Esophagectomy is mainly performed for malignancy near the E-G junction.
For most specimens, radial margin along with the proximal and distal resections margins must also be assessed.
Orient the specimen (proximal and distal, anterior and posterior).
Photograph any specimen with: tumor arising in an identifiable area of Barrett’s esophagus (finely granular and tan pink that may be patchy), tumor >5 cm in diameter, or invading a co-resected organ.
Measure the specimen:
Esophagus: length and circumference
Stomach: length of greater curvature, length of lesser curvature, circumference of distal margin
Ink the proximal and distal margins and any areas of the external surface which are suspicious for tumor involvement (radial margin).
Dissect the lymph node groups in the unfixed state by anatomic location: esophageal (proximal vs. distal to mass), cardiac, lesser curvature, greater curvature, pyloric. Measure the smallest and largest lymph nodes and describe the cut surfaces (color, consistency).
Palpate the specimen in order to determine the location of the mass and longitudinally open the specimen along the opposite surface. Try to open the stomach along the greater curvature unless the mass is located there (in which case, open along the lesser curvature). Apply ink along the external surface in the region of the tumor if not already done.
Tumor: measure (three dimensions) and approximate the percent of circumference involved, describe the tumor (color, configuration, ulceration, borders, location) and measure its distance from the proximal, distal, radial margins, and the esophago-gastric junction (EG junction). Determine whether there is luminal dilatation proximal to the tumor and if there is involvement of extraneous tissue.
Describe the non-neoplastic mucosa (color, texture, varices, folds, ulceration, plaque, hemorrhage, wall thickness) and the EG junction.
Pin the specimen to a board, mucosal side up, and submerge in formalin for a few hours or overnight.
Section the tumor and determine the extent of mural involvement.
Tumor: five to seven full-thickness (including fat) longitudinal sections. Include adjacent uninvolved mucosa proximal to and distal to tumor in some sections and area of greatest depth of invasion.
Proximal and distal resection margins: if the tumor is < 2.0 cm from the margin, take longitudinal sections that include both tumor and the closest inked margin. Otherwise, entirely submit the proximal margin en face and entirely (if esophageal or cardiac) or representatively (if fundic or antral) submit the distal margin en face Also obtain margins of extraneous tissue (pericardium) if it is attached to tumor.
Uninvolved esophageal mucosa: two to three sections (proximal to and distal to tumor if possible). Additional sections of lesions.
EG junction: two sections. If no gross tumor or if surgery performed for carcinoma in situ at EG junction, entirely submit the EG junction longitudinally.
Stomach: one to two sections taken perpendicular to the folds.
Lymph nodes: entirely submit according to anatomic groups.
Received without fixative/in formalin, labeled with the patient’s name, medical record number, and “ _____”, is a partial esophagectomy/esophagogastrectomy specimen including a segment of esophagus (__ cm in length x __ cm in circumference) and a portion of proximal stomach ( __ cm along the less curvature, __ cm along the greater curvature, __ cm circumference at the stapled/open distal resection margin). The outer surface of the esophagus is _____ (color, texture, with/without segmental dilation). The serosal surface of the stomach is _____ (color, texture, focally puckered over an area of __ cm over the _____ surface). The specimen is inked as follows: proximal margin _____, distal margin _____, puckered mucosal area _____. There is a fungating/ulcerated __ x __ cm mass, with borders __ cm above the adjacent mucosa surface at the EG junction/_____ curvature/anterior vs. posterior aspect. The mass does not appear to invade the wall/has a depth of invasion of __ cm and is transmural/is __ cm from the serosa. It is __ cm from the distal resection margin, __ cm from the proximal resection margin, and __ cm from the EG junction. The EG junction is regular/irregular. There is/is no perforation. The remaining mucosal surface of the stomach has _____ (color, texture) folds. __ (number) lymph nodes ranging from __ to __ cm in diameter are present in the periesophageal/perigastric soft tissue. The majority of the nodes have _____ (color, consistency) cut surfaces, but the largest node, which is located _____, has a _____ (color, consistency) cut surface. Photographs are taken. Representative____ (percent of tissue) submitted as follows: