Blocks for histology

• it may be helpful to use a diagram such as Figure 34.2 to identify the origin of blocks for histology.

• longitudinal limit blocks of colon, rectum, ureters, urethra and distal vagina.

• the remaining blocks taken for histology depend on the type and origin of the tumour, if a tumour can be identified:

Cervical carcinoma

• blocks of tumour and tumour in relation to:

- anterior rectal wall.

- posterior bladder wall.

- pericervical tissues with lateral circumferential margins.

- ureters.

- peritoneum.

- if no cervical tumour is apparent post-radiotherapy, then the cervix must be blocked to identify residual disease histologically. It may be "clock-faced", submitting the entire cervix for histology or more pragmatically, four quadrants taken from the transformation zone.

• representative sections are also submitted from uninvolved tissues:

- bladder wall.

- urethra.

Tumour block harvest in relation to: Peritoneum

Cervix and

vagina

SArhj);

Posterior^

bladder

////// ■>

Pericervical tissues including the lateral circumferential limits

Proximal bowel margin

Tube and ovary

Tube and ovary

Proximal bowel margin

Distal urethra-.,^ limit

Distal vaginal limit

Distal bowel margin

Figure 34.2. Blocking of total pelvic exenteration specimen for a pT4 cervical carcinoma.

Anterior rectal wall

Sample normal tissues

• colorectum

• endo/myometrium

• tubes/ovaries

Distal urethra-.,^ limit

Distal vaginal limit

Distal bowel margin

Figure 34.2. Blocking of total pelvic exenteration specimen for a pT4 cervical carcinoma.

- ureters.

- endometrium/myometrium.

- fallopian tubes and ovaries.

- colorectum.

• pelvic lymph node dissections will often be submitted separately and individually labelled and are described later.

Rectal Carcinoma

• blocks of tumour and tumour in relation to:

- posterior vaginal wall.

- dome of urinary bladder.

- prostate and seminal vesicles (in males).

- cirumferential margin of mesorectum.

- peritoneum.

• the mesorectal fat must be dissected to identify lymph nodes.

• representative sections of uninvolved tissues are also submitted.

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