Intestine with tumor: Difference between revisions
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==Gross examination== | ==Gross examination== | ||
*Determine the proximal (oral) and distal (aboral) parts of the specimen if possible.<ref name=Stora>Unless otherwise specified, | *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/> Optionally, also measure diameter. | ||
*Surfaces that appear to overlie a tumor can be inked{{Ink note}}. | *Surfaces that appear to overlie a tumor can be inked{{Ink note}}. | ||
Revision as of 10:46, 27 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 of the entire specimen.[1] Optionally, also measure diameter.
- 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
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.
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See also: General notes on reporting
Microscopic evaluation
Determine tumor type and differentiation.
Determine depth of growth and/or infiltration. In case of cancer, stage by the AJCC or TNM system:
| AJCC stage[2] | TNM stage[2] | TNM stage criteria[2] |
|---|---|---|
| Stage 0 | Tis N0 M0 | Tis: Tumor confined to mucosa; cancer-in-situ |
| Stage I | T1 N0 M0 | T1: Tumor invades submucosa |
| T2 N0 M0 | T2: Tumor invades muscularis propria | |
| Stage II-A | T3 N0 M0 | T3: Tumor invades subserosa or beyond (without other organs involved) |
| Stage II-B | T4a N0 M0 | T4a: Tumor perforates the visceral peritoneum |
| Stage II-C | T4b N0 M0 | T4b: Tumor invades adjacent organs |
| Stage III-A |
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| Stage III-B |
|
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| Stage III-C |
|
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| Stage IVa | any T, any N, M1a | M1a: Metastasis to 1 other part of the body beyond the colon, rectum or regional lymph nodes. Any T, any N. |
| Stage IVb | any T, any N, M1b | M1b: Metastasis to more than 1 other part of the body beyond the colon, rectum or regional lymph nodes. Any T, any N. |
| Stage IVc | any T, any N, M1c | M1c: Metastasis to the peritoneal surface. Any T, any N. |
Microscopy report
It should include:[1]
- 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:
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.
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See also: General notes on reporting
Notes
- ↑ 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
- ↑ 1.00 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, reference is: Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.
- ↑ 2.0 2.1 2.2 . Colorectal Cancer: Stages. Cancer.net (American Society of Clinical Oncology). Retrieved on 2019-09-26. Approved by the Cancer.Net Editorial Board, 11/2018. In turn citing:
Amin, Mahul B.; Greene, Frederick L.; Edge, Stephen B.; Compton, Carolyn C.; Gershenwald, Jeffrey E.; Brookland, Robert K.; Meyer, Laura; Gress, Donna M.; et al. (2017). "The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging ". CA: A Cancer Journal for Clinicians 67 (2): 93–99. doi:. ISSN 00079235.
Image sources