Gastrointestinal Specimens: General Comments

  • Derek C. Allen
  • R. Iain Cameron
  • Maurice B. Loughrey


The type of histopathology resection specimen received is dictated by the nature of any previous operations and the current disease process, its distribution, and degree of local spread within the organ and to adjacent structures. Resection surgery must provide adequate clearance of longitudinal and deep circumferential radial margins. It must also take into account the lymphovascular supply to achieve satisfactory anastomoses and the regional lymph node drainage for an adequate radical cancer operation. Site location within any given organ may influence the nature of the pathological abnormality and surgical procedure undertaken, e.g., anterior resection for high rectal cancer versus abdominoperineal resection for low rectal cancer, or mid-esophagus (squamous carcinoma) versus distal esophagus (adenocarcinoma). Multifocal distribution may be seen in both inflammatory (Crohn’s disease) and neoplastic (malignant lymphoma) disorders. Inflammatory disease can be mucosa confined (ulcerative colitis), transmural (Crohn’s disease), or mixed (ischemic colitis). Tumor growth may be predominantly polypoid and intraluminal, with only a minor mural component and variable presentation depending on the organ involved, e.g., symptomatic dysphagia due to esophageal polypoid carcinoma or asymptomatic iron-deficiency anemia with a cecal carcinoma. Often cancer ulcerates and deeply invades the wall, stenosing and obstructing the proximal bowel with early access to mesenteric nodes, lymphovascular channels, and peritoneum, and potential perforation. Alternatively the tumor may be characterized by an intact mucosa and incipient thickening of the wall with a tendency for longitudinal spread and skip lesions (diffuse gastric carcinoma – linitis plastica). Thus, normal anatomy is variably distorted by differing disease processes, and this must be considered in handling the specimen to obtain appropriate management and prognostic data, e.g., depth of local tumor spread, peritoneal and regional lymph node involvement, and excision margin clearance. Allowance must also be made for variation in normal anatomy between and within individuals. For example, harvest of lymph nodes from the mesorectum is scanty compared to the sigmoid mesocolon, and in some patients few mesorectal nodes will be found. This is also made more difficult by preoperative radiotherapy, emphasizing the importance of taking into account the previous treatment history and request form information. The surgical histopathology specimen also acts as an audit tool for surgical practice and expertise, e.g., rates of anterior resection versus abdominoperineal resection or completeness of mesorectal excision in rectal cancers. Similarly it allows close correlation with preoperative clinical and radiological (e.g., MRI) assessment, and is a gauge of thoroughness of pathological examination. Thus, preoperative and operative techniques alter the specimen anatomy, resulting in differing management and prognostic implications for an equivalent degree of tumor spread in similar specimens from different patients.


Ischemic Colitis Linitis Plastica Tuberculous Peritonitis Mesorectal Node Sigmoid Mesocolon 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Allen DC. The W5, how and what next of BMS specimen dissection. Curr Diagn Pathol. 2004;10:429–34.CrossRefGoogle Scholar
  2. Allen DC. Histopathology reporting. Guidelines for surgical cancer. 2nd ed. London: Springer; 2006.Google Scholar
  3. Allen DC, Cameron RI. Histopathology specimens: clinical, pathological and laboratory aspects. 1st ed. Berlin/Heidelberg: Springer; 2004.Google Scholar
  4. American Registry of Pathology. AFIP atlas of tumor pathology, Series I-IV. Accessed on Dec 2011.
  5. College of American Pathologists. Cancer protocols and checklists. Accessed at
  6. Domizio P, Lowe D. Reporting histopathology sections. London: Chapman and Hall; 1997.Google Scholar
  7. Fletcher CDM, editor. Diagnostic histopathology of tumours. 3rd ed. Philadelphia: Churchill Livingstone; 2007.Google Scholar
  8. Lester SC. Manual of surgical pathology. 3rd ed. New York: Elsevier/Saunders; 2010.Google Scholar
  9. McKee PH, Chinyama CN, Whimster WF, Bogomoletz WV, Delides GS, de Wolf CJM, editors. Comprehensive tumour technology handbook. UICC. New York: Wiley-Liss; 2001.Google Scholar
  10. Rosai J. Rosai and Ackerman’s surgical pathology. 10th ed. Edinburgh: Elsevier; 2011.Google Scholar
  11. Silverberg SG, DeLellis RA, Frable WJ, LiVolsi VA, Wick R, editors. Silverberg’s principles and practices of surgical pathology and cytopathology. 4th ed. Philadelphia: Churchill Livingstone; 2006.Google Scholar
  12. Simmons EJV, Saunders DSA, Carr RA. Current experience and attitudes to biomedical scientist cut-up: results of an online survey of UK consultant histopathologists. J Clin Pathol. 2011;64:363–6.PubMedCrossRefGoogle Scholar
  13. Sobin LH, Gospodarowicz M, Wittekind Ch, editors. TNM classification of malignant tumours. UICC. 7th ed. Oxford: Wiley-Blackwell; 2010.Google Scholar
  14. Spence RAJ, Johnston PG, editors. Oncology. Oxford: Oxford University Press; 2001.Google Scholar
  15. Sturgeon CM, Lai LC, Duffy MJ. Serum tumour markers: how to order and interpret them. BMJ. 2009;339:852–8.CrossRefGoogle Scholar
  16. The Royal College of Pathologists. Cancer datasets and tissue pathways. Accessed at
  17. The Royal College of Pathologists. Joint RCPath/IBMS Working Group. Implementation of the extended role of biomedical scientists in specimen dissection and sampling – final report.
  18. The Royal College of Pathologists of Australasia. Structured reporting cancer protocols. Available at
  19. Vollmer RT. Pathologists’ assistants in surgical pathology. The truth is out. Am J Clin Pathol. 1999;112:597–8.PubMedGoogle Scholar
  20. Westra WH, Hruban RH, Phelps TH, Isacson C. Surgical pathology dissection: an illustrated guide. 2nd ed. New York: Springer; 2003.Google Scholar
  21. WHO classification of tumours. Lyon: IARC Press. Accessed at
  22. Wittekind C, Greene FL, Hutter RVP, Klimfinger M, Sobin LH. TNM atlas: illustrated guide to the TNM/pTNM classification of malignant tumours. UICC. 5th ed. Berlin: Springer; 2004.Google Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Derek C. Allen
    • 1
  • R. Iain Cameron
    • 2
  • Maurice B. Loughrey
    • 3
  1. 1.Histopathology LaboratoryBelfast City Hospital, Belfast Health and Social Care TrustBelfastUK
  2. 2.Histopathology LaboratoryAltnagelvin Hospital, Western Health and Social Care TrustLondonderryUK
  3. 3.Histopathology LaboratoryInstitute of Pathology, Royal Victoria Hospital, Belfast Health and Social Care TrustBelfastUK

Personalised recommendations