Orient the specimen (proximal and distal, anterior and posterior).
Measure the specimen: stomach – length of greater curvature, length of lesser curvature, circumference of proximal margin, circumference of distal margin; omentum – three dimensions; length and diameter of esophagus and duodenum; weight and three dimensions of spleen.
Ink the proximal and distal margins and any areas of the external surface which are suspicious for tumor involvement.
Palpate the specimen in order to determine the location of the mass or ulcer and longitudinally open the specimen along the opposite surface. Try to open the stomach along the greater curvature unless the lesion is located there (in which case, open along the lesser curvature). Apply ink along the external surface in the region of the lesion if not already done. If duodenum is attached, open it via a continuation of the stomach incision.
Dissect all lymph node groups in the unfixed state by anatomic location: cardiac, lesser curvature, greater curvature, pyloric, splenic hilar, omental. Describe any gross involvement of lymph nodes by tumor.
Measure (three dimensions) and describe the lesion (color, configuration, ulceration, borders, location) and measure its distance from the proximal and distal margins and the esophago-gastric junction (EG junction), if present.
Tumor: six transmural sections. Include adjacent uninvolved mucosa and greatest depth of invasion in some sections.
Ulcer: four to six transmural sections. Include adjacent uninvolved mucosa in some sections.
Uninvolved gastric wall: two sections from different areas, taken perpendicular to the folds. Additional sections of lesions.
Proximal and distal resection margins: if the tumor/ulcer is < 2.0 cm from the margin, take longitudinal sections that include both tumor/ulcer and the closest inked margin. Otherwise, a) for tumor, submit the margins en face, either representatively or entirely depending on distance from tumor and nature of tumor (consult with the attending pathologist if unsure), b) for ulcer, submit the margins en face representatively.
Omentum and other organs: one to three sections, depending on tumor involvement and extent of organ resection.
Lymph nodes: entirely submit, according to anatomic groups, in tumor cases. For ulcer cases, there is less of a requirement for a comprehensive lymph node dissection, but any identified lymph nodes should be entirely submitted.
Received without fixative/in formalin, labeled _____ and "_____," is a __ partial / total gastrectoduodenectomy specimen consisting of a portion of stomach with attached perigastric adipose tissue, and a segment of duodenum. The stomach measures __ cm along the greater curvature, __ cm along the lesser curvature, and __ cm in circumference at the proximal margin. The duodenum has a length of __ cm and a circumference of __ cm at the distal margin. Attached perigastric adipose tissue measures __ x __ x __ cm.
The serosal surface of the stomach is _____ (e.g. smooth, shiny) / shows a ___ x ___ cm focal induration / puckering / hemorrhage in ___ wall / curvature. The stomach is opened along the greater / lesser curvature to reveal a ___ x ___ cm _____ (color, firm, exophytic, ulcerated, plaque-like, well-/poorly-circumscribed) _____ (mass, ulcer) with _____ (raised, flat) borders involving the _____ wall/curvature. It is __ cm from the proximal (gastric) margin and __ cm from the distal (duodenal) margin. It (does not) involve the duodenum and (does not) extends into _____ (e.g. submucosa, subserosa) / through the gastric wall into the surrounding soft tissue/appears predominantly intramural. The uninvolved gastric and duodenal mucosa is tan with normal-appearing folds/have focal pinpoint hemorrhage. The gastric wall away from the tumor has an average thickness of __ cm. The attached adipose tissue contains multiple lymph nodes, ranging from __ to __ cm in greatest diameter. Most of these are _____ (color, consistency), but one, located in the _____ region, is _____ (color, consistency) and measures __ x __ x __ cm. The external surface of the stomach adjacent to the mucosal mass / ulcer is inked _____. Representative sections are submitted as follows:
#__ - #__ = mass / ulcer (2 sections with uninvolved mucosa, 2 sections with closest margin), __ pieces in each cassette.
#__ - #__ = entire proximal margin, __ pieces in each cassette.
#__ - #__ = distal margin, __ pieces in each cassette.
#__ & #__ = uninvolved stomach, __ pieces in each cassette.