Tumors
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Goals of evaluation are to assess margins and stage tumor
Medical liver disease
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Goal of evaluation is to determine or confirm cause of liver disease &/or liver failure
MACROSCOPIC
Specimen Handling
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Partial hepatectomy
Determine what procedure was performed
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Including exactly what structures/organs are present
Orient specimen
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May require surgeon’s assistance
Identify surgical margin (exposed, cauterized, cut surface of hepatic parenchyma) and ink it
Specimen dimensions
Examine external surface
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Bulges and areas of serosal retraction may indicate tumors
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Resection for trauma may have capsular lacerations, similar to spleen
Make initial slice through center of tumor, perpendicular to resection margin
Continue to thinly serially section specimen perpendicular to margin, parallel to initial slice
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Identify closest approach of tumor(s) to margin and take these sections
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Examine all cut surfaces for additional lesions
Document all lesions
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Note necrosis, scarring, or hemorrhage
If patient has received preoperative ablative therapy, describe areas of necrosis vs. grossly viable tumor
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Sections of tumor(s) should demonstrate relationship of tumor to surrounding liver and margin
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Interface between nonneoplastic liver and tumor are important and often less necrotic
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Primary tumors should be sampled more extensively than known metastases
Search for vascular invasion
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Document and sample if present grossly
Examine and describe nonneoplastic hepatic parenchyma and take sections
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Note especially if there is background of cirrhosis
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Take sections of nonneoplastic liver away from tumor mass
Examine lymph nodes if present
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Liver explant
Determine what procedure was performed
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Note exactly what structures/organs are present
Orient liver
