Abdominal Wall

Ranging from biopsy fragments taken at laparotomy to formal excision of an abnormal segment of tissue. Specimens from the inner aspect of the wall comprise rectus sheath muscle orientated along one edge to peritoneum and with distortion by the relevant pathological condition. External specimens are composed of skin, subcutaneous fat ± abdominal wall muscle and may also contain the umbilicus, a stoma or incisional hernia. Biopsy fragments are processed in the usual manner but larger specimens need to be individually described as to their constituent parts, their respective dimensions and the abnormalities that are present. These specimens are usually submitted already fixed in formalin.

Mass lesion (tumour, fibromatosis, endometriosis, abscess):

• maximum dimension (cm), edges (circumscribed/irregular), cut surface (mucinous/scir-rhous/fibrotic/haemorrhage/pus), distances (mm) to the skin and nearest resection margin, involvement of skin (ulceration/tethering), subcutis, muscle or peritoneum.

• paint the deep and lateral resection margins.

Figure 10.1. (a) Sectioning of an abdominal wall mass, stoma (illustrated) or hernia. (b) Sectioning of omentum.

• serially section transversely at 3-4 mm intervals perpendicular to the skin or peritoneal surface.

• sample four or five representative blocks of the lesion showing its relationship to the various anatomical layers and resection margins. If close (< 0.5 cm) to a long-axis margin, obtain a longitudinal block to demonstrate this.

Stomas:

• note any mucosal prolapse, ulceration, ischaemia or tumour at the mucocutaneous junction, or bowel stricture - record their maximum dimensions (cm) and distances (cm) to the cutaneous, subcutaneous and proximal bowel resection limits.

• paint the deep and lateral resection margins.

• transverse section the proximal bowel resection limit.

• serially section the specimen transversely at 3-4 mm intervals perpendicular to the skin surface (Figure 10.1a).

• sample four or five representative blocks of the stomal junction/opening and any other relevant macroscopic abnormality.

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