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Handling of Polypectomy

Specimen

 Dr Sampurna Roy MD

 
 

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Colorectal polyps may be biopsied or removed by snare diathermy.

Gross description of the polyp should include:

1. Diameter of head and length of the stalk.

2. Polyp stalk present or absent - sessile or pedunculated. 

3. Surface - smooth or papillary.

4. Surface ulceration present or absent.

5. Cross-section of polyp - any cyst, mucoid areas, haemorrhage .  

6. Appearance of stalk - normal or abnormal.

I. Local excision specimens:

Key to the handling of polyps is to provide a block that ensures a complete section through its stalk, base and head.

-Small polyps -  embedded whole.

-Lesions less than 1cm - bisection through the stalk

-Lesions more than 1cm - (see diagram). Edges should be  trimmed. There should be three pieces. The central section contain the intact stalk. The two side pieces are put into a separate cassette.

At least three levels are cut from a small polyp and six or more from a larger polyp.

II Submucosal polypectomies and transanal full thickness local excision specimens:

Indication: 1. In cases of large adenomas and early carcinomas. 2. Performed as palliative procedure in patients unsuitable for more radical surgery

Specimen: Both types of specimens consist of a  lesion with narrow rim of surrounding normal tissue.

Procedure: (see diagram)

1.For proper examination the fresh specimen needs to be pinned around the entire circumference and fixed for at least 24 hrs.

(Note: Fixing of specimen without pinning can cause tissue shrinkage. It becomes difficult to orientate the specimen and assess the resection margins.)

2.Next specimen margins are identified with coloured markers.

3.The whole specimen is transversely sectioned into 3mm slices and submitted for histology in sequentially labelled cassettes.

Pedunculated polyp - (with a stalk ).

Less than 3 cm in diameter.

 

                

 

                

 Sessile polyp - (without a stalk) - Larger size

 

 

4. In specimens where the margin of normal tissue is less than 3mm, a 10mm slice containing the relevant margin should be made and further sectioned at right angles as shown in the diagram.

Further reading: Examination of large intestine resection specimens

III Sampling of multiple polyps and polyposis:

Multiple adenomatous and metaplastic polyps may be present in the backround of colorectal resections performed for both neoplastic and non-neoplastic lesions and in polyposis syndromes.

All polyps under 1cm in a colectomy specimen do not necessarily need to be sampled.

All suspected adenomas above 1 cm in diameter should be submitted for histology.
 

 

GI Path Online-Home Page  

 

Pathology of Large  Intestine - Home Page

 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

 

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