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4 Notes
- Appropriate personal protection and dissection equipment is
available in all accredited tissue pathology laboratories. The
macroscopic assessment forms part of the pathology report
and is generally transcribed from a dictation recorded during
the assessment and cut up. - Multiple specimens may be received in one or more containers
depending on the technique. Endoscopic submucosal dissection
technique often provides “en bloc” specimens while endoscopic
mucosal resections tend to be piecemeal. All mucosa specimens
should be pinned to a firm base by the responsible clinician to
maintain the specimen integrity during fixation. There may or
may not be orienting marks. If the specimen is received unpinned,
ensure it is pinned out before fixation. If the specimen is allowed
to fix without being pinned out, the tissue will distort and the
edges will roll up, hampering assessment. - Dictations should include matching the request form and spec-
imen label details according to local laboratory protocols.
Specimen photography is encouraged for record keeping and
correlation of macroscopic and microscopic features including
margin status in particular the specimens that are oriented. - If orientation has been provided, different colored inks should
be used on the side margins as appropriate. If there are multi-
ple pieces or if no orientation has been provided, the deep
margins should still be painted with ink. The ink is to indicate
to the pathologist that the entire depth is present on the slide
for microscopic assessment (Fig. 3 ). The depth of invasion in
early carcinomas (T1) is staged using either the American Joint
Committee on Cancer (AJCC) or Stolte systems, or both. The
deeper the invasion classified by either system is associated with
higher frequencies of lymph node metastasis and a major crite-
rion indicating the need for further treatment. The AJCC
described the following classification in the 7th edition for
early carcinomas (T1) as follows [ 2 – 4 ]:- M1 carcinoma limited to the epithelial layer (Tis).
- M2 carcinoma invades the lamina propria (T1a).
- M3 carcinoma invades into, but not through the muscu-
laris mucosae (T1a). - SM1 carcinoma penetrates the shallowest one-third of the
submucosa (T1b). - SM2 carcinoma penetrates into the intermediate one-
third of the submucosa (T1b). - SM3 carcinoma penetrates the deepest one-third of the
submucosa (T1b).
Benjamin M. Allanson and M. Priyanthi Kumarasinghe