Difference between revisions of "Intestine with tumor"

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==Gross examination==
 
==Gross examination==
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*Determine the proximal (oral) and distal (aboral) of the specimen if possible.<ref name=Stora>{{cite web|url=http://www.svfp.se/stora_utskarningen|title=Stora utskärningen|website=KVAST (Swedish Society of Pathology)|author=Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg|accessdate=2019-09-26}}</ref>
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*Determine the proximal (oral) and distal (aboral) parts of the specimen if possible.<ref name=Stora>Unless otherwise specified, refereence is: {{cite web|url=http://www.svfp.se/stora_utskarningen|title=Stora utskärningen|website=KVAST (Swedish Society of Pathology)|author=Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg|accessdate=2019-09-26}}</ref>
 
*Measure the length and diameter of the entire specimen.<ref name=Stora/>
 
*Measure the length and diameter of the entire specimen.<ref name=Stora/>
 
*Surfaces that appear to overlie a tumor can be inked{{Ink note}}.
 
*Surfaces that appear to overlie a tumor can be inked{{Ink note}}.
 
*Initial cutting can be:
 
*Initial cutting can be:
−
:*A ''longitudinal'' cut opposite to the tumor if it is relatively demarcated
+
:*A ''longitudinal'' cut opposite to the tumor if it is relatively demarcated (by sight and/or palpation).
−
:*''Cross-sectional'' slicing, particularly for circumferential tumors or those not readily visible.
+
:*''Transverse'' (cross-sectional) slicing, until reacing the tumor, particularly for circumferential tumors.
−
*Measure the distance proximal and distal of the tumor.<ref name=Stora/>
+
*Measure the distance proximal and distal to the tumor.<ref name=Stora/>
 
*Note any accompanying "polyps".<ref name=Stora/>
 
*Note any accompanying "polyps".<ref name=Stora/>
 
*Describe the serosa, and whether there are any suspected tumor breakthroughs hereof.<ref name=Stora/>
 
*Describe the serosa, and whether there are any suspected tumor breakthroughs hereof.<ref name=Stora/>
−
*Further tumor evaluation:<ref name=Stora/>
+
*Evaluate the following either before or after slicing it up:<ref name=Stora/>
−
:*Size
+
:*Tumor size
 
:*The proportion of the circumference involved
 
:*The proportion of the circumference involved
−
:*Distance to the resection edges
+
*Slice the tumor, either by transverse or longitudinal slicing.<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/>
−
· Cut through the tumor, preferably in parallel slices, either transversely or longitudinally
 
  
−
· Review each disc and note any infiltration in the wall and its greatest depth
+
===Tissue selection===
 +
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.
 +
*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.
 +
*Take slices of any other suspicious findings
 +
*Take a slice of the normal intestinal wall
 +
*Take slices from any adherent structures and/or organ parts
 +
*Carefully go through included mesentery for lymph nodes, and cut each in two parts.
  
−
 
+
===Gross report===
−
 
+
Should include:<ref name=Stora/>
−
Bits for microscopic examination:
+
*Dimensions of entire sample, as well as for the tumor
−
 
+
*Distance to proximal and distal resection margins
−
· Take pieces from the tumor that show the deepest penetration, its relation to the outside of the preparation and to normal mucosa
+
*Depth of tumor invasion and/or infiltration
 +
{{Reporting}}
  
−
· Take pieces from the respective resection border, from transverse discs. If the tumor is critically close to a resection border, it is advisable to take pieces perpendicular to the resection border, which includes both the edge portion of the tumor and the resection border itself.
+
==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
 +
:*Number of them with periglandular growth
  
−
· Take pieces from any other changes that may occur
 
−
 
−
· Take a piece from the normal intestinal wall and from any adherent structures and organs nearby
 
−
 
−
· Look carefully for lymph nodes in mesocolon and mesentery and all take histology
 
−
 
−
 
−
 
−
 
−
 
−
 
 
−
 
−
The answer must include information on:
 
−
 
−
· Tumor type and degree of differentiation
 
−
 
−
· Depth of infiltration, as well as radicality
 
−
 
−
· Ev. breakthrough to the surface of the preparation, localization
 
−
 
−
· Number of lymph nodes found, number thereof with metastases, as well as number with periglandular plant (similar to breast cancer). Divided if necessary. in lymph nodes outside the tumor, above and below the same
 
−
 
−
· For colon cancer, Dukes' classification is stated
 
−
-->
 
−
 
−
 
−
===Tissue selection===
 
−
===Gross report===
 
 
==Microscopic evaluation==  
 
==Microscopic evaluation==  
 
===Microscopyreport===
 
===Microscopyreport===
 
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Revision as of 09:42, 26 September 2019

Author: Mikael Häggström [note 1]

Gross examination

  • Determine the proximal (oral) and distal (aboral) parts of the specimen if possible.[1]
  • Measure the length and diameter of the entire specimen.[1]
  • Surfaces that appear to overlie a tumor can be inkedTemplate:Ink note.
  • Initial cutting 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 distance proximal and distal to the tumor.[1]
  • Note any accompanying "polyps".[1]
  • Describe the serosa, and whether there are any suspected tumor breakthroughs hereof.[1]
  • Evaluate the following either before or after slicing it up:[1]
  • Tumor size
  • The proportion of the circumference involved
  • Slice the tumor, either by transverse or longitudinal slicing.[1]
  • 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.[1]

Tissue selection

Should include:[1]

  • 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.
  • 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.
  • Take slices of any other suspicious findings
  • Take a slice of the normal intestinal wall
  • Take slices from any adherent structures and/or organ parts
  • Carefully go through included mesentery for lymph nodes, and cut each in two parts.

Gross report

Should include:[1]

  • Dimensions of entire sample, as well as for the tumor
  • Distance to proximal and distal resection margins
  • Depth of tumor invasion and/or infiltration

  See also: General notes on reporting


Microscopy report

It should include:[1]

  • Tumor type[1]
  • Degree of differentiation[1]
  • 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
  • Number of them with periglandular growth

Microscopic evaluation

Microscopyreport

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 Unless otherwise specified, refereence is: Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.

Image sources


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