Gross Examination of the Gastrectomy Specimen

A careful and systematic approach to examination of

gross specimen is essential for accurate interpretation
of the microscopic features.

Indications:

1. Mostly performed for advanced gastric carcinoma.

(To confirm that the tumour is completely removed & to
describe pathological indicators of prognosis.)

2. Rarely for:

i) Gastric lymphoma

ii) Carcinoid tumour

iii) Gastric Stromal Tumour

iv) Peptic ulcer

v) Zollinger Ellison syndrome

vi) Gastric antral vascular ectasia (GAVE)

vii) Bleeding vascular malformation

viii) Perforated stomal ulcer

Handling of specimen:

- Specimen ideally received fresh after resection.

- Paint the margins before opening the specimen.

- Stomach opened along greater curvature.

(Opened along lesser curvature in case of focal lesion
on greater curvature.)

- Opened stomach pinned on corkboard.

(Stomach kept under tension to avoid shrinkage
artifact).
- Corkboard floated on a bath containing 10% formalin
for 24-48 hrs.

Note: A diagram is useful to record the site of lesion

and blocks, specially in case of more than one lesion.

Blocks:- (see diagram below)

The following gross features must be recorded in the

report:

1) Type of specimen: Total or partial gastrectomy

specimen or esophagogastrectomy specimen.
Mention whether spleen or pancreas is included.

2) Length of greater curvature.

3) Length of lesser curvature.

4) Length of esophagus and duodenum (if included).

5) Lesion:

Site: (pylorus, antrum, body, O-G junction, lesser curve,

greater curve, anterior wall or posterior wall)
Dimensions: (length, width and thickness)

Distance from resection margins:

Gross subtypes:

1) Polypoid Carcinoma

2) Excavated Ulcerating Carcinoma

3) Diffusely Infiltrative Gastric Carcinoma

Gross types of early gastric carcinoma

Gross features of gastric stromal tumour

Gross features in case of gastric dysplasia

6. Describe rest of the mucosa:

Erosions : Acute gastritis

Gastric ulcers

Hemorrhagic folds (GAVE) ; Thickened rugal folds in

Menetrier's disease. Mucosal atrophy- Autoimmune
gastritis

7. Macroscopically enlarged lymphnode: Described -

Site and dimension recorded.

Lymphnode examination in gastrectomy specimen:

D= Stands for level of dissection of lymph node.

D1= Wide gastric resection including local lymph

nodes.

D2 = Extensive gastric resection including extra level of

lymphnodes (coeliac axis & its branches).

Lymphnode invasion is an important determinant of

prognosis.

The pathologist must report the total number of

lymphnodes retrieved and the number of lymphnodes
showing metastatic tumour.

Procedure: Lymphnodes are isolated from fat along the

curvatures. These should be sliced at 3-5mm intervals.
Surgeon may sent fat and lymphnodes in separate pots.
These pots should be carefully labelled according to site
of origin and pathologist should report the specimens
separately.

Note: Lymphnode is cut through its greatest dimension

and one half submitted for processing.

[N0= 0 involved, N1=1-6 involved, N2= 7-15 involved

N3= >15 involved.]

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