Minimal Reporting Guidelines for the Treatment of
Cancer Patients
As laboratory physicians, our contribution to patient care
is knowledge: this is the starting point
from which all informed therapeutic intervention proceeds. How that knowledge is obtained and communicated is the art and science of our profession. These minimal diagnostic guidelines are
designed to be used as an aid, not a
constraint, in that process. The
guidelines are presented in a specific format out of necessity, but any format
that effectively communicates the necessary information in a given pathology report is valid. Furthermore, it is accepted that not all of
the information specified by these guidelines may be available at the time of
diagnosis. Specific examples may include
estrogen receptor or C-ERB B2 status of
breast tumours or adequate information for meaningful pathologic staging. A lack of this information should not prevent the timely
release of a final diagnosis in any case.
It is assumed that the pathologist
will provide all pertinent information that is available, either at the time of
initial diagnosis, or further along in
the course of the patient’s care.
Minimal Reporting Guidelines – Breast Carcinoma
Microscopic Diagnosis
(Right/Left) Breast, (core biopsy, wire local. biopsy,
lumpectomy, mastectomy specimen)
a) Invasive carcinoma, histologic type
b) Greatest linear tumour dimension (define
gross or microscopic measurement) of invasive
carcinoma, specify, if multifocal
c) Extent (% of total tumour volume) type and
grade, (low, intermed., high) of intraductal
component (w/wo comedonecrosis)
d) Histologic grade of invasive carcinoma
(Nottingham modification, Bloom and Richardson)
Nuclear
grade -
low = 1
- intermediate = 2
- high = 3
Mitotic
rate* -
<4/sq mm = 1 (low)
- 4-7/sq mm = 2 (intermediate)
- >7/sq mm = 3 (high)
Tubule
formation - >75% = high = 1
- 10-75% = intermediate = 2
- <10% = low = 3
Add points for
each feature to obtain total score
3-5 points =
well differentiated
6-7 points = moderately differentiated
8-9 points =
poorly differentiated
e) Venous or lymphatic space invasion
(identified/not identified); specify if multiple vessels
involved; (specify if dermal lymphatics are involved)
f) Surgical Margins (positive/negative,
indeterminate; site specific, focal or extensive, closest
approach of invasive/in-situ tumour to margins in mm)
g) Lymph node status (x of y lymph nodes
positive for metastatic carcinoma, size of largest
metastasis, with/wo extranodal tumour spread). Note 2002 changes to TNM staging for
microscopic lymph node metastasis.
h) Involvement of skin, nipple, or skeletal
muscle by invasive carcinoma (present/absent)
i) Index microcalcifications present (if seen in
specimen radiograph)
j) Status of background breast tissue (atypical
hyperplasia, benign mass forming lesions)
k) Status of estrogen receptors (all invasive
CAs)
Status of progesterone receptors (all ER negative tumours)
Status of Her 2-neu expression (all metastatic positive CAs)
Report should indicate tissue block suitable for immunohistochemical
prognostic markers.
Cut off for ER/PR is 5% of tumour cell nuclei staining. Her2-neu expression should be
reported as negative, equivocal (1+ to 2+), or positive
(3+). All equivocal Her2-neu
immunostaining should be referred for FISH analysis.
L ) pTNM tumour stage
Minimal Reporting Guidelines – Melanoma
Microscopic Diagnosis
Skin of (site), (biopsy/excision)
a) Positive for invasive malignant melanoma,
(histologic type)
b) Clark’s Level
II –
papillary dermis invasion
III –
fills papillary dermis, abuts retic. dermis
IV – into
reticular dermis
V –
into subcutis
c) Breslow Depth (mm, from granular layer)
d) Ulceration (present/absent)
e) Dermal Satellitosis (present/absent)
f) Mitotic figures/square mm
g) Vascular space invasion (present/absent)
h) Margins of excision (positive/negative,
closest approach in mm)
i) Lymph node status (if applicable)
Minimal Reporting Guidelines – Soft Tissue Sarcoma
Microscopic Diagnosis
Soft tissue of (site), (resection/biopsy)
a) Sarcoma type
b) Tumour size (3 dimensions)
c) Tumour grade (Trojani system)
Differentiation
score –
Close
resemblance to adult tissue 1
Tumour type
clearly recognized 2
Undifferentiated
sarcoma 3
Necrosis score –
None 0
<50% 1
>50% 2
Mitotic score –
0-9 per 10 hpf
1
10-19 per 10 hpf
2
20 or more per 10 hpf
3
Total score –
2,3 =
Grade 1
4,5 =
Grade 2
6,7,8 =
Grade 3
* NOTE:
Alveolar and embryonal rhabdomyosarcoma, neuroblastoma, Ewing’s sarcoma
and PNET are, by definition, high grade sarcomas.
d) Vascular space invasion (present/absent)
e) Surgical resection margin
i) positive/<2 cm from margin/>2 cm from
margin
ii) nearest margin location (sup/inf/med/lat,
ant/post)
iii) composition of nearest margin (muscle,
vessel, fascia, skin, etc.)
Minimal Reporting Guidelines – Laryngeal Carcinoma
Microscopic Diagnosis
Larynx, radical resection
a) Positive for invasive squamous cell carcinoma
(histologic subtype, if applicable)
b) Tumour site
c) Tumour size
d) Tumour grade (well, moderately, poorly
differentiated)
e) Direct
tumour extension (commissure, ventricle, false cords, subglottis)
f)
Depth of invasion
g) Vascular space invasion
h) Perineural invasion
i) In-situ component (present/absent)
j) Surgical margins and distance from margins
k) Lymph node status (Site specific: submandibular; upper jugular; mid jugular;
lower jugular;
posterior cervical; juxtathyroid; paratracheal. Size of largest metastasis and extranodal
tumour spread should be mentioned.)
l) pTNM tumour stage
Minimal Reporting
Guidelines – Thyroid Carcinoma
Microscopic Diagnosis
Thyroid, (right/left lobe or total) resection
a) Positive for
(papillary/follicular/medullary/other) carcinoma
b) Tumour location (or locations if
multicentric)
c) Greatest linear tumour dimension
d) Encapsulation (complete/incomplete/absent);
w/wo invasion
e) Extrathyroidal extension (present/absent,
include measurement)
f) Vascular space invasion
g) Surgical margins (if positive, include
measurement)
h) Lymph node status (ipsilateral, midline,
bilateral, mediastinal)
i) Status of non-neoplastic thyroid
(thyroiditis, nodular hyperplasia)
j) pTNM tumour stage
Minimal Reporting Guidelines – Lung Carcinoma
Microscopic Diagnosis
Lung, (lobectomy, pneumonectomy, side)
a) Histologic tumour type (small cell/non small
cell/other)
b) Greatest single tumour dimension
c) Location –
<2 cm from bronchial resection margin
>2 cm from
bronchial resection margin
d) Bronchial margin pos/neg
e) Pleural involvement (into visceral pleura,
through pleura, extension into chest wall)
f) Lymphangitic spread (present/absent)
g) Direct venous invasion
h) Lymph node involvement (Subdivide ipsilateral
peribronchial/hilar nodes from
extrapulmonary mediastinal/subcarinal nodes. Direct extension counts as lymph node
involvement.)
i) Lung parenchyma away from tumour
j) pTNM tumour stage
Minimal Reporting Guidelines – Upper Gastrointestinal and
Ileocolic
Microscopic Diagnosis
Esophagus/Stomach/Duodenum/Small Bowel/Colon Resection
a) Positive for (well, moderately, poorly)
differentiated carcinoma (specify type)
b) Longitudinal tumour dimension; polypoid,
semicircumferential, circumferential lesion
c) Depth of invasion (submucosa, muscularis
propria, perivisceral adipose tissue, peritonealized
serosa, extension into adjacent organs) measure the depth of
extension beyond the muscularis
propria in mm.
d) Surgical margins (proximal, distal, radial;
distance to radial margins in mm.)
Direct tumour
extension within 1 mm or a positive lymph node at the radial
resection margin is considered a
positive margin.
e) Venous space invasion (present/absent)
f) Lymph node status *(x of y lymph nodes
positive for metastatic carcinoma). Any
mesenteric
tumour deposit with a rounded contour counts as a replaced
lymph node. Stellate deposits are
defined as angiolymphatic tumour spread.
g) Perforation (present/absent)
h) Status of non-carcinomatous mucosa (Barrett’s
mucosa, gastritis, multifocal dysplasia).
i) pTNM tumour stage.
* A minimum of 12 lymph nodes are required to accurately
predict pNO stage.
Minimal Reporting Guidelines – Rectum
Microscopic Diagnosis
Rectum, resection
a) Positive for (well, moderately, poorly)
differentiated adenocarcinoma (if specific subtype,
define).
b) Tumour site (anterior, posterior, left,
right; above or below peritoneal reflection).
c) Longitudinal tumour dimension and fraction of
rectal circumference involved by tumour.
d) Depth of invasion (submucosa, muscularis
propria, perirectal adipose tissue, peritonealized
serosa, adjacent structures). Measure distance of tumour extension beyond
muscularis
propria in mm.
e) Surgical margins (proximal, distal,
radial). Measure closest approach of
tumour to radial
margin in mm. (Direct tumour extension within 1 mm or a
positive lymph node at the radial
margins are defined as a positive margin).
f) Completeness of mesorectal excision specimen
(essentially complete with minimal
defects/incomplete with exposure of rectal muscularis
propria).
g) Venous space invasion (present/absent).
h) Lymph node status *(x of y lymph nodes
positive for metastatic carcinoma). Any
mesenteric
tumour deposit with a rounded contour counts as a replaced
lymph node. Stellate deposits are
defined as angiolymphatic tumour spread.
i) Perforation (present/absent).
j) Status of noncarcinomatous mucosa (adenomas,
CIBD, multifocal dysplasia).
k) pTNM tumour stage.
* A minimum of 12 lymph nodes are required to accurately
predict pNO stage.
Minimal Reporting Guidelines – Pancreatic/Biliary Carcinoma
Microscopic Diagnosis
Pancreas/common bile duct, total/subtotal resection
a) Positive for carcinoma of (tumour site: common bile duct, ampulla, pancreatic head,
etc.)
b) Tumour size (significant discrepancies
between gross and microscopic estimates are
common. Unless
microscopic growth is confluent, the gross estimate is preferred.)
c) Tumour subtype (solid, cystic, papillary,
tubular, signet -ring cell, acinic cell, neuroendocrine)
d) Tumour grade (well, moderately, poorly
differentiated)
e) In situ component (present/absent)
f) Vascular space invasion (present/absent)
g) Perineural invasion (present/absent)
h) Direct tumour extension (ie., duodenum, bile
ducts, peripancreatic tissue, stomach, spleen,
bowel, large vascular channel)
i) Surgical margins: radial, ductal (if subtotal pancreatectomy or
CBD resection)
j) Lymph node status: separate regional (peripancreatic, hepatic
artery, peripyloric, celiac,
mesenteric, periaortic) lymph nodes from distant metastases
k) Status of non-neoplastic pancreas/bile ducts
(pancreatitis, gallstones, sclerosing cholangitis)
l) pTNM tumour stage
Minimal Reporting Guidelines – Cervical Carcinoma
Microscopic Diagnosis
Cervix, cone excision or Uterus, resection
a) Cervical tumour cell type
b) Grade of invasive carcinoma
c) In situ component (present/absent)
d) Depth and breadth of invasive component
e) Vascular space invasion (present/absent)
f) Extension beyond cervix (parametrium, pelvic
wall, vagina, bladder)
g) Resection margins (ectocervical,
endocervical, deep; with closest approach in mm; define if
mucosal margin is positive for in situ or invasive disease)
h) Lymph node status
i) FIGO tumour stage
Minimal Reporting Guidelines – Vulva (non-melanoma)
Microscopic Diagnosis
Vulva, (simple/radical) resection
a) Vulvar tumour cell type
b) Tumour grade (well, moderately, poorly
differentiated)
c) Depth of invasion and overall tumour size
d) Vascular space invasion (present/absent)
e) In-situ component (present/absent)
f) Extension to extra-vulvar sites (mention if
present)
g) Surgical margins (peripheral, deep, vaginal;
define if positive for in situ or invasive disease).
h) Lymph node status
i) Status of non-neoplastic mucosa (condyloma)
j) FIGO tumour stage
Minimal Reporting Guidelines – Endometrial Carcinoma
Microscopic Diagnosis
Uterus (tubes, ovaries), resection (curettings)
a) Positive for (endometrioid, papillary serous,
clear cell, etc.) adenocarcinoma
b) FIGO tumour grade –
1 - 5%
or less solid growth
2
- 6-50% solid growth
3 -
more than 50% solid growth
(Morular growth
excluded. High grade nuclei raises
tumour grade by 1. Serous and clear
cell carcinomas are almost always grade 3.)
c) Myometrial invasion (none, inner ½ of
myometrium, outer ½ of myometrium). (If
possible,
measure maximum depth of invasion and thickness of
uninvolved myometrium at this site.)
d) Vascular space invasion
e) Cervical involvement (absent, noninvasive,
invasive)
f) Extrauterine spread (bladder, bowel)
g) Status of non-carcinomatous endometrium
h) Lymph node status (if submitted)
i) FIGO tumour stage
Minimal Reporting Guidelines – Ovarian Carcinoma
Microscopic Diagnosis
(Right/left/bilateral/TAHBSO) Ovary, resection
a) Positive for (endometrioid, serous, mucinous)
adenocarcinoma.
(Borderline
tumours are reported using the same guidelines.)
b) Tumour Grade (Invasive carcinoma only, Silverberg)
Nuclear score - 1,
2, 3
Mitotic score -
<10 per 10 hpf = 1
10-24 per 10 hpf = 2
25 or
more per 10 hpf = 3
Architecture
score -
glandular = 1
papillary = 2
solid = 3
Total score: 3-5
= Grade 1
6-7 =
Grade 2
8-9 =
Grade 3
c) Ovarian surface involvement (present/absent)
d) Tumour capsule intact/ruptured
e) Tumour involvement unilateral/bilateral
f) Extraovarian spread (define sites of
implants, invasive or non-invasive; size of implants
g) Status of peritoneal washings (if known)
h) Lymph node status (if submitted)
i) FIGO tumour stage
Minimal Reporting Guidelines – Penis for Squamous Carcinoma
Microscopic Diagnosis
Penis, resection
a) Positive for invasive squamous cell carcinoma
b) Tumour site (urethra, foreskin, glans, shaft)
c) Tumour grade (well, moderately, poorly
differentiated, or verrucous)
d) Tumour extension: subepithelial connective tissue, tunica
albuginea, corpus spongiosum,
corpus cavernosum, urethra
e) Vascular space invasion (present/absent)
f) In situ component (present/absent/extent,
multifocal)
g) Surgical margins: urethra, corpora, skin; define if positive
for in situ or invasive disease
h) Lymph node status
i) Status of non-neoplastic epithelium
(condyloma, inflammatory process)
j) pTNM tumour stage
Minimal Reporting Guidelines – Testis for Germ Cell Tumour
Microscopic Diagnosis
(Right/Left) Testis, radical orchidectomy
a) Positive for (germ cell tumour type)
b) Tumour size
c) Tumour extension (limited to seminiferous
tissues, extension into rete testis/tunica
albuginea/epididymis or spermatic cord)
d) Vascular space invasion (present/absent,
non-seminomatous GCT only)
e) Estimated percent of different germ cell
components (mixed GCT only)
f) Surgical margins (peritesticular, adnexal
structures, spermatic cord)
g) Status of lymph nodes (if submitted)
h) Status of non-neoplastic testis:
spermatogenesis, intratubular germ cell neoplasm
i) pTNM tumour stage
Minimal Reporting Guidelines – Radical Prostatectomy for
Prostatic Carcinoma
Microscopic Diagnosis
Prostate, radical resection
a) Positive for prostatic adenocarcinoma
b) Gleason primary and secondary grades and
total score (omit if treatment effect evident)
c) Sites involved (peripheral/transitional zone;
single or both lobes; apex, mid or bladder base)
d) Greatest single tumour dimension
e) Estimated percent of gland involvement
f) Tumour extension: limited to gland, periprostatic fat, seminal
vesicles
g) Vascular space invasion
h) Surgical margins: peripheral, apex, bladder neck (define: mm, involvement, type of tissue
involved – capsule/soft tissue)
i) Lymph node status (x of y positive, site
specific)
j) Status of non-malignant prostate (PIN)
k) Status of prostatic urothelium (if abnormal)
l) pTNM tumour stage
Minimal Reporting Guidelines – Prostate Needle Biopsies
Microscopic Diagnosis
Prostate, needle biopsy (or biopsies xN)
a) Positive for prostatic adenocarcinoma
b) Gleason primary and secondary grade and score
c) Number of and location of cores involved (if
multiple at one site)
d) Greatest single linear tumour dimension
(confluent growth)
e) Vascular space invasion (present/not
identified)
f) Extraprostatic fat involvement (present/not
identified)
g) High Grade PIN (report if present only)
* NOTE: Use these
same criteria for reporting TUPR specimens.
Substitute number of chips involved
(eg., 4 of 20 chips positive) for linear tumour
dimension. Report prostatic urothelium
and
seminal vesicle status, if present.
Gleason Grading (omit if treatment effect evident)
1) Single, separate uniform glands closely
packed, with definite edge.
2) Single, separate uniform glands loosely
packed, with irregular edge.
3) Single, separate, scattered glands (very
small or uniform) or smoothly circumscribed
papillary/cribriform masses.
4) Fused glands with ragged infiltration, with
or without large pale cells (hypernephroid).
5) Solid masses with any necrosis
(comedocarcinoma) or anaplastic raggedly infiltrating.
Gleason Score
Predominant pattern
plus the worst of any additional patterns.
If only one pattern
is seen, the grade is doubled to arrive at score.
Minimal Reporting Guidelines – Bladder Carcinoma
Microscopic Diagnosis
Urinary Bladder (transurethral resection/radical cystectomy
or cystoprostatectomy)
a) Positive for urothelial carcinoma (subtype,
invasive/noninvasive)
b) Tumour site(s) (single or multifocal)
c) Tumour size
d) Tumour depth of invasion (lamina propria,
submucosa, inner or outer half of muscularis
propria, extravesicle)*
e) Involvement of ureters, urethra, prostate or
seminal vesicles
f) Vascular space invasion (present/absent)
g) Histologic grade of invasive component
(1,2,3)
h) High grade flat carcinoma in situ
(present/absent)
i) Surgical margins
i) ureters
ii) urethra
iii) perivesical
iv)
periprostatic
j) Lymph node status (if submitted)
k) Prostate Gland (as per prostatectomy
guidelines)
l) pTNM tumour stage
* NOTE: Report should delineate, where possible,
invasion into bladder lamina propria versus
submucosa.
Minimal Reporting Guidelines – Renal Carcinoma
Microscopic Diagnosis
(Right/Left) Kidney, (segmental, simple, radical) resection
a) Positive for renal cell carcinoma, histologic subtype
b) Tumour site(s) (pole, mid region, capsule,
multiple)
c) Tumour size
d) Nuclear grade (Fuhrman)
Grade 1: round nuclei: nucleoli visible only at x 400
magnification
Grade 2: slightly irregular nuclei; nucleoli visible
at x 200 magnification
Grade 3: irregular nuclei; nucleoli visible at x 100
magnification
Grade 4: enlarged pleomorphic nuclei or giant cells
e) Tumour
extension (capsular perforation, renal pelvis, adrenal, renal vein, IVC)
f)
Surgical margins (perinephric, hilar vascular, ureteric)
g) Lymph node status (if submitted)
h) Status of non-malignant renal tissue
i) pTNM tumour stage
GROSS AND MICROSCOPIC NOTES ON PATHOLOGY REPORTING OF EXCISIONAL BREAST BIOPSIES OR MASTECTOMY SPECIMENS
REPORT
a) Specimen
· 3 dimensional size
and nature of specimen perimeter (ie.,specify if fragmented)
b) Invasive carcinoma
i) Size in mm
· re-evaluate maximum
exact size of apparent T1 or T2 invasive carcinoma (exclude
size of DCIS if it is major part of tumour nodule)
microscopically
· note critical
invasive carcinoma size threshold for node negative cases: <20 mm
versus > 21 mm for chemo, Grade III duct < 10 versus
> 10 mm for chemo, and
potentially at 5 and 10 mm thresholds for necessity of node
dissection
ii) Type
· duct, lobular,
mixed, and other variants
iii) Grade
· I-III/III
Nottingham modification of Bloom and Richardson scoring system
· architecture –
tubule; nuclear grade; mitosis
· record overall
average for tubula r differentiation, but highest (even focal) nuclear
grade and mitotic rate; ie., consider grade heterogeneity
iv) Single or multifocal
· specify details for
each focus
v) Margin status
· exact distance in
mm (eg., touching inked margin, <1 mm, 1 – 2 mm, 2 – 5 mm, >5
mm or indeterminate)
· amount of invasive
carcinoma at margin (eg., transected, focal microscopic,
number of mm and sections with close/positive margins)
· exact location of
all positive and close (<5 mm) margins composition of margin,
eg., breast parenchyma, fascia, skeletal muscle, skin, etc.
vi) Peritumoral lymphatic and vascular invasion
· record only if
definite lymphatic invasion, as may lead to chemotherapy for node
negative T1 carcinoma.
· comment if
lymphatic invasion is extensive (multiple vessels involved)
· perineural invasion
is of lesser importance unless a large nerve is involved near the
margin
· true peritumoral
venous invasion is rare
vii) Skin or skeletal muscle involvement
viii) ER, PR & HER2 (see latter)
c) Ductal Carcinoma In-Situ
· size, grade and
distance to closest margins (0 – 10 mm) are important treatment
parameters for cases with DCIS only (re: Van Nuys Prognostic System)
i) Size
· 15, 25, 40 and 50
mm size thresholds for DCIS potentially clinically important.
· often DCIS size can
only be evaluated by summing up thickness of sequentially
submitted blocks
ii) Nuclear Grade (I – III) +/- necrosis
iii) Type
· cribriform, solid,
micropapillary, other
d) ADH, ALH and LCIS
· Comment about
extent
· Relationship to
margin generally not pertinent
· Differentiate solid
DCIS from LCIS at margins
e) Lymph Nodes
i) Number
· exact number
obtained and number positive
ii) Size of positive nodes
· maximal size of
largest metastatic carcinoma deposit (not just size of enlarged
node)
iii) Extranodal
soft tissue extension (comment if focal or extensive)
iv) Perinodal lymphatic or venous invasion
RECOMMENDATIONS FOR OPTIMAL HANDLING
OF COLORECTAL CARCINOMA SPECIMENS
GROSS SPECIMEN HANDLING
1) For rectal
resection specimens, identify the peritoneal reflection for orientation. This well be
located at the anterior superior aspect of the rectum. Ink all nonperitonealized radial rectal
margins.
For colonic specimens, locate the mesenteric resection
margin, where the surgeon’s knife has cut
through the mesentery to remove it from the abdomen, and ink
this nonperitonealized surface.
2) Open and rinse the
bowel (starting at the proximal end for rectal specimens, and from both ends
for
colonic specimens) but stop when the scissors reach the
tumour. Do not longitudinally transect
the
tumour. Leave the
tumour intact and fix the partially opened specimen for 48 hours.
3) After fixation,
slice the bowel through the area of the tumour involvement in radial sections
(like a
sausage) at 5 mm intervals.
4) Examination of
these slices should allow measurement of the circumference of the bowel
involved
by tumour, gross assessment of the radial margin, and
identification of the minimum 12 pericolic or
perirectal lymph nodes.
HINT: Reportedly, most of the lymph nodes will be
found at the outer edge of the specimen.
5) Lymph nodes should
be submitted for histology in their entirety (bisect them if they are big, but
try
to be accurate on the count.
The radial resection margin of a total mesorectal excision should be
sampled in three tissue blocks (one should suffice for the
mesenteric root of a colonic specimen) at
the site of closest approach by tumour. Proximal and distal resection margins only
require
sampling if closer than 3 cm to the tumour, in the fixed
state.
NOTES ON MICROSCOPIC REPORTING
1) Radial resection
margins and depth of invasion are separate criteria with different clinical
implications.
Extension of a cecal carcinoma to the mesenteric resection margin
without extension
to the peritonealized serosal surface is a T3 lesion with
residual disease. Involvement of the serosa
is T4 disease but is considered completely excised.
2) Tumour at the
serosal surface with an inflammatory response is the same as tumour on the
serosal
surface
(identical clinical implications).
3) If we can’t find
12 lymph nodes, we are obliged to go back to the bottle and look for more. This
recommendation is based upon validated studies indicating
that a minimum of 12 lymph nodes is
required in order to accurately stage a patient as n0. If less than 12 nodes are examined, and the
pathologist diagnoses the case as negative for node
metastasis, there is a significant
chance that
the pathologist is wrong.
However, if the surgeon has not
provided an adequate mesenteric pedicle,
we will not find many nodes.
It is advisable to provide a 1 dimension assessment of the width of
the mesentery, along with the length of the specimen, in the
gross description. This measuresment
is likely to prevent arguments about who’s dissection (the
pathologist’s or the surgeon’s) was
inadequate. Reporting
on more than 15 lymph nodes provides no additional information.
