Auto Text: “Insert Esophagus Tumor”
- Palpate the specimen to find the location of the tumor – most often at the GE junction.
- Ink the adventitia over the tumor.
- Open the specimen longitudinally. Avoid cutting through the tumor if possible. It helps to use your finger to feel for tumor as you open the specimen.
- Make and record the following measurements:
- Length of the esophagus and stomach.
- Luminal circumference at the proximal margin, at the tumor site, at the GE junction, and at the distal margin.
- Wall thickness of esophagus and stomach.
- The maximal dimensions of the tumor.
- The distance of the tumor from the proximal resection margin and from the distal resection margin.
- The relationship of the tumor (or ulcer in treated cases) to the esophagogastric junction (EGJ) MUST be explicitly stated for staging purposes as follows:
- Tumor/ulcer is located entirely within the tubular esophagus without involvement of the EGJ
- Tumor/ulcer midpoint lies in the distal esophagus and tumor involves the EGJ
- Tumor/ulcer midpoint is located at the EGJ
- Tumor/ulcer midpoint is 2 cm or less into the proximal stomach and involves the EGJ
- Note: In some cases the patient will have received preoperative radiation and chemotherapy, and the tumor may not be grossly evident, or there may be only slight roughening or ulceration of the mucosal surface. Often the location of the previous biopsy can be used to guide the selection of the area to sample.
- Note: If the tumor is thought to be an adenocarcinoma, examine the specimen closely for Barrett’s mucosa, which will appear as salmon/pink, granular mucosa (similar to gastric mucosa) above the gastroesophageal junction, replacing the shiny white squamous mucosa.
- Measure the length of the Barrett’s mucosa from the gastroesophageal junction.
- Take photographs.
- Pin out the specimen on wax and submerge specimen-side down in a large container of formalin.
- Obtain the following sections:
- Nearest Margin: If the tumor is within 2.0 cm of the nearest margin: ink the margin a different color, remove the proximal 2 cm of margin (with lesion and margin), section perpendicularly to the margin, and submit entirely (or showing closest approach to margin). If there is remaining margin grossly >2.0 cm from lesion, a representative section can be submitted en face. (see diagram)
- Farthest Margin: If the tumor is > 2.0 cm from one or both margins: submit either a) circumferential margin (if small diameter), b) a representative en face section, or c) a representative perpendicular section. (see diagram)
- If the tumor is an adenocarcinoma arising in Barrett’s mucosa, then the entire segment of Barrett’s mucosa (including the tumor) should be submitted (blocked in).
- For squamous cell carcinomas and adenocarcinomas of the gastroesophageal junction, three sections of tumor, including the area of deepest penetration into the wall are sufficient.
- If the tumor is small or not apparent the entire area of “abnormal” mucosa (often a roughened contracted, superficial ulceration) should be embedded in order to document microscopic foci of residual tumor.
- Submit sections from additional lesions in the esophagus or stomach, or representative section of each if no other lesions are seen.
- Dissect and submit all lymph nodes: including paraesophageal nodes, gastroesophageal junction nodes, and gastric lymph nodes. If 12 convincing lymph nodes are not found, submit all paraesophageal/GE junctional fat and any suspicious perigastric fat.
Updated 2-8-2019 NAC