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Gross Examination of the

Gastrectomy Specimen

Dr Sampurna Roy MD

 

 

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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

ii) Carcinoid tumour

iii) Gastric Stromal Tumour

iv) Peptic ulcer

v)  Zollinger Ellison syndrome 

vi) Gastric antral vascular ectasia  (GAVE) 

vii) Bleeding vascular malformation  

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 below)

 

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 and thickness)

Distance from resection margins:

Gross subtypes:

Advanced carcinoma  (see diagrams)

1) Polypoid Carcinoma

2) Excavated Ulcerating Carcinoma

3) Diffusely Infiltrative Gastric Carcinoma

Gross types of early gastric carcinoma


Gross features of gastric stromal tumour


Gross features in case of gastric dysplasia

 

6. Describe rest of the mucosa:

Erosions : Acute gastritis

Gastric ulcers 

Hemorrhagic folds (GAVE) ;  Thickened rugal folds in Menetrier's disease. Mucosal atrophy- Autoimmune gastritis

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.]

 

Further reading: 

Multivariate prognostic study on large gastric cancer.

Critical review in the surgical pathology of carcinoma of the stomach.

Comparative study on biological difference between gastric cancer and colorectal cancer.

Clinicopathologic studies of gastric carcinoma.

Clinicopathologic profile of gastric carcinomas at the University Hospital of the West Indies.

Pathology and prognosis of gastric carcinoma. Findings in 10,000 patients who underwent primary gastrectomy.

 

 

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Gastric Pathology - Home Page

 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

 

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