Lymphovascular Invasion

Present/absent. Intra-/extratumoral.

Vessel wall fibrosis/stenosis in carcinoid tumour.

Metastatic carcinoma often shows quite extensive lymphovascular invasion in the various layers of the bowel wall.

6. LYMPH NODES

Site/number/size/number involved/limit node/extracapsular spread. Regional nodes: duodenum—gastroduodenal, pancreaticoduodenal, pyloric, hepatic, superior mesenteric; ileum/jejunum—mesenteric; terminal ileum—ileocolic, posterior caecal. A regional lymphadenectomy will ordinarily include a minimum of six lymph nodes.

pN0 no regional lymph node metastasis pN1 metastasis in regional lymph node(s)

7. EXCISION MARGINS

Distances (mm) to the nearest longitudinal limit of resection and painted deep radial (non-peritonealized soft tissue) mesenteric margin. In a segmental bowel resection it is usual to clear a 5-cm length of intestine on either side of the tumour with en bloc resection of a wedge of mesentery.

Tumour invades the visceral peritoneum pi4

Tumour invades through the muscularis propria into subserosa

Subserosa Serosa

Figure 4.1. Small intestinal carcinoma.

Tumour invades through the muscularis propria into subserosa

Subserosa Serosa

Tumour invades the visceral peritoneum

Figure 4.1. Small intestinal carcinoma.

Tumour invades

through muscularis propria and >2 cm into mesentery or retroperitoneum or involves adjacent organs/structures

1 - Mucosa

2 - Submucosa

3 - Muscularis propria

4 - Perimuscular

Figure 4.2. Small intestinal carcinoma. |W

through muscularis propria and >2 cm into mesentery or retroperitoneum or involves adjacent organs/structures

1 - Mucosa

2 - Submucosa

3 - Muscularis propria

4 - Perimuscular tissue (mesentery, retroperitoneum)

Figure 4.2. Small intestinal carcinoma. |W

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