Blocks for histology Figure

• sample the proximal and distal limits of surgical resection - complete circumferential transverse section (oesophagus) or multiple circumferential blocks (proximal stomach).

• alternatively, if separate anastomotic doughnuts are submitted, take one complete circumferential transverse section of each.

• serially section the bulk of the tumour transversely at 3-4 mm intervals.

• lay the slices out in sequence and photograph.

• sample a minimum of four blocks of tumour and wall to show the deepest point of circumferential invasion.

• sample two longitudinal blocks of tumour and adjacent mucosa, proximal and distal to the gross lesion respectively.

• sample one block of oesophagus proximal to the tumour, and one block of oesophagus (or proximal stomach) distal to the tumour.

• sample any abnormal background mucosa, e.g., multiple sequential blocks may be required to map the extent of Barrett's metaplasia.

• if tumour is not seen grossly, sequentially sample and correspondingly label unremarkable and abnormal areas of mucosa.

Figure 1.4. Recommended blocks for histology in resected oesophageal neoplasms. A. Oesophagectomy specimen. B. Oesophago-gastrectomy specimen containing tumour above the gastro-oesophageal junction. C. Oesophago-gastrectomy specimen containing tumour at the gastro-oesophageal junction. D. Resected specimen for high-grade dysplasia/in situ carcinoma. Shaded blocks represent the recommended minimum number to be sampled. Reproduced with permission from Ibrahim, NBN. Guidelines for handling oesophageal biopsies and resection specimens and their reporting. J Clin Pathol 2000;53:89-94.

• count and sample all lymph nodes.

• sample the mid-point and proximal surgical limit (as marked by the surgeon) of any separate proximal segment of normal oesophagus excised to facilitate pull-through of the oesophagogastric anastomosis to the neck.

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