeeHwang2016">{{cite journal|last1=Lee|first1=So Jung|last2=Hwang|first2=Chung Su|last3=Kim|first3=Ahrong|last4=Kim|first4=Kyungbin|last5=Choi|first5=Kyung Un|title=Gastrointestinal tract spindle cell tumors with interstitial cells of Cajal: Prevalence excluding gastrointestinal stromal tumors|journal=Oncology Letters|volume=12|issue=2|year=2016|pages=1287–1292|issn=1792-1074|doi=10.3892/ol.2016.4758}}</ref> || [[File:Histopathology of leiomyoma of the ileocecal valve.jpg|thumb|190px|Leiomyoma of the ileocecal valve]]

|-

! '''Lipoma'''

| As per '''[[lipomatous tumor]]'''

| [[File:Histopathology of submucosal lipoma.jpg|190px]]

|}

==Microscopy report==

~~It should include:<ref name=Stora/>~~

*Tumor type<ref name=Stora/>

*Degree of differentiation<ref name=Stora/>

*Depth of growth and/or infiltration

~~:*Whether the resection is radical~~

~~:*Any breakthrough of the serosa and/or resection margin~~

*Number of lymph nodes found

~~:*Number of them~~ with ~~metastases and/or periglandular growth~~

*AJCC or TNM stage if applicable

Example:

{|class="wikitable"

| Colon ~~sample with 50 mm large tubulovillous~~ adenoma with ~~up to~~ high grade ~~columnar epithelial~~ dysplasia. ~~No infiltration.~~ 18 ~~tumor-free~~ lymph nodes. ~~Radical excision.~~

| Colon, segmental colectomy: Tubulovillous adenoma (5.0 cm in greatest dimension) with high-grade dysplasia. 18 lymph nodes negative for carcinoma.

~~{{Public Domain example}}~~

|}

@@ Line 3: / Line 3: @@
 |author2=
 }}
+{{Comprehensiveness}}
 ==Gross examination==
+[[File:Gross pathology of minimally invasive colorectal surgery of tubulovillous adenoma.jpg|thumb|150px|There is a separate article for the '''[[Grossing of minimally invasive colorectal surgery]]'''.]]
 *'''Orientation''': Determine the proximal (oral) and distal (aboral) parts of the specimen if possible.<ref name=Stora>Unless otherwise specified, reference is: {{Stora utskärningen}}</ref>
-*Measure the '''length''' of the entire specimen.<ref name=Stora/> Optionally, also measure diameter.
+*Measure the '''length''' of the entire specimen.<ref name=Stora/> {{Moderate-begin}}Also measure diameter.{{Moderate-end}}
-*Surfaces that appear to overlie a tumor can be '''inked'''{{Ink note}}.
+*For extraperitoneal segments such as the distal and posterior rectum, rate the completeness of the attached '''mesocolon''', with following example for mesorectal excisions:<ref name="Delibegovic2017">{{cite journal|last1=Delibegovic|first1=Samir|title=Introduction to Total Mesorectal Excision|journal=Medical Archives|volume=71|issue=6|year=2017|pages=434|issn=0350-199X|doi=10.5455/medarh.2017.71.434-438}}</ref>
-*'''Initial cutting''' can be:
+{|class=wikitable
+!  !! Volume !! Defects !! Cone shape<ref group=notes>A cone shape is a tapered distal end, generally by removed mesorectum. It is applicable mainly to low anterior resection (LAR) specimens.</ref> !! Circumferential resection margin
+|-
+! Complete
+| Smooth, intact || Less than 5 mm || No || Smooth, regular
+|-
+! Almost complete
+| Moderate volume || There is no visible muscularis propria || Moderate || Irregular
+|-
+! Incomplete
+| Small volume || Up to the muscularis propria || Yes || irregular
+|}
+*{{Moderate-begin}}Surfaces that appear to overlie a known or suspected tumor are preferably '''[[inked]]''', even for serosal surfaces.{{Moderate-end}} {{Moderate-begin}}Also take a '''photo''' of surfaces overlying a tumor.{{Moderate-end}}
+*Describe the '''serosa''', and whether there are any suspected tumor breakthroughs hereof.<ref name=Stora/>
+*'''Initial intestinal opening''' can be:
 :*A ''longitudinal'' cut opposite to the tumor if it is relatively demarcated (by sight and/or palpation).
 :*''Transverse'' (cross-sectional) slicing, until reacing the tumor, particularly for circumferential tumors.
-*Measure the '''distances''' proximal and distal to the tumor.<ref name=Stora/>
+*Measure the '''distances''' to the proximal and distal surgical margins.<ref name=Stora/>
 *Note any accompanying '''polyps'''.<ref name=Stora/> ''See [[Colorectal polyp]]''
-*Describe the '''serosa''', and whether there are any suspected tumor breakthroughs hereof.<ref name=Stora/>
 *Evaluate the following either before or after slicing it up:<ref name=Stora/>
 :*Tumor '''size'''
 :*The proportion of the '''circumference''' involved
 :*Any significant '''stricture''' of the lumen
-*'''Slice''' the tumor, either by transverse or longitudinal slicing.<ref name=Stora/>
+*'''Serially section''' the tumor, either by transverse or longitudinal sectioning.<ref name=Stora/>
 *Review each slice and note the '''depth''' (in terms of anatomic layer, possibly with rough percentage thereof) and distance to the serosa or transverse resection margin for any tumor invasion and/or infiltration.<ref name=Stora/>
+<gallery mode=packed heights=190>
+File:Gross pathology of small intestinal adenocarcinoma, serosal view.jpg|Gross pathology of small intestine with adenocarcinoma, serosal view, showing cancer with infiltrative growth (in this case an adenocarcinoma), causing stenosis.
+File:Gross pathology of small intestinal adenocarcinoma, luminal view.jpg|Luminal view, showing the stenotic infiltrative growth across the entire intestinal wall.
+File:Edges and margins in intestinal tumor.svg|Margins that need to be determined.
+</gallery>
+*Carefully go through included '''mesentery''' for lymph nodes. A consensus standard is to find at least 12 lymph nodes from colon specimens.<ref name="pmid19461921">{{cite journal| author=Wong SL| title=Lymph node counts and survival rates after resection for colon and rectal cancer. | journal=Gastrointest Cancer Res | year= 2009 | volume= 3 | issue= 2 Suppl | pages= S33-5 | pmid=19461921 | doi= | pmc=2684729 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19461921  }} </ref> {{Further|Lymph nodes}}
 ===Tissue selection===
+[[File:Gross pathology of metastatic melanoma to small intestine.jpg|thumb|240px|For presumable '''metastases''' to the colon (melanoma pictured), one slice from each deposit is enough (or from representative deposits if there are many of them). For presumably primary tumors, generally sample one slice per centimeter of tumor.]]
 Should include:<ref name=Stora/>
-*The tumor slices that show the deepest penetration. The slices should include tumor relation to the serosa or resection margin, as well as adjacent normal mucosa.
+*The tumor slices that show the '''deepest penetration'''. The slices should include tumor relation to the serosa or resection margin, as well as adjacent normal mucosa. If transported or processed together with other cases, put the tumor slices in thin-mesh cassettes or tissue bags to limit contamination.<ref group=note>Colorectal adenocarcinoma (the most common colon tumor) is a promiscuous contaminant of other tissues.<br>- {{cite journal| author=Carll T, Fuja C, Antic T, Lastra R, Pytel P| title=Tissue Contamination During Transportation of Formalin-Fixed, Paraffin-Embedded Blocks. | journal=Am J Clin Pathol | year= 2022 | volume= 158 | issue= 1 | pages= 96-104 | pmid=35195717 | doi=10.1093/ajcp/aqac014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=35195717  }} </ref>
-*Proximal and distal resection margin, respectively. Take transverse slices except if the tumor is critically close to the margin, in which case it is advisable to take slices perpendicular to that margin, including both the tumor border and the resection margin.
+*Proximal and distal '''resection margin''', respectively. Take transverse slices except if the tumor is within 2 cm from the margin, in which case it is advisable to take slices perpendicular to that margin, including both the tumor border and the resection margin. [[Ink]] the margins when taking perpendicular sections{{Moderate-begin}}, but this is optional when taking transverse slices.{{Moderate-end}}
-*Take slices of any other suspicious findings
+*Take slices of any '''other suspicious''' findings
-*Take a slice of the normal intestinal wall
+*Take a slice of the '''normal''' intestinal wall
-*Take slices from any adherent structures and/or organ parts
+*Take slices from any '''adherent''' structures and/or organ parts
-*Carefully go through included mesentery for lymph nodes, and cut each in two parts.
+*'''[[Lymph nodes]]'''.
 ===Gross report===
-Should include:<ref name=Stora/>
+Legend:
-*Dimensions of entire sample, as well as for the tumor
+<< Decision needed between alternatives separated by / signs >>
-*Distance to proximal and distal resection margins
+<br>{{Finding-begin}}Common findings / In case of findings{{Finding-end}}
-*Depth of tumor invasion and/or infiltration. It can include a "macroscopic staging" as per the [[#Staging]] section below.
+<br>'''Organs'''  or '''important regions''' are in bold in the report example, but does not need to be in an actual report.
+The gross report include:<ref name=Stora/>
+*'''Dimensions''' of entire sample, as well as for the tumor
+*Distance to proximal and distal '''resection margins'''
+*'''Depth''' of tumor invasion and/or infiltration, preferably with distance to circumferential margin. It can include a "macroscopic staging" as per the [[#Staging]] section below.
+*Completeness of the attached '''mesocolon''' for extraperitoneal segments.
+Minimal reporting example:
 {|class="wikitable"
 | 11.5 cm long intestinal sample. 23 mm from distal margin is a polypoid irregular brown tumor, measuring 58 x 39 x 28 mm. 18 mm to circumferential margin.
-{{Public domain example}}
+|}
+Comprehensive example for a rectal resection:
+{|class=wikitable
+|
+* The specimen is received in <<fresh / in formalin>> and consists of a low anterior, total mesorectal resection specimen {{Finding-begin}}which includes:__{{Finding-end}}.
+*The bowel measures __ cm in length and ranges from __cm to __cm in diameter.
+*The serosa is __.
+*The anterior peritoneal reflection is __cm from the distal surgical margin.
+*The mesorectal envelope is <<complete / nearly complete / incomplete>>
+*The anterior mesorectum is inked __ and the posterior mesorectum __.
+*The specimen is opened longitudinally.
+*The mucosa displays a _ x_ x _ cm tumor.
+*The tumor is located __ cm from the proximal surgical margin, _cm from the distal surgical margin, _cm from the nearest radial mesorectal margin {{Finding-begin}} and ___ cm from the dentate line{{Finding-end}}.
+*On sectioning the tumor has a maximum thickness of __cm and grossly extends into the __.
+*The tumor is <<at / __cm above / __cm below) the anterior peritoneal reflection.
+*The tumor occupies approximately __% of the circumference of the lumen, which is <<patent / partially obstructed / completely obstructed>>.
+*The wall measures up to __cm in thickness.
+*The attached mesorectum measures from _cm up to _cm in thickness.
+*Within the mesorectum there are __ possible lymph nodes measuring up to _cm in greatest dimension.
+*Representative sections are submitted for microscopic examination in __cassettes.
 |}
 {{Reporting}}
-==Microscopic evaluation==
+==Microscopic evaluation of colorectal tumors==
 Determine tumor type and differentiation.
+[[File:Relative incidence of colorectal cancers.svg|thumb|230px|The vast majority of colorectal cancers are adenocarcinomas.<ref>{{cite journal|last1=Kang|first1=Hakjung|last2=O’Connell|first2=Jessica B.|last3=Leonardi|first3=Michael J.|last4=Maggard|first4=Melinda A.|last5=McGory|first5=Marcia L.|last6=Ko|first6=Clifford Y.|title=Rare tumors of the colon and rectum: a national review|journal=International Journal of Colorectal Disease|volume=22|issue=2|year=2006|pages=183–189|issn=0179-1958|doi=10.1007/s00384-006-0145-2}}</ref>]]
+[[File:Pie chart of colorectal carcinoma etiologies.svg|thumb|250px|Relative incidences of colorectal carcinomas.]]
+Intestinal tumors are generally colorectal carcinomas, specifically [[colorectal adenocarcinoma]], so each evaluation can primarily focus on whether such is the case. ''Other cancer types are displayed in section on small intestinal tumors below''
+[[File:Colorectal adenocarcinoma, not otherwise specified.jpg|thumb|250px|Colorectal adenocarcinoma, not otherwise specified]]
 {{Colorectal adenocarcinoma - microscopy criteria}}
 ''Further reading: [[Colorectal adenocarcinoma]]''
 ===Staging===
 Determine depth of growth and/or infiltration. In case of cancer, stage by the AJCC or TNM system:
 {{Colorectal cancer staging }}
+{{Evaluation of tumors}}
+==Microscopic evaluation of small intestinal tumors==
+[[File:Small intestinal cancers by incidence and prognosis.jpg|thumb|330px|Relative incidences of small intestinal cancers.<ref>{{cite journal|last1=Qubaiah|first1=O.|last2=Devesa|first2=S. S.|last3=Platz|first3=C. E.|last4=Huycke|first4=M. M.|last5=Dores|first5=G. M.|title=Small Intestinal Cancer: a Population-Based Study of Incidence and Survival Patterns in the United States, 1992 to 2006|journal=Cancer Epidemiology Biomarkers & Prevention|volume=19|issue=8|year=2010|pages=1908–1918|issn=1055-9965|doi=10.1158/1055-9965.EPI-10-0328}}</ref>]]
+Consider mainly the most common tumors:
+*'''Malignant''' small intestinal tumors (60% of cases)<ref>{{cite|url=https://radiopaedia.org/articles/tumours-of-the-small-intestine?lang=us|title=Tumors of the small intestine|author=Dr Matt A. Morgan and Dr Erik Ranschaert et al.|website=Radiopaedia|accessdate=2020-12-23}}</ref>, see diagram.
+*'''Leiomyoma''', approximately 15%, generally evaluated as a '''[[Spindle-cell tumors of the midgut]]'''.<ref name=Rodriguez-Vigil2006>{{cite web|url=https://www.diagnosticimaging.com/view/small-bowel-findings-reveal-tumor-spectrum|title=Small bowel findings reveal tumor spectrum|author=Beatriz Rodriguez-Vigil, MD , Manuel Lamas, MD , Arturo Alvarez-luque, MD|date=2006-06-03|website=diagnosticimaging.com}}</ref>
+*'''Adenoma''', approximately 7%.<ref name=Rodriguez-Vigil2006/>
+*'''Lipoma''', approximately 5%.<ref name=Rodriguez-Vigil2006/>
+{|class="wikitable"
+! Type !! Evaluation !! Image
+|-
+! [[Adenocarcinoma]]
+| As per colorectal cancer in previous section || [[File:Light microscopy of small intestinal adenocarcinoma.jpg|190px]]
+|-
+! [[Neuroendocrine tumors of the midgut]]
+|  || [[File:Histopathology of small intestinal well-differentiated grade 1 (G1) carcinoid.jpg|190px]]
+|-
+! [[Spindle-cell tumors of the midgut]]
+| Generally perform c-Kit immunohistochemistry to detect any [[gastrointestinal stromal tumor]].<ref name="LeeHwang2016">{{cite journal|last1=Lee|first1=So Jung|last2=Hwang|first2=Chung Su|last3=Kim|first3=Ahrong|last4=Kim|first4=Kyungbin|last5=Choi|first5=Kyung Un|title=Gastrointestinal tract spindle cell tumors with interstitial cells of Cajal: Prevalence excluding gastrointestinal stromal tumors|journal=Oncology Letters|volume=12|issue=2|year=2016|pages=1287–1292|issn=1792-1074|doi=10.3892/ol.2016.4758}}</ref> || [[File:Histopathology of leiomyoma of the ileocecal valve.jpg|thumb|190px|Leiomyoma of the ileocecal valve]]
+|-
+! '''Lipoma'''
+| As per '''[[lipomatous tumor]]'''
+| [[File:Histopathology of submucosal lipoma.jpg|190px]]
+|}
+{{Evaluation of tumors}}
 ==Microscopy report==
-It should include:<ref name=Stora/>
+{{Intestine with tumor - report}}
-*Tumor type<ref name=Stora/>
-*Degree of differentiation<ref name=Stora/>
-*Depth of growth and/or infiltration
-:*Whether the resection is radical
-:*Any breakthrough of the serosa and/or resection margin
-*Number of lymph nodes found
-:*Number of them with metastases and/or periglandular growth
-*AJCC or TNM stage if applicable
 Example:
 {|class="wikitable"
-| Colon sample with 50 mm large tubulovillous adenoma with up to high grade columnar epithelial dysplasia. No infiltration. 18 tumor-free lymph nodes. Radical excision.
+| Colon, segmental colectomy:<br>Tubulovillous adenoma (5.0 cm in greatest dimension) with high-grade dysplasia.<br>18 lymph nodes negative for carcinoma.
-{{Public Domain example}}
 |}
+{{CAP}}
 {{Reporting}}
 {{Bottom}}

Intestine with tumor: Difference between revisions

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