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United States Government Work, uncopyrighted, public-domain,
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PRINCIPLE OF THE TEST.
A gastrectomy is performed for known or suspected cancer, or other
clinical indication, and received in surgical pathology for evaluation.
The specimen should be oriented, evaluated grossly, surgical margins inked,
and any gross abnormalities described thoroughly. The final report
should reflect an adequate sampling of tissue, and should include
the size and TNM stage of any tumor.
SPECIMEN REQUIRED.
Tissue Specimen and filled-out
Tissue Examination Form (USSF515).
REAGENTS, INSTRUMENTATION.
1. Dissection Instruments.
STEP-BY-STEP DESCRIPTION.
1. Orient the specimen using greater curvature (inferior),
lesser curvature (superior), and pyloric ring (distal).
2. Attempt to appreciate the four anatomic regions
of the stomach: cardia; fundus; body; antrum.
3. Ink the proximal and distal surgical resection margins.
4. Remove the omentum from the greater and lesser curvatures,
for subsequent lymph node dissection.
5. Open the specimen along the greater curvature.
Attempt not to cut across the tumor.
6. Describe shape, size, location (cardia, fundus, body, antrum),
depth (mucosal, muscular wall, serosa, perforation) of any ulcers
or tumors, including distance from proximal and distal surgical margins.
7. For peptic ulcers, block out the entire lesion for sectioning.
8. For tumors, submit sections from the center and periphery,
including adjacent unremarkable stomach tissue.
9. Sample each region (cardia, fundus, body, antrum)
of unremarkable stomach.
10. Submit all candidate lymph nodes.
FIGURE 169.001.0. Gastrectomy specimen.
TNM STAGING.
TUMOR STAGING:
T1 ... Lamina propria or submucosal invasion.
T2 ... Muscularis propria or subserosal invasion.
T3 ... Penetration of serosa.
T4 ... Adjacent structures.
NODAL STAGING:
N0 ... None.
N1 ... Perigastric nodes within 3 cm of primary involved.
N2 ... Perigastric nodes >3 cm from primary; other local lymph nodes.
METASTASIS STAGING:
M0 ... No metastases.
M1 ... Distant metastases.
REFERENCES.
1. Rosai J.
Rosai and Ackerman's Surgical Pathology. Ninth Edition.
St Louis: C.V. Mosby. 2004;:.
ISBN: 0323013422, 3080 pages.
2. Mills SE, Carter D, Greenson JK, Oberman HA,
Reuter VE, Stoler MH, eds.
Sternberg's Diagnostic Surgical Pathology. Fourth Edition.
New York: Lippincott Williams & Wilkins. 2004;:.
ISBN: 0781740517, 3089 pages.
3. Westra WH, Hruban RH, Phelps TH, Isacson C.
Surgical Pathology Dissection. An Illustrated Guide.
Second Edition. With a Forward by Askin FB.
New York: Springer. 2002.
ISBN 0-387-95559-3, 258 pages.
4. Lester SC.
Manual of Surgical Pathology.
New York: Churchill Livingstone.
A Harcourt Health Sciences Company. 2001;:.
ISBN 0-443-07918-8, 336 pages.
5. Sinard JH.
Outlines in Pathology.
Philadelphia: W.B.Saunders Company.
A Harcourt Health Sciences Company. 1996.
ISBN 0-7216-6341-9, 229 pages.
6. American Joint Committee on Cancer.
AJCC Cancer Staging Manual. Sixth Edition.
New York: Springer. 2002.
ISBN 0-387-95271-3, 421 pages.