Liver, partial resection

Introduction

This type of procedure may be done for primary or metastatic carcinoma (metastatic colon adenocarcinoma can be treated with chemotherapy and then resected) or for benign lesions (vascular malformation, abscess, echinococcus cyst).

Fresh Handling

1. Measure and weight the specimen.
2. Identify the cauterized surgical margin, measure and ink black.
3. Section the portion of liver perpendicular to the cauterized edge (0.5 cm thick slices).
4. Photograph a representative slice of liver with tumor.
5. Fix overnight in an appropriate amount of formalin. The use of paper towels in between the sections facilitates formalin penetration.

Grossing In

1. Describe the type of resection (partial lobectomy, segmentectomy, etc.) and state the overall dimensions and weight, describe capsular surface (is there tumor visible?).
2. Describe the tumor: color, shape and consistency, number of nodules, necrosis, hemorrhage, presence of vascular invasion. Describe any other incidental lesions.
3. Describe the uninvolved liver - general appearance including color and consistency, cirrhosis, nodularity, congestion, necrosis, retraction of capsule…
4. Summary of sections:
   1. Sections of any lesions or tumor (in general and for primary lesions use the 1 section per 1 cm rule; for large tumors, fewer than 1 section per 1 cm may be submitted, but be sure to include heterogeneous areas, including areas of necrosis, in the sections. Also, consult the attending). For known metastasis 2-3 sections including the closest to the inked margin is sufficient. Most sections should show tumor in respect to the adjacent liver parenchyma. At least one section should include the capsule (if close). At least one section should show relationship to the nearest inked margin of resection.
   2. Submit shaved bile duct and vascular margins, if present.
   3. At least one section of representative uninvolved liver away from tumor mass. Obtain liver panel of special stains on one section of non-neoplastic liver (e.g., trichome, reticulin, PAS-D and iron stains).
   4. Sections of any additional lesions.

Sample dictation

Specimen #1 is designated "left lateral segment wedge" and consists of an unoriented portion of liver measuring 7.0 x 5.5 x 3 cm, with a capsular surface and an opposite cauterized parenchymal surface measuring 7.0 x 5.0 cm. On the capsule there is a 3.0 x 2.0 cm area of adipose tissue and potential adhesion. The specimen is inked entirely black. There is a palpable mass in the center of the specimen, measuring 1.9 x 1.8 x 1.6 cm. This mass is firm, yellow and homogeneous on cut surface and appears well circumscribed with a potential capsule surrounding the mass. There are focal lobulated projections growing into the surrounding liver parenchyma, which is unremarkable. Representative sections are submitted as follows: 1A through 1D tumor in relation to surrounding parenchyma, parenchymal margin, and capsular adhesion, 1E representative section of uninvolved liver.

Review and Signout

Document the nature of the lesion and the margins.

1. Liver, left lateral segment, wedge resection:

A. Metastatic adenocarcinoma, x cm, (well, moderately, poorly) differentiated, morphologically consistent with colorectal primary, present within x mm of the transected parenchymal margin.

B. Non-neoplastic liver with no specific pathologic change.

Remember to include a note for the non-neoplastic liver special stains.

NOTE: The biopsy has _ portal tracts available for review. The biopsy shows _. The trichrome and reticulin stains support the above diagnosis. The iron stain shows _ (i.e. grade 1) intrahepatocellular hemosiderin and _ (i.e. moderate) hemosiderin accumulation in Kupffer cells. The PAS stain shows _ (i.e. no) intrahepatocellular PAS-positive globules and _ (i.e. no) Kupffer cell hyperplasia.

1. Liver, right liver lobe, lobectomy:

A. Hepatic cavernous hemangioma, 9.0 cm.

B. Focal nodular hyperplasia, 2.5 cm.

C. Hepatocellular adenoma, 0.8 cm.

D. Background liver with portal tract mild chronic inflammation without significant fibrosis, see note.

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