grossing of esophagus
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SAKSHI
Grossing of Esophagus & Stomach
Normal Anatomy•begins at the level of cricoid cartilage •measures approx 25 cm in length and 2 cm in diameter (adult).•On ENDOSCOPY : from incisors – (16cm distal)•35-40 cm GEJ
Gross Examination and Tissue Handling
1. Endoscopic biopsies2. Endoscopic mucosal resection (EMR)- for
the treatment of Barrett's esophagus– associated high-grade dysplasia (HGD) and superficial carcinoma as determined by endoscopic ultrasound.
3. Esophagectomy or Esophagogastrectomy: - the specimen is opened longitudinally The esophagus and the attached portion of the stomach
are then measured for - length, - circumference, and - wall thicknessThe size and appearance – - polypoid, - fungating, - ulcerated, - or diffuse thickening with narrowing of the lumenIts relationship to the - GE junction and - distance from the proximal and distal margins
Esophagectomy
•Upper third – deep cervical nodes.● Middle third – superior and posterior mediastinal nodes.● Lower third – nodes along the left gastric blood vessels and the coeliac n
On gross Barrett's mucosa can be patchy and is recognized as salmon colored and finely granular, similar to gastric mucosa,
In contrast to the gray-white, smooth, and glistening squamous cell lining of the normal esophagus
The grossly identified lesion is then longitudinally cross-sectioned to examine the depth of invasion
Choice of surgical procedure in oesophageal neoplasia
Proximal 1/3 tumours - Pharyngo-oesophagectomy.Middle 1/3 tumours - Ivor Lewis technique
- Thoracoabdominal oesophagectomy- Two field transhiatal oesophagectomy
Lower 1/3 tumours - Ivor Lewis technique- Thoracoabdominal oesophagectomy- Transhiatal oesophagectomy
Barrett’s - Transhiatal oesophagectomy
Surgeries
5 cm longitudinal margin of clearance with adenocarcinoma
and 10 cm for squamous carcinoma. A) Ivor Lewis technique: upper abdominal and
right thoracotomy incisions.
The proximal stomach is divided and the oesophagus is transected proximal to the tumour.
Esophagogastric anastomosis is done in chest.
Thoracoabdominal oesophagectomy
continuous incision extending from the midline of the upper abdomen running obliquely across the rib margin and posterolateral aspect of the chest wall is made
potential enbloc resection of the oesophagus, stomach, gastric nodes and, if required, the spleen anddistal pancreas.
An oesophagojejunal or oesophagogastric anastomosis is fashioned in theneck.
Transhiatal oesophagectomy
‘Two-field approach’ – the entire oesophagus and stomach is mobilised via upper abdominal and oblique neck incisions.
The cervical oesophagus is divided and anastomosed to stomach, which had been mobilised and raised high into the posterior mediastinum.
Distal oesophagectomy with proximal gastrectomy
for distal oesophageal/junctional tumours. Only an upper abdominal incision is used,
with the distal oesophagus being mobilised and an oesophagogastric anastomosis
fashioned in the chest.
Stomach Grossing Specimen Handling
Biopsy:Fragments, non-orientated: Fragments, orientated:Polyp – Non-orientated fragments:snare specimens:Wedge biopsyNeedle core biopsy:
Resection Specimens
Before fixation assess the tumour – for location, margin clearance as it shrinks
Fixation: Adequate fixation of a cleaned, opened specimen requires 36–48 hours immersion in formalin
Margins: Longitudinal margins:
Cardia: mucin-secreting cells.Fundus/body: parietal cells (acid), chief cells
(pepsin) and scattered endocrine cells.Antrum/pylorus: endocrine (mostly gastrin G
cells) and mucin-secreting cells.
Lymphatics