Esophageal Adenocarcinoma Methods and Protocols

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Alfred K. Lam (ed.), Esophageal Adenocarcinoma: Methods and Protocols, Methods in Molecular Biology, vol. 1756,
https://doi.org/10.1007/978-1-4939-7734-5_7, © Springer Science+Business Media, LLC 2018

Chapter 7

Macroscopic Assessment and Cut Up of Endoscopic

Resection Specimens for Early Esophageal

Glandular Malignancies

Benjamin M. Allanson and M. Priyanthi Kumarasinghe

Abstract

Pathological assessment of tissue is the gold standard for diagnosis and staging of neoplasia and provides
key prognostic information for clinical management. Proper macroscopic assessment and cut-up technique
is essential to ensure that the overall assessment is correct and reproducible. Endoscopic mucosal resection
is a technique used for removing early neoplastic glandular lesions of the esophagus at the level of submu-
cosa. Here, we describe the macroscopic assessment and dissection techniques used for the routine han-
dling of endoscopic mucosal resection specimens in the clinical laboratory.

Key words Esophageal adenocarcinoma, Endoscopic mucosal resection, Macroscopic, Cut up, Early

stage cancer

1 Introduction

Pathological assessment of tissue is the gold standard for diagnosis

and staging of neoplasia and provides key prognostic information

for clinical management. Proper macroscopic assessment and cut-

up technique is essential to ensure that the overall diagnosis is cor-

rect and reproducible. Incorrect assessment or technique can lead

to loss of precious diagnostic material in small specimens and errors

in the microscopic interpretation.

Endoscopic resection is a technique used for removing mucosa

and superficial submucosa from the distal esophagus, gastresopha-

geal junction, and proximal stomach. It is performed after a diag-

nostic tissue biopsy has already been obtained and the intent is to

cure a proven neoplastic epithelial lesion. The tissue is assessed his-

topathologically to confirm the biopsy diagnosis and assess prog-

nostic features such as the depth of invasion, degree of

differentiation, presence or absence of lymphovascular invasion,

and margin status [ 1 , 2 ]. Ancillary studies such as histochemical

and immunohistochemical studies can be performed in optimally