Small intestine & ampulla


Grossing & features to report

Topic Completed: 1 August 2012

Minor changes: 11 December 2020

Copyright: 2003-2021,, Inc.

PubMed Search: Features to report for tumors small bowel[TI]

Hanni Gulwani, M.B.B.S.
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Cite this page: Gulwani H. Grossing & features to report. website. Accessed December 8th, 2021.
  • Ink pancreatic duct and common bile duct margins, also retroperitoneal margin
  • Probe common bile duct and pancreatic duct, and section along plane of both probes
  • Should examine at least 12 lymph nodes in a pancreaticoduodenectomy specimen
Features to report - small intestine
  • Tumor location
  • Histologic type
  • Histologic grade if relevant (well differentiated: > 95% glands; moderately: 50 - 95% glands; poorly: 5 - 49% glands; undifferentiated: < 5% glands)
  • Tumor size
  • Extent / depth of invasion
  • Margin involvement (proximal, distal, radial [soft tissue closest to deepest tumor penetration]) and distance of tumor to margin
  • Invasion of other structures
  • Obstruction, perforation, ulceration, proximal dilation
  • Nuclear grade, presence of necrosis
  • Angiolymphatic invasion
  • Other pathologic findings (polyps, Crohn's disease, celiac disease)
  • Nodal involvement (number involved, number identified)
  • Results of special studies
Features to report - ampulla
    • Specimen type
    • Tumor site
    • Presumed tumor origin (intraampullary, periampullary duodenum, mixed, common bile duct, pancreatic)
    • Histologic type
    • Histologic grade (well, moderate, poor or undifferentiated)
    • Tumor size (invasive carcinoma component)
    • Depth of invasion, local extension
    • Margins - invasive carcinoma; distance to closest margin and identify margin (recommended to ink posterior retroperitoneal surface of pancreas and submit sections of tumor closest to this margin)
    • Margins - carcinoma in situ; involvement of pancreatic duct or common bile duct margin
    • Margins - PanIn
    • Pathologic staging
    • Perineural invasion (for resections)
    • Angiolymphatic invasion (for resections)
    • Lymph nodes
    • Additional findings: PanIN / dysplasia, adenoma, inflammation, adenomyosis, pancreatitis, gastritis, other
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