Auto Text: “Insert Stomach Tumor”
Most gastrectomy specimens are actually partial gastrectomies, encompassing either the proximal or distal half of the organ. Proximal gastrectomies will include a portion of esophagus as the proximal margin, while distal gastrectomies will contain a portion of duodenum as the distal resection margin.
Most of these operations are performed for adenocarcinomas or GISTs, but occasionally a gastric ulcer will be resected if bleeding can not be controlled. Please keep in mind that gastric lymphomas can mimic either simple ulcers or adenocarcinoma, so frozen tumor tissue should be saved on every case, when possible.
- If the case is a prophylactic gastrectomy for CDH1 mutation, see “Stomach (prophylactic)” and consult an attending prior to grossing.
- Palpate for tumor. Ink the serosa over the lesion. Open the stomach longitudinally, along the greater curvature if possible, unless this would require cutting through the lesion.
- Make the following measurements:
- circumference of the proximal and distal resection margins
- maximal gastric circumference
- length of the stomach and attached esophagus and/or duodenum
- maximal tumor size in three dimensions
- distance from the edges of the tumor to the proximal, distal, and lesser curvature (radial) resection margins
- Photograph the specimen as a whole and photograph the tumor close-up.
- Pin the specimen on wax and submerge facedown in formalin overnight.
- 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 the margins: submit either a) circumferential margin (if small diameter), b) a representative en face section, or c) a representative perpendicular section. (see diagram)
- Serially section lesion and measure deepest extent of invasion, distance to inked serosa
- Photograph cut surface at deepest point of invasion
- Take sections of tumor to include the deepest invasion into gastric wall
- Take sections of additional lesions
- Measure gastric wall thickness
- Take representative sections of gastric (and duodenal/esophageal) mucosa
- Dissect all lymph nodes: paraesophageal, gastric, paraduodenal, omental nodes
Updated 2-20-19 NAC, 8-22-19 NAC