Neoplastic Conditions

Ampullary adenocarcinoma arising from adenomatous dysplasia of either the periampullary duodenal or intra-ampullary duct mucosae, it is one of the commonest causes of death in FAPC. Adenoma may be amenable to local excision but radical surgical resection is often required for large lesions and because a surface biopsy showing epithelial dysplasia may harbour underlying invasive adenocarcinoma. Most cases have a well-defined intestinal pattern but in a minority it can be difficult to separate...

Histopathology report

Final reports of thyroid specimens should include details on the specimen type, side, size (cm) and weight (g) the type and subtype of tumour present, if any - papillary carcinoma and variants. - follicular carcinoma and variants. the macroscopic size of tumour and degree of encapsulation. the presence or absence of invasion of the capsule and surrounding tissues. the distance of tumour from the nearest margin. the presence or absence of vascular invasion. involvement of perithyroid lymph...

Clinical Investigations

The ease with which the oral cavity can be examined by direct visualization facilitates preoperative diagnosis and reduces the need for complex investigative procedures. Nevertheless, haematolog-ical investigations are often useful to determine haemoglobin levels, red blood cell indices, serum ferritin, vitamin B12 and folate levels. Identification of pathological forms of Candida species can be achieved by direct visualization of Periodic acid Schiff-stained smears sampled directly from...

Clinical Presentation

Grade Thyroid Gland

Disease affecting the thyroid gland can present as enlargement (called goitre) that may be diffuse or nodular or as a consequence of hormonal imbalance rarely there may be pain. Hypothyroidism is characterised by lethargy, mental slowness or depression, intolerance of cold or weight gain Figure 17.1. Thyroid gland and parathyroid glands. a. View of thyroid gland from anterior aspect to show relation to larynx and regional lymph nodes. b. View of thyroid gland from posterior aspect to show...

Biopsy Specimens

The vast majority of teeth are removed because of dental caries or periodontal disease and are not submitted for histological examination unless there are unusual clinical or radiological findings. Teeth adjacent to cystic lesions are removed either as part of the treatment for the lesion (e.g., the unerupted tooth associated with a dentigerous cyst) or because they cannot be restored to useful function (e.g., a tooth whose roots have been extensively resorbed by a keratocyst). Where a primary...

Pathological Conditions

Inflammatory disease biopsies require histology and close correlation with clinical details as do tumourous lesions which can arise from all the structures in the three skin layers resulting in a range of benign and malignant conditions. Cysts there is a variety of benign epithelial cysts that usually occur in the dermis and present as a dermal swelling. The type of cyst is determined by microscopic examination of the cell lining. Common examples are pilar and epidermal inclusion cysts -...

Nonneoplastic Conditions

Atherosclerosis very common and affects the elastic arteries (aorta, carotid, iliac) and large and medium-sized muscular arteries (coronary and popliteal). The vessels show intimal thickening and lipid accumulation producing atheromatous plaques, which may become complicated by calcification, focal rupture or gross ulceration. Debris can be discharged into the bloodstream forming microemboli. Haemorrhage may occur into a plaque or a thrombus may form on the surface, potentially occluding the...

Resection Specimens

Traditionally, when surgery is advised in Graves' disease, subtotal thyroidectomy has been carried out although, because of recurrent hyperthyroidism in 5-10 of cases, there is an increasing tendency to perform total thyroidectomy. On the few occasions when operation is required for aesthetics and or obstructive symptoms in Hashimoto's thyroiditis, total thyroidectomy is the operation of choice. Likewise, total thyroidectomy may be required for patients with multinodular goitre because of...

Other Skin Tumours

Merkel cell tumours of neuroendocrine origin that occur in elderly patients, usually presenting as a rapidly growing nodule often in the head and neck area. They may present with skin involvement and lymph node spread. Prognosis in these tumours is poor. Secondary spread from small cell carcinoma of lung must be excluded. Paget's disease of nipple presents as an eczematous area on the nipple or areola. It is associated with underlying malignancy in the breast. Extramammary Paget's disease...

Resection of Nonneoplastic Lesions

Fissure-in-ano - acute fissures can usually be treated conservatively by introducing stool-softening measures. However, a chronic anal fissure can be treated by either anal dilatation or lateral internal sphincterotomy. Haemorrhoids - if haemorrhoids are small and asymptomatic then no treatment is necessary except for measures to avoid constipation. Non-prolapsing piles are probably best treated by injection sclerotherapy. Larger prolapsing piles above the dentate line are treated by...

Transplantation

The first successful human liver transplant was carried out in 1967 and today over 80 of recipients survive one year. Not only can adult livers be transplanted to adult recipients, but the shortage of donor organs has led to adult donor organs being transplanted to children. This is facilitated by resecting and transplanting only part of the donor liver, e.g., left liver (segments I-IV). General indications for transplantation are acute liver failure, end-stage chronic liver disease and...

Initial Procedure

In general, specimens are measured, opened with blunt-ended scissors along the antemesenteric border and then blocked longitudinally (but see diverticular disease and tumour) following gentle washing out of faecal debris, pinning out with avoidance of unnecessary traction, and immersion in 10 formalin fixative for 48 hours. Photographs may be taken before and after dissection. When opening avoid areas of perforation or tumour. Tumour segments may either be left unopened for fixation and...

Disorders of the Valves

In valvular disease, assessment of the gross appearance often contributes to the final diagnosis more than microscopic examination. Mitral valve stenosis most commonly due to rheumatic fever with commissural fusion, cusp scarring and dystrophic calcification. Mitral valve regurgitation due to floppy mitral valve, shows valve cusps which are increased in area, dome shaped and show myxoid change. Other causes include rheumatic fever, rupture of a papillary muscle or chordae tendinae, ventricular...

Blocks for histology

In cases of neoplastic disease, the histology should represent the tumour, its relationship to its own capsule (if any), the capsule of the thyroid gland and adjacent structures (Figure 17.2). Focal abnormalities of the thyroid parenchyma need to be sampled as do adjacent lymph nodes and the parathyroid glands. In inflammatory or diffuse reactive disease, representative samples of gland and capsule are required. Macroscopically encapsulated neoplastic disease for tumours up to 5 cm in diameter,...

Excision Biopsy of Lymph Node

The general principle is to remove a representative lymph node and submit it for histology with minimal tissue distortion - this requires careful surgical expertise. If only a single enlarged lymph node is identified, it is removed for histological assessment. In cases of widespread lymphadenopathy, excision of a large node is more diagnostically useful than a smaller, easily accessible lymph node, which may be uninvolved or only focally involved by the disease process. Table 44.4. Subtypes of...

Immunohistochemistry and Immunofluorescence

The development of antigen-retrieval techniques and the increasing range of monoclonal and polyclonal antibodies have been accompaniedby widespread application of immunohistochemistry to routinely fixed paraffin wax-embedded material. Adequate, controlled fixation is still crucial in obtaining the best results from immunohistochemistry, but there is little indication for the use of fixatives other than formalin outside a research setting. Heat-mediated antigen-retrieval techniques (HMAR) are...

Pancreas Ampulla of Vater and Extrahepatic Bile Ducts

The pancreas is a soft, lobulated retroperitoneal organ which is both an endocrine and exocrine gland. The exocrine portion produces enzymes (lipases, proteases) which are conveyed to the duodenum by the pancreatic duct and are concerned with digestion. The endocrine portion (including the islets of Langerhans) produces hormones such as insulin and glucagon. The pancreas is subdivided as follows (Figure 3.1) Head - that part to the right of the left border of the superior mesenteric vein. It...

Lymphovascular Drainage

Lymph vessels from the nasopharynx, oropharynx, hypopharynx and the tonsils drain to Level II nodes in the upper deep cervical chain either directly or via the retropharyngeal groups (Figure 19.1). Bilateral drainage is common with nasopharyngeal, hypopharyngeal and laryngeal lesions. Elevation of mucosa by apex of left arytenoid cartilage Cut portion of cricoid lamina Inferior cornu of thyroid cartilage Tracheal rings Cut portion of cricoid lamina Inferior cornu of thyroid cartilage Tracheal...

Disorders of the Myocardium

Myocarditis viral, bacterial or fungal. In developed countries viral infections predominate. Parasitic aetiologies include toxoplasmosis and the protozoon Trypanosoma cruzi. Granuloma-tous myocarditis can occur due to TB or sarcoidosis. Myocarditis occurs secondary to collagen vascular disease, especially rheumatic fever, and may also be drug or radiation induced. Idiopathic hypertrophic obstructive cardiomyopathy (HOCM) massive myocardial hypertrophy and classically there is asymmetric...

Malignant Tumours

Carcinoma in situ carcinoma in situ is a proliferation of malignant epithelial cells within the ductulo-lobular system of the breast which on light microscopy shows no evidence of breaching the basement membrane to invade the adjacent stroma. There are two forms - ductal (DCIS) and lobular (LCIS) carcinoma in situ. LCIS cannot be diagnosed preoperatively and is seen incidentally on excision specimens as a marker for increased risk of developing malignancy. DCIS, on the other hand, is a...

Anatomy

The type of histopathology resection specimen received is dictated by the nature of any previous operations and the current disease process, its distribution and degree of local spread within the organ and to adjacent structures. Resection surgery must provide adequate clearance of longitudinal and deep circumferential radial margins. It must also take into account the lymphovascular supply to achieve satisfactory anastomoses and the regional lymph node drainage for an adequate radical cancer...

Colorectal Mucosal Biopsies for Hirschsprungs Disease

Pinch biopsies of colonic and rectal mucosa may be taken for the evaluation and determination of the severity and extent of Hirschsprung's disease in children. The innervation and motility of the gut can be determined using enzyme histochemistry for acetylcholinesterase activity . If there is no staining the bowel is innervated. Positive staining indicates an aganglionic or hypogan-glionic area which results in a bowel stricture and constipation. Using a series of biopsies, the distribution of...

Cortex

Congenital adrenal hyperplasia this autosomal recessive disorder is caused by an enzyme deficiency in the cortisol biosynthetic pathway, most commonly 21-hydroxylase. ACTH levels are elevated by negative feedback, causing adrenal enlargement. Symptoms are caused by diversion of cortisol precursors into androgenic steroid pathways, leading to virilisation. A spectrum of severity exists and the condition may go unrecognised in males. Affected females may present at birth with sexual ambiguity and...

Mechanical Disorders

Melanosis coli characterised by pigmented macrophages in the lamina propria that impart a dusky mucosal appearance mimicking ischaemia. The pigment is lipofuscin and degenerative in nature, and is thought to relate to cellular apoptosis. There is an association with use of laxatives and bowel dysmotility. Volvulus usually comprises a markedly dilated atonic sigmoid colon in either Africans (due to a high-fibre diet with bulky stools), or constipation-related acquired megacolon in the elderly....

Radical Prostatectomy

The three aims of this operation are cancer control, preservation of urinary continence and of sexual function. Two approaches are available the perineal approach was pioneered first and has the advantages of usually less blood loss and greater exposure of and access to the apex of the prostate, thus optimising removal of tumour from this critical margin and allowing precise transection of the urethra. However, its main disadvantage is that it does not allow access to perform a pelvic...

Disorders of the Endocardium

Infective endocarditis a disorder affecting the endocardial surface of the heart as the result of infection. The characteristic lesion is the vegetation, which consists of thrombus containing microorganisms. In acute bacterial endocarditis large friable vegetations are found on the valves, which can cause erosion or perforation of the underlying tissue. Predisposing factors to endocarditis are valvular anatomical abnormalities (congenital or acquired, e.g., rheumatic heart disease), sepsis,...

Biopsy and Excision Specimens

A variety of biopsies are submitted depending on the clinical diagnosis and the type of information the clinician wants. Curettage a curetted specimen is used to remove or sample small warty-type lesions which are usually benign or small basal or squamous cell carcinomas. This can be associated with cautery to the lesion base (C+C). Occasionally, a basal cell carcinoma, actinic keratosis or squamous cell carcinoma may be removed by curettage and then formal surgical excision is carried out of...

Cardiothoracic Specimens and Vessels

Association of Directors of Anatomic and Surgical Pathology. Recommendations for the reporting of resected primary lung carcinoma. Hum Pathol 1995 26 937-939 Baumgartner WA, Reitz B, Kasper E, Theodore J. Heart and lung transplantation. 2nd edn. Saunders London, 2001 Billingham M, Carey N, Stewart S, Goddard M. Atlas of biopsy histopathology for heart and lung transplantation. 1st edn. Arnold London, 2000 Billingham ME, Cary NRB, Hammond ME et al. A working formulation for the standardisation...

Septal Excision Medial Maxillectomy and Craniofacial Resection Specimens

Most septal excision and medial maxillectomy specimens are for the less extensive or less locally aggressive neoplastic diseases, such as inverted nasal papilloma, olfactory neuroblastoma and even malignant melanoma. They are usually received as multiple fragments of mucosa with underlying bone and or cartilage. In medial maxillectomy specimens, at least the inferior turbinate is included but, depending on tumour location, all turbinates may be represented. Most craniofacial resection specimens...

Tissue Banking and the Use of Surplus Tissue for Research

The increasing use of minimally invasive techniques and the advent of screening programmes for breast and cervical carcinoma have been accompanied by a reduction in the size and amount of tumour tissue submitted and an increased range of investigative techniques. Radiotherapy and or neoadjuvant chemotherapy has been used in the treatment of oesophageal, rectal, breast and cervical carcinoma and when successful there may be very little evidence of residual tumour. Pathologists have an important...

Resection of Neoplastic Disease

Anal carcinoma - small lesions (< 2 cm) present at the anal verge are usually treated by local excision with a 2 cm margin of skin around the tumour. The resection should extend down to the perianal fat. For larger tumours, or extensive tumours of the anal canal that are unresponsive to radio- chemotherapy, abdominoperineal resection is the procedure of choice. A 2 cm margin of perineal skin should be excised around the tumour and there should be a radical ischiorectal resection. If there is...

Tumourlike Conditions

Postoperative necrobiotic granulomas seen following transurethral surgery with diathermy. Microscopy reveals central necrosis with peripheral palisading of histiocyes and occasional giant cells. Postoperative spindle cell nodule nodular bladder masses seen up to several months following surgery. Histology shows interlacing fascicles of mitotically active bland spindle cells resembling leiomyosarcoma. Clinical history is most important. Behaviour is benign with spontaneous resolution in many...

Special Sites

Hair hair samples should be plucked, not cut, from the patient and sent unfixed to the laboratory. The hair is mounted unfixed on glass slides and examined for hair shaft anomalies, or to look at the hair roots and count the telogen anagen ratio - this requires a minimum of 50 hairs. Scanning electron microscopy provides more information in patients with hair shaft anomalies and picks up more subtle changes than those seen at light microscopy. Nails fragments of nails may be submitted for...

Lymphovascular Supply

The internal pudendal artery gives off a branch which provides part of the blood supply to the vulva, which is also contributed to by branches from the femoral artery. The venous drainage follows the arterial blood supply. The lymphatic drainage of each side of the vulva is largely to the ipsilateral inguinal and femoral lymph nodes although some contralateral drainage occurs. Most of the lymphatic drainage is to the superficial inguinal lymph nodes and therefore these are usually the first...

Insitu Hybridisation including FISH

This technique has been regarded as a research tool but improved technologies (proprietary kits and integrated instruments for automated immunohistochemistry and in-situ hybridisation) are leading to clinical applications. In-situ hybridisation may be used to detect viral nucleic acid, examples being the detection of EBV in post-transplant lymphoproliferative disorders or HPV subtyping in cervical biopsies. In-situ hybridisation for k and light chain mRNA may have advantages over conventional...

Disorders of the Pericardium

Acute pericarditis due to infection caused by viruses or bacteria. Viruses include coxsackie B, echoviruses, influenza, mumps and Epstein-Barr virus. Bacterial pericarditis may be due to Staphylococcus aureus, Streptococci or Haemophilus influenza. Tuberculous pericarditis usually becomes chronic. Acute pericarditis can also be secondary to acute rheumatic fever, myocardial infarction, connective tissue disorders such as systemic lupus erythematosus and rheumatoid disease, uraemia, renal...

Blocks for histology Figure 293

transverse section the urethral and ureteric limits. if bilateral ureteric limits are submitted separately, measure the two lengths and sample the proximal surgical margin of each (if orientated by the surgeon), then serially section the remainder and process separately. sample at least four blocks of tumour to demonstrate depth of invasion, distance to perivesical soft tissue margins and relationship to adjacent mucosa, ureters, prostate or other organs. sample any suspicious background...

Benign Conditions

As alluded to above, surgery for chronic peptic ulceration is now unusual. It aims to remove the gastric ulcer and the gastrin-producing G cells that drive acid secretion. This is accomplished by a Bilroth I distal gastrectomy with a gastroduodenal anastomosis (Figure 2.3). Alternatively, blockage of gastric innervation is achieved by transecting the vagus nerve trunks as they emerge through the diaphragmatic hiatus (truncal vagotomy) resulting in reduced gastric secretions and motility....

Special Techniques and Considerations

Immunofluorescence immunofluorescent examinations are required for the diagnosis of chronic blistering diseases and are useful in connective tissue diseases. The site of biopsy is important for immunofluorescence, particularly in the blistering disorders. In dermatitis herpetiformis a biopsy for immunofluorescence should be taken from clinically normal skin away from the area of blistering. In the other blistering disorders, perilesional skin is submitted. The skin should have an intact...

Omentum and Peritoneum

The omental fat and peritoneal serosa may be involved by various inflammatory and neoplastic disorders. Inflammation acute due to appendicitis or a perforated viscus (GU, diverticulitis), or granulomatous, e.g., tuberculosis, fungal peritonitis (chronic ambulatory peritoneal dialysis (CAPD)) or after previous surgery. CAPD can also be associated with the rare condition of fibrous or scle-rosing peritonitis. Infarction spontaneous, idiopathic omental infarction in the right iliac fossa mimicking...

Inflammatory Lesions

Balanitis circumscripta plasmacellularis ( Zoon's balantitis) occurs in uncircumcised men with an unknown aetiology (possibly autoimmune). It consists grossly of well-defined brown red plaques, solitary or multiple, and clinically resembles erythroplasia of Queyrat. Balanitis xerotica obliterans (BXO) this is the male equivalent of lichen sclerosus et atroph-icus of vulva. It may cause narrowing of the urethral meatus or phimosis. There is a weak association with carcinoma of the foreskin. The...

Adult Tumours

Oncocytoma represents 4 of renal tumours and usually occurs in adults over 50 as an incidental finding. It has a benign behaviour if strict diagnostic criteria are followed. Grossly it is circumscribed, brown-yellow, with a stellate central scar in larger lesions. It may be bilateral or multifocal and can invade the renal capsule. Histologically it has a sheeted or nested pattern of uniform cells with intensely eosinophilic and coarse granular cytoplasm. Patterns not allowed include papillary...

Benign Tumours

Fibroadenoma this is the commonest benign tumour of the breast, most often encountered in premenopausal women who present with a palpable, painless and mobile discrete lump. Nonoperative diagnosis can be confidently made by the triple approach except in large lesions where excision may be advised to exclude a low-grade phyllodes tumour. Proliferative lesions (radial scar complex sclerosing lesion, intraduct papilloma, nipple adenoma, myoepithelioma) these lesions are due to epithelial...

Specimen Handling

usually multiple fragments, free floating in fixative, non-orientated. place in cassette between foam insert pads or loosely wrap in moist filter paper. align in the block at the embedding stage as this facilitates microscopic assessment and fragments are not missed. separate specimens use separate cassettes and site identification labels appropriate to the request form information. cut through multiple levels. this allows better assessment of mucosal architecture and site distribution of...

Anterior Mediastinal Masses

Neurogenic tumours-neurofibroma, neurilemmoma (schwannoma),ganglioneuroma, ganglioneuroblastoma, malignant schwannoma, neuroblastoma, paraganglioma Unilocular thymic cysts of developmental origin and occur more often in the neck than the mediastinum. The lining may be flattened, cuboidal, columnar or (rarely) squamous epithelium with thymic tissue in the wall. Multilocular thymic cysts acquired and thought to be secondary to inflammation. Some cases are seen in HIV infection. They can mimic an...

Blocks for histology Figure 332

shave section from shaft margin (including skin, erectile bodies and urethra). samples of foreskin to include associated conditions. sample four sections of tumour to demonstrate depth of invasion, relationships to the adjacent surface epithelium, corpora cavernosa, corpus spongiosum and urethra. sample two to three transverse sections through the shaft at different levels. Blocks of foreskin, Blocks of shaft skin, Blocks of foreskin, Blocks of shaft skin, proximal resection margin of the...

Aryepiglottal Folds And Lymphoid Tissue

Arytenoid Cartilages Position

The pharynx connects the nasal cavities and mouth with the larynx and oesophagus. It is divided into three functional parts, namely the nasopharynx, the oropharynx and the hypopharynx (Figure 15.1). The nasopharynx lies behind the nasal cavities and above the level of the soft palate. The roof and posterior wall relate closely to the skull base and the first cervical vertebra. The lateral wall is an extension of fascia from the skull base called the pharyngobasilar fascia. The Eustachian tube...

The Core Data in Histopathology Specimens

Specimen dissection must be geared to provide information relevant to the clinician who is managing the patient. Reports must be timely, i.e., prompt, but in the context of an adequate period of fixation so that acquisition of accurate data is not compromised. The report content must not only come to an interpretationally accurate diagnosis but also be qualified by assessment of various prognostic indicators. In the field of surgical cancer pathology this is reflected by the trend towards...

Gastrointestinal Specimens

Albores-Saavedra J, Henson DE, Klimstra DS. Tumors of the gall bladder, extrahepatic bile ducts and ampulla of vater. Atlas of tumor pathology. 3rd series. Fascicle 27. Washington AFIP, 2000 Bateman AC. How to handle and report pancreatic specimens. CPD Cellular Pathology 2001 3 94-98 Beckingham IJ (ed). ABC of liver, pancreas and gall bladder diseases. London BMJ Books, 2001 Biddlestone LR, Bailey TA, Whittles CE, Shepherd NA. The clinical and molecular pathology of Barrett's oesophagus. In...

Dissection

Cancer resections for optimal demonstration of the deepest point of tumour spread, its relationship to the CRM and correlation with ELUS CT cross sectional imaging multiple, serial, 3-4 mm thick slices of the cancer in the transverse axis are recommended. The slices can then be laid out in sequence and a photographic or digital record provided. Generally, four or five blocks of the tumour and wall are selected to adequately define the pT stage. Some pathologists leave the tumour segment...

Resections Specimens

Corpus Carcinom

The uterus is usually removed together with the cervix as part of a hysterectomy. Occasionally the cervix is left in situ and a subtotal hysterectomy is performed. Myomectomies may also be performed, especially for uterine fibroids. the specimen is weighed g . the specimen is measured in three dimensions cm , i.e., superior to inferior, medial to lateral, anterior to posterior. the specimen is orientated. The peritoneal reflection extends lower on the posterior aspect of the uterus than...

Surgical Pathology Specimens Laboratory Protocols

Punch Biopsy Alopecia

Punch, ellipse or shave biopsy embedded intact. Figure 37.1. Punch, ellipse or shave biopsy embedded intact. Figure 37.2. Punch, shave or ellipse bisected and embedded. Figure 37.2. Punch, shave or ellipse bisected and embedded. Diagnostic punch biopsy diagnostic punch biopsies come in a variety of sizes ranging from 2 mm to 8 mm. The smaller-sized punch biopsies are usually for diagnostic purposes. The size of the punch is recorded and a description of any lesion seen. Small...

Resection in Neoplastic Conditions

Right Colectomy

Adenomatous polyps as discussed above, the majority of adenomatous lesions can be removed by endoscopic techniques. However, large sessile polyps gt 5 cm in diameter and occupying more than one third of the colon circumference should be removed by a localised resection. Sessile adenomas in the rectum can be removed by transanal submucosal resection. In this procedure adrenaline solution is infiltrated into the submucosa around the lesion and the mucosa is incised rectal stump CIBD, diversion...

Pelvic and Retroperitoneal Specimens

ACTH adrenocorticotrophic hormone MEN multiple endocrine neoplasia syndrome RPLND retroperitoneal lymph node dissection basal cell papilloma seborrhoeic keratosis dysplastic atypical melanocytic naevus pityriasis lichenoides et varioliformis acuta pruritic urticarial papules and plaques of pregnancy

Resection in Nonneoplastic Conditions

Terminal End Colostomy

Hartmann's procedure - this is one of the most commonly used emergency operations for colorectal disease. Although this was initially devised for the elective treatment of proximal rectal tumours, it is now usually used in the emergency setting to treat conditions such as perforated diverticular disease most commonly , perforated tumour, etc. The procedure itself is defined as resection of the sigmoid colon and a variable length of proximal rectum if required with the fashioning of a terminal...

Abdominal Wall and Umbilicus

Various conditions can affect the abdominal wall and result in both FNAC and histopathology specimens. Secondary carcinoma commonly due to either gastrointestinal or gynaecological cancer involvement, can be by direct spread at presentation or because of a subsequent metastatic recurrence. The former is not infrequently seen with a perforated bowel cancer and the inner layers of the abdominal wall may be dissected off separately or in continuity with it. The latter tends to be encountered as an...

Blocks for histology Figure

sample the proximal and distal limits of resection - complete circumferential transverse sections duodenum, oesophagus or multiple circumferential blocks mid-stomach . alternatively, if separate anastomotic doughnuts are submitted - one complete circumferential transverse section of each. count and sample all lymph nodes lesser greater omenta, splenic hilum and process separately any named lymph nodes. sample a minimum of four blocks of tumour and wall to show any serosal involvement and the...