Gross Examination of the Gastrectomy Specimen

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Atypical Fibroxanthoma

April 2007

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An outline of the anatomy and normal histology of the stomach for pathologists.

Reporting of gastric biopsies (non-neoplastic gastric lesions).

Pathology and pathogenesis of peptic ulcer.

Acute Gastritis

Chronic Gastritis

Helicobacter pylori associated(TypeB) Gastritis

Autoimmune Gastritis (Type A)

Reactive /Reflux/ Chemical Gastritis (Type C)

Lymphocytic Gastritis

Collagenous Gastritis

Granulomatous Gastritis

Eosinophilic Gastritis

Gastric Xanthoma/Xanthelasma

Other Non-Neoplastic Gastric Lesions

Benign tumour and tumour- like lesions

Gastric Lymphoma

Gastric Carcinoid Tumour

Gastrointestinal Stromal Tumour

Gastric Epithelial Dysplasia

Early Gastric Carcinoma

Gross Examination of the Gastrectomy Specimen

Normal histology of the small intestine for anatomic pathologists

An approach to evaluation of small intestinal biopsy.

Malabsorption syndrome (causes and clinical investigations)

Tropical Sprue

Coeliac Disease

Enteropathy-associated T-cell lymphoma

Intestinal lymphangiectasia

Pathogens commonly affecting Small Intestine

Ascariasis

Cryptosporidium

Cytomegalovirus infection

Mycobacterium Avium Intracellulare

Schistosomiasis

Whipple's disease

Lesions causing small bowel obstruction and bleeding -
Intussusception : Adhesions : Volvulus

Meckel's diverticulum

Ischemic bowel disease

Brunner's Gland Adenoma

Duodenal Gangliocytic Paraganglioma

Lymphoma of the small intestine

A careful and systematic approach to examination of gross specimen is essential for accurate interpretation of the microscopic features.

Indications:

1. Mostly performed for advanced gastric carcinoma.
(To confirm that the tumour is completely removed & to describe pathological indicators of prognosis.)

2.Rarely for:
i.   Gastric lymphoma CLICK
ii. Carcinoid tumour   CLICK
iii. Gastric Stromal Tumour CLICK
iv. Peptic ulcer CLICK
v. Zollinger Ellison syndrome CLICK
vi. Gastric antral vascular ectasia (GAVE) CLICK
vii Bleeding vascular malformation CLICK
viii Perforated stomal ulcer

Handling of specimen:

- Specimen ideally received fresh after resection.
- Paint the margins before opening the specimen
- Stomach opened along greater curvature.
(Opened along lesser curvature in case of focal lesion on greater curvature.)
- Opened stomach pinned on corkboard.
(Stomach kept under tension to avoid shrinkage artifact).
- Corkboard floated on a bath containing 10% formalin for 24-48 hrs.

Note: A diagram is useful to record the site of lesion and blocks, specially in case of more than one lesion. Blocks:- (see diagram --->)

The following gross features must be recorded in the report:

1. Type of specimen: Total or partial gastrectomy specimen or esophagogastrectomy specimen.
Mention whether spleen or pancreas is included.
2. Length of greater curvature.
3. Length of lesser curvature.
4. Length of esophagus and duodenum (if included).
5. Lesion:
Site: (pylorus,antrum, body, O-G junction, lesser curve,greater curve, anterior wall or posterior wall)
Dimensions: (length,width & thickness)
Distance from resection margins:
Gross subtypes:
Advanced carcinoma (see diagram --->).
Gross types of early gastric carcinoma: click
Gross features of gastric stromal tumour: click
Gross features in case of gastric dysplasia: click

6. Describe rest of the mucosa-
Erosions : Acute gastritis: click
Gastric ulcers : click
Hemorrhagic folds (GAVE) ; Thickened rugal folds in Menetrier's disease.
Mucosal atrophy- Autoimmune gastritis: click

7. Macroscopically enlarged lymphnode : Described - Site and dimension recorded.

Lymphnode examination in gastrectomy specimen:

D = Stands for level of dissection of lymph node
D1= Wide gastric resection including local lymph nodes.
D2 = Extensive gastric resection including extra level of lymphnodes (coeliac axis & its branches).

Lymphnode invasion is an important determinant of prognosis. The pathologist must report the total number of lymphnodes retrieved and the number of lymphnodes showing metastatic tumour.
Procedure: Lymphnodes are isolated from fat along the curvatures. These should be sliced at 3-5mm intervals.
Surgeon may sent fat and lymphnodes in separate pots. These pots should be carefully labelled according to site of origin and pathologist should report the specimens separately.
Note: Lymphnode is cut through its greatest dimension and one half submitted for processing.

[N0= 0 involved, N1=1-6 involved, N2= 7-15 involved
N3= >15 involved.]