Colorectal Resection Specimens Research Articles

Current Challenges and Controversies in Colorectal Carcinoma Pathologic Staging-A Practical Guide.

The pathologic assessment of colorectal carcinoma specimens plays a crucial role in the therapeutic management of patients and disease prognostication. The TNM staging system is used globally and is a critical component of colorectal carcinoma pathology reporting. However, our experience informs us that there are significant variations in the assignment of the TNM stage, both between pathologists and between hospital centers. We identify several potential reasons for this, among them suboptimal gross and microscopic assessment of colorectal resection specimens and, later, nonuniformity in applying criteria set forth in pathologic TNM staging guidelines. In addition, some defining characteristics of the staging system remain poorly defined. We aim to enlist those issues with potential remedies to improve reproducibility and, therefore, multidisciplinary discussion.

GLUT1 and ASCT2 expression and their prognostic value in colorectal carcinoma.

Investigation of new molecular markers expressed in colorectal carcinoma can help to select patients getting benefits from new target therapeutic modalities. Investigation of expression of GLUT1 and ASCT2 in colorectal carcinoma. Sixty three colorectal resection specimens for cases diagnosed with colorectal carcinoma were included in the study. Full sections were examined for histopathological data including tumor type, grade, stage, and lymphovascular invasion were recorded. TMA blocks were constructed and immunostained with polyclonal antibodies for both GLUT1 and ASCT2. GLUT1 was expressed in 82% of cases while ASCT2 was expressed in 76% of cases. Statistically significant correlation was found between both GLUT1 and ASCT2. A statistically significant correlation was found between either marker with both disease stage and lymph node metastases. No significant correlation was found between either GLUT1 or ASCT2 and any of the clinical parameters as well as with disease-free survival. GLUT1 and ASCT2 are more prevalent in poorly differentiated and advanced stage colorectal carcinoma. Their expression in high percentage of cases can suggest the possible role of their target therapies in colorectal carcinoma.

Creating a Surgical Biobank: The Hershey Medical Center Experience.

Tissue harvesting at the time of surgery offers surgeons and scientists a unique opportunity to discover and better understand disease pathophysiology. Tissue biobanking presents challenges in patient consents, specimen collection, preparation, and storage, but the potential for scientific discovery justifies the effort. Although the number of tissue biobanks is increasing worldwide, information regarding necessary infrastructure, process flow, and management of expected obstacles is lacking. To provide a framework and motivation for clinician scientists intending to start an intestinal tissue biobank under their direction. The Carlino Family Inflammatory Bowel and Colorectal Diseases Biobank is housed at the Milton S. Hershey Medical Center. Review. Implementation of a surgical tissue biobank at a large tertiary care institution. Assess critical challenges and obstacles over the years as well as keys to the success of the program. Over 2 decades, the institutional biobank grew from an IBD biobank to one which now incorporates thousands of surgical specimens representing numerous colorectal diseases. This was done through a process of refinement focusing on patient recruitment and an efficient consenting and specimen management process. The biobank's success is further insured by institutional, external, and philanthropic support; scientific collaborations; and sharing of biological specimens with other groups of dedicated researchers. This is a single-center experience in collecting surgically resected colorectal specimens. Surgical specimen biobanks are essential in studying disease cause using genomics, transcriptomics, and proteomic technologies. Therefore, surgeons, clinicians, and scientists should build biobanks at their institutions to promote further scientific discovery and improve specimen diversity.

Molecular prognostic factors in colorectal cancer: 5-year follow-up.

Colorectal cancer (CRC) is a frequently diagnosed and lethal disease. The risk of developing CRC is determined by environmental and genetic factors. Surgical treatment is the main curative modality for patients with CRC up to stage III. In recent years, a special place has been given to biological agents used as targeted therapy following the genetic analysis of the tumor: Bevacizumab (Avastin), Cetuximab (Erbitux), Ziv-aflibercept (Zaltrap). We present a study based on 46 colorectal tumor resection specimens from patients operated for CRC in the Surgery Departments of the Emergency County Clinical Hospital of Craiova, Romania. Histopathological examination and immunohistochemistry staining of tissue sections were performed to determine the degree of aggressiveness. Using the Kaplan-Meier test, we calculated the correlation coefficient between survival time and immunohistochemical prognostic factors. The patients were followed for 60 months postoperatively.

221 Lynch Syndrome - Do We Really Screen for It?

Abstract Aim Firstly, assess the compliance of our Trust with the DG27 NICE Guidelines (2017) recommending universal screening of patients with Colorectal Cancer (CRC) for Lynch Syndrome (LS), using Immunohistochemistry or Microsatellite Instability testing. Secondly, provide a cost estimate for the Trust to implement universal screening for LS. Method Retrospective data collection for all CRC resection specimens reported by the Trust's Pathology Lab in 2019, and check of pathology reports, Clinic letters, and lab results through the Trust's electronic system for screening for LS. Cost estimates were calculated using information from the Histopathology Department and similar Audits by other NHS Trusts. Results From the 361 colorectal resection specimens examined at the Trust's Pathology lab, 340 were not screened for LS (NICE Guidelines compliance = 5.8%). Of the 21 screened, 12 patients did not have LS, and for 9 screening was not completed. By categorising the patients into groups by age, location of cancer, and presence of synchronous or metachronous cancers, we found that there was no consistent rationale behind screening (i.e., patients with phenotypical characteristics traditionally related to LS were not screened). We estimated that universal LS screening would cost the Trust approximately £25,000 annually. Conclusions There is extremely poor compliance with the NICE Guidelines in a Trust with one of the highest numbers of CRC resections annually. Even the Amsterdam Criteria are not used to screen patients for LS. Screening could change the surgical and oncological management of the patients and also suggest different surveillance and prophylaxis for the affected family members.

Potential Factors Predicting Histopathologically Upgrade Discrepancies between Endoscopic Forceps Biopsy of the Colorectal Low-Grade Intraepithelial Neoplasia and Endoscopic Resection Specimens.

Background It was gradually accepted that endoscopic fragment biopsy (EFB) diagnosis cannot accurately guarantee the absence of higher-grade neoplasms within the lesion of the digestive tract. There are no well-established predictors for histopathologically upgrade discrepancies between EFB diagnosing colorectal low-grade intraepithelial neoplasia (LGIN) and endoscopic resection (ER) specimens. Methods A total of 918 colorectal LGINs was histopathologically diagnosed by EFB, including 162 cases with upgrade discrepancy and 756 concordant cases. We compared clinicopathological data of EFB and ER specimens between these two groups. Multivariate analysis was performed to identify predictors for this upgrade histopathology. Results The predominant upgrade discrepancy of LGINs diagnosed by EFB was upgrades to high-grade dysplasia (114/918, 12.4%), followed by upgrades to intramucosal carcinoma (33/918, 3.6%), submucosal adenocarcinoma (10/918, 1.1%), and advanced adenocarcinoma (5/918, 0.5%). NSAID history (OR 4.83; 95% CI, 2.27-10.27; p < 0.001), insufficient EFB number (OR 2.99; 95% CI, 1.91-4.68; p < 0.001), maximum diameter ≥ 1.0 cm (OR 6.18; 95% CI, 1.32-28.99; p = 0.021), lobulated shape (OR 2.68; 95% CI, 1.65-4.36; p < 0.001), erythema (OR 2.42; 95% CI, 1.50-3.91; p < 0.001), erosion (OR 7.12; 95% CI, 3.91-12.94; p < 0.001), surface unevenness (OR 2.31; 95% CI, 1.33-4.01; p = 0.003), and distal location of the target adenoma (OR 3.29; 95% CI, 1.68-6.41; p < 0.001) were associated with the histologically upgrade discrepancies. Conclusion NSAID history, insufficient EFB number, adenoma size and location, and abnormal macroscopic patterns are potential predictors for upgrade histopathology of LGINs diagnosed by EFBs. The standardization of EFB number and advanced imaging techniques could minimize the risk of neglecting the potential of this upgrade histopathology.

Histomorphological spectrum of colonic biopsies: A two year study

Introduction: Colonoscopy and accompanying mucosal biopsy is the diagnostic tool of choice in the evaluation of patients with colo rectal pathologies. The objectives of this study were to study the histo morphological spectrum of colonoscopic biopsies, to find age, gender, site distribution of these lesions and to correlate them with clinical presentation and colonoscopic diagnosis. Materials and Methods: The study included all the colonoscopic biopsies received at Department of Pathology, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad from January 2015 to December 2016, over a period of two years. Results: There were 198 colonoscopic biopsies during this period. Two biopsies were inadequate for opinion and were excluded from the study. All the colorectal resection specimens, anal lesion were excluded from the study. Out of total 196 biopsies, 104 were non-neoplastic lesions, 92 were neoplastic lesions. Mean age of patients was 49.7 years with a male to female ratio of 1.6:1. Most common location of the lesion was rectum. The most common presenting complaint for both non-neoplastic and neoplastic lesions was bleeding per rectum. Non-specific colitis was commonest non-neoplastic lesion followed by ulcerative colitis. In the neoplastic lesions, adenocarcinoma was the commonest subtype followed by adenomatous polyps. Conclusion: Both neoplastic and non-neoplastic lesions equally affect colon. Non-specific colitis, ulcerative colitis, Crohns disease, tuberculosis, amoebic colitis, eosinophilic enteritis, hamartomatous and hyperplastic polyps were the various non neoplastic lesions encountered in our study. Adenocarcinoma was the most common malignancy on colonic biopsies. Carcinomas occurred at a later age than adenomas. Colonscopic diagnosis correlated well with histopathology diagnosis in carcinomas. Keywords: Colonoscopy, Mucosal biopsy, Non-neoplastic lesions, Neoplastic lesions, Rectum, Non-specific colitis, Adenocarcinoma.

Assessment of Histo-Pathological Outcomes of Colorectal Cancer

Background: Careful and accurate pathology reporting of colorectal cancer resection is vital because pathology reports are used to inform the prognosis, evaluate the quality of other clinical services, surgery and oncology and plan the treatment of patients. Objectives: To evaluate histopathological outcomes of resected colorectal specimens in terms of adequacy of resection, quality of pathological reports and the demographic data of the patients in El Demerdash Hospital in the period between June 2016 to June 2018. Patients and methods: This is a retrospective study conducted at Ain Shams University Hospital by collecting the data from histopathological reports of 142 patients who underwent surgical resection and histopathological assessment of colorectal cancers. Results: In our 2-year study period, 142 patients were included, mean age 52.95 years (56% male) and (43% female). The most common site was ano-rectal tumors (30.3%). (92.3%) of pathology reports were fulfilling the criteria of qualified reports. Adequacy of resection in colon cancer was (70.7%) and it was higher than that of rectal cancer (44%). In the group of patients who received NAT there were 43.5% adequate LNS harvesting. Conclusion: One of the most important prognostic factors in colorectal cancers is adequacy of resection. It was higher in colon cancer than that of rectal cancer. The commonest factor that affects the resection adequacy is the lymph node harvesting, which was apparently less in cases of rectal cancer. This may be attributed to the effect of neoadjuvant therapy on lymph nodes depletion, giving a false picture of inadequate resection.

Colorectal invasion of endometriosis

Aim: Endometriosis is a common gynecological disorder affecting women of reproductive age. The localization and stage of endometriosis determine the clinical course of the disease. In this study, colorectal invasion in endometriosis cases were evaluated retrospectively.Material and Methods: Between January 2011 and December 2019, female patients aged 18-60 that had undertaken colonoscopy examinations, appendectomies, colorectal resections and bowel shave was performed to remove mass in the intestinal wall. All results were evaluated retrospectively. After histopathological examinations, the results obtained, including findings of endometriosis were included in the study.Results: The mean age of patients was found to be 41.78±2.03. 30078 patients who had colonoscopy and rectosigmoidoscopy only two endometriosis was found(0.06%). Five out of 554 colorectal resection specimens (0.9%) and 8 out of 1516 appendectomy specimens were detected with endometriosis. Endometriosis was detected in 3 other cases with an invasive mass on the colon wall during gynecological operations and finally, in one patient holding the entire intestinal system along with the peritoneal surfaces in the abdomen. Altogether 19 cases of endometriosis were detected, 42% was invasion of the appendix tissue (most common) and the rectum being second with 21% most common localization.Conclusion: Colorectal invasion of the endometriosis is a rare clinical condition. The radiological appearance of the lumen obstruction could be confused with malignancy, cases that have not been diagnosed can visit emergency services with ileus due to lumen obstruction. In these cases surgical treatments are the best treatment option.

1955P - Live biobank of patient-derived organoids from Thai colorectal cancer patients enables clinical outcome prediction

BackgroundPatient-derived organoids (PDOs) are versatile experimental models for cancer research. At the Faculty of medicine Siriraj Hospital, we have recently established live biobank of over seventy PDO models from stage I-IV Thai colorectal cancer patients. Our biobank included at least 10 patients who underwent neoadjuvant chemotherapy. We aimed to apply this resource for N-of-1 co-clinical trials, for the discovery of novel therapeutic agents and for biomarker development. We report here our application of the developed PDO models for predicting clinical outcome of colorectal cancer patients. MethodsSurgically resected colorectal specimens from both normal and cancerous tissue were digested and embedded in appropriate matrices to form PDO models. Subsequently, all successful PDO models were collected in Siriraj live biobank together with their clinical data. Herein, we characterized our derived PDO models by pathological and molecular techniques. Some models were profiled with panel sequencing to assess for the causal driver mutations. Drug sensitivity of each PDO model to standard-of-care drugs were generated and compared with clinical outcome in each patient. ResultsWe successfully established PDO models from different colorectal sites, of different pathological grades and staging. We identified heterogeneous morphologies of PDO models which appear to be corresponding well with the pathological and genomic profiles of each specimen origin. Although the PDO models from different colorectal cancer patients exhibited variable response to 5-fluorouracil (5-Fu), Leucovorin and Oxaliplatin, the response patterns are consistent with the clinical outcome of the individual patients as determined by tumor regression grade or radiologic imaging for neoadjuvant cases. We are examining the use of drug sensitivity profiling of PDO models for prioritizing anti-cancer treatment choices in a prospective clinical study. ConclusionsThe Siriraj live biobank of PDO from colorectal cancer patients can serve as a useful resource for N-of-1 co-clinical trials, and for comparison of drug response among patients from different ethnic backgrounds. Legal entity responsible for the studyFaculty of Medicine Siriraj Hospital, Mahidol University, Thailand. FundingThe National Research Council of Thailand and Siriraj foundation, Siriraj Hospital. DisclosureAll authors have declared no conflicts of interest.

Clinical Implications of Lymph Node Metastasis in Colorectal Cancer: Current Status and Future Perspectives.

Lymph node metastasis is regarded as an indubitable prognostic factor for predicting disease recurrence and survival in patients with colorectal cancer. Lymph node status based on examination of a resected specimen is a key element of the current staging system and is also a crucial factor to determine use of adjuvant chemotherapy after surgical resection. However, the current tumor-node-metastasis (TNM) staging system only incorporates the number of metastatic lymph nodes in the N category. Numerous attempts have been made to supplement this simplified N staging including lymph node ratio, distribution of metastatic lymph nodes, tumor deposits, or extracapsular invasion. In addition, several attempts have been made to identify more specific prognostic factors in resected colorectal specimens than lymph node status. In this review, we will discuss controversies in lymph node staging and factors that may influence survival beyond lymph node status.

Cost Effectiveness of Intraoperative Gross Examination in Colorectal Resections: A Retrospective Review of 200 Consecutive Cases.

Intraoperative pathology consultation is an important tool for many surgical procedures and is deemed appropriate when the pathology result immediately alters surgical management. To evaluate the utility of intraoperative gross examinations of colorectal resections and to better understand the associated costs. The pathology database of our institution was searched for colorectal resections for primary disease, and those cases were separated into 3 categories: frozen section performed, intraoperative gross examination performed, and no intraoperative consultation. We reviewed 270 cases during a 15-month period. Of the 270 cases, 200 (74.1%) had an intraoperative gross examination. In 34 of the 200 cases (17%), additional specimens were taken and, therefore, required operative note review to ascertain whether the additional specimens taken were based on the findings from the intraoperative gross examination. After reviewing the operative notes for those 34 cases, none (0%) were a result of the gross findings reported. The average associated time for intraoperative gross examinations was 27.67 minutes (including transport). The billable costs exceeded $7000 during the study period, and the cost of the pathology assistant's time per case was $22.10. Our study demonstrates that no change in surgical management was a result of gross examination of colorectal resection specimens and that the associated costs were significant. Decreasing unnecessary consultations will directly save the health care system money by eliminating billable services and will also increase the efficiency of the pathology department by reducing the opportunity costs for the time of the pathologist and the pathology staff.

Correlation of immunohistochemical mismatch repair protein status between colorectal carcinoma endoscopic biopsy and resection specimens

BackgroundMicrosatellite instability is reflective of a deficient mismatch repair system (dMMR), which may be due to either sporadic or germline mutations in the relevant mismatch repair (MMR) gene. MMR status...

DNA mismatch repair protein deficient non-neoplastic colonic crypts: a novel indicator of Lynch syndrome

Lynch syndrome is the most common form of hereditary colorectal carcinoma. However, establishing the diagnosis of Lynch syndrome is challenging, and ancillary studies that distinguish between sporadic DNA mismatch repair (MMR) protein deficiency and Lynch syndrome are needed, particularly when germline mutation studies are inconclusive. The aim of this study was to determine if MMR protein-deficient non-neoplastic intestinal crypts can help distinguish between patients with and without Lynch syndrome. We evaluated the expression of MMR proteins in non-neoplastic intestinal mucosa obtained from colorectal surgical resection specimens from patients with Lynch syndrome-associated colorectal carcinoma (n = 52) and patients with colorectal carcinoma without evidence of Lynch syndrome (n = 70), including sporadic MMR protein-deficient colorectal carcinoma (n = 30), MMR protein proficient colorectal carcinoma (n = 30), and “Lynch-like” syndrome (n = 10). MMR protein-deficient non-neoplastic colonic crypts were identified in 19 of 122 (16%) patients. MMR protein-deficient colonic crypts were identified in 18 of 52 (35%) patients with Lynch syndrome compared to only 1 of 70 (1%) patients without Lynch syndrome (p < 0.001). This one patient had “Lynch-like” syndrome and harbored two MSH2-deficient non-neoplastic colonic crypts. MMR protein-deficient non-neoplastic colonic crypts were not identified in patients with sporadic MMR protein-deficient or MMR protein proficient colorectal carcinoma. Our findings suggest that MMR protein-deficient colonic crypts are a novel indicator of Lynch syndrome, and evaluation for MMR protein-deficient crypts may be a helpful addition to Lynch syndrome diagnostics.

Circulating cytokeratin-positive cells and tumor budding in colorectal cancer.

AIMTo investigate whether circulating cytokeratin-positive (CK+) cells in the mesenteric blood of resected colorectal specimens are prognostic and correlate with tumor budding.METHODSFifty-six colorectal specimens were collected between 9/2007 and 7/2008. Blood from the mesenteric vein was drawn immediately after receiving the fresh and unfixed specimens in the pathology department. After separation of the mononuclear cells by Ficoll-Hypaque density-gradient centrifugation, cytological smears were immunocytochemically stained for CK18. Tumor budding was evaluated on slides stained for pan-cytokeratin. The identification of ≥ 30 buds/1.3 mm2 was defined as high grade budding.RESULTSCK+ cells and clusters were identified in 29 (48%) and 14 (25%) of the samples, respectively. Two cells were identified in one of three non-malignant cases. Clusters were found exclusively in malignant cases. The occurrence of CK+ cells or clusters was not associated with any of the evaluated clinicopathological factors, including surgical technique and tumor budding. Moreover, the occurrence of CK+ cells or clusters had no influence on the cancer-specific survival [75 mo (CI: 61; 88) vs 83 mo (CI: 72; 95) and 80 mo (CI: 63; 98) vs 79 mo (CI: 69; 89), respectively].CONCLUSIONCK+ cells and showed neither prognostic significance nor an association with tumor budding. It is very likely that CK18-staining is not specific enough to identify the relevant cells.

Bowel occult microscopic endometriosis in resection margins in deep colorectal endometriosis specimens has no impact on short-term postoperative outcomes

To evaluate the impact of bowel occult microscopic endometriosis (BOME) implants on postoperative outcomes in patients treated with colorectal resection for deep infiltrating digestive endometriosis. Prospective series of consecutive patients with deep colorectal endometriosis managed by colorectal resection in our department from June 2009 to November 2014 and enrolled in the CIRENDO database (NCT02294825). University tertiary referral center. One hundred three patients managed by colorectal resection for deep infiltrating endometriosis. Histologic examination of colorectal resection specimens. Patient characteristics, preoperative and 1-year postoperative symptoms and intraoperative findings were compared between women with and without BOME on specimen resection margins. In 15 cases, BOME was found in one (nine cases) or both resection limits (six cases). No statistical significance was found between BOME and height of colorectal anastomosis, length of the resected bowel specimen or depth of rectal wall infiltration. One patient with BOME underwent a second colorectal resection 5 years later for rectal recurrence. Comparison between the rates of dyschezia, diarrhea, constipation, bloating and overall values of GIQLI and KESS scores 1 and 3 years postoperatively showed no statistical significance between women with and without BOME. BOME was found in 14.6% of specimen resection margins. No impact on either pelvic or digestive symptoms was observed after 1-year follow-up postoperatively. NCT02294825.

Up-regulation of Neutrophil Gelatinase-Associated Lipocalin in Colorectal Cancer Predicts Poor Patient Survival

Lipocalin-2 (Lcn-2) is expressed in human neutrophils and epithelial cells, particularly in the presence of inflammation or cancer. It was shown to be highly expressed in various human cancers. Increased protein levels were associated with decreased survival of patients with breast or gastric cancer. The main focus of this work was to analyze the implication of Lcn-2 up-regulation in the genesis of colon cancer. Expression of Lcn-2 was analyzed in colorectal carcinoma cell lines, paired colorectal carcinoma tissues, and regular mucosa by Western blot analysis. Lcn-2 immunohistochemical staining was performed in 192 colorectal carcinoma resection specimens and correlated with clinicopathologic parameters. Western blot analysis of colorectal carcinoma tissues demonstrated Lcn-2 overexpression in carcinomas as compared with regular mucosa. Immunohistochemical staining revealed Lcn-2 expression in 179 (93.2%) colorectal carcinoma tissues. Intense immunoreactivity was significantly correlated with metastasis (p = 0.042) and UICC stage (p = 0.027). Survival analysis according to the Kaplan-Meier method revealed a significant association between Lcn-2 overexpressing tumors and overall survival (p < 0.001) and disease-free survival (p < 0.001). Our data provide evidence that Lcn-2 expression is up-regulated with tumor progression and was found to be a predictor of overall survival.

A survey of reporting of colorectal cancer in Scotland: compliance with guidelines and effect of proforma reporting

AimsThe main purpose of the study was to present a baseline audit of reporting of colorectal cancers resection specimens in Scotland, audited against the Royal College of Pathologists (RCPath) standards...

Histological study of macroscopically normal mucosa adjacent to tumour in colorectal resection specimens

<p style="margin-bottom: 0in;"><span style="font-family: TimesNewRomanPS-BoldMT, serif;"><span style="font-size: x-small;"><strong>Objective: </strong><span style="font-family: TimesNewRomanPSMT, serif;">To study the histological features of macroscopically normal mucosa in colorectal carcinoma specimens and attempt to correlate the severity of these changes and the distance of the mucosa from the tumour.</span></span></span> <p style="margin-bottom: 0in;"><span style="font-family: TimesNewRomanPS-BoldMT, serif;"><span style="font-size: x-small;"><strong>Method: </strong><span style="font-family: TimesNewRomanPSMT, serif;">Ninety three resection margins from 52 specimens were categorized according to the distance from the tumour, 0-1cm, 1.1-5cm and more than 5cm. The histological parameters assessed included, lymphoid aggregates, acute inflammation, chronic inflammation, crypt distortion and villous change. These were graded as absent, mild, moderate and severe. The presence of intraepithelial lymphocytes, cystically dilated ducts and epithelial erosions were recorded as absent or present. Results were analyzed using Pearson Chi- square test and Fischer-Exact statistics.</span></span></span> <p style="margin-bottom: 0in;"><span style="font-family: TimesNewRomanPS-BoldMT, serif;"><span style="font-size: x-small;"><strong>Results: </strong><span style="font-family: TimesNewRomanPSMT, serif;">The histological features found included, lymphoid aggregates in 40% acute inflammation </span></span></span><span style="font-family: TimesNewRomanPSMT, serif;"><span style="font-size: x-small;">in 15% chronic inflammation in 16% crypt distortion 17%, cystically dilated glands 21%, epithelial erosion 13% and villous change 32%. The presence of cystically dilated glands showed a significant correlation with the distance from the tumour.</span></span> <p style="margin-bottom: 0in;"><span style="font-size: x-small;"><span style="font-family: TimesNewRomanPS-BoldMT, serif;"><strong>Conclusion: </strong></span><span style="font-family: TimesNewRomanPSMT, serif;">Varied histopathological features were observed in the mucosa adjacent to the tumour, awareness of which can prevent misinterpretation and over diagnosis of these features.</span></span> <p style="margin-bottom: 0in;"><span style="font-size: x-small;"><span style="font-family: TimesNewRomanPSMT, serif;">DOI: <a href="http://dx.doi.org/10.4038/jdp.v7i1.5594">http://dx.doi.org/10.4038/jdp.v7i1.5594</a></span></span> <p style="margin-bottom: 0in;"><span style="font-size: x-small;"><span style="font-family: TimesNewRomanPSMT, serif;"> </span></span><span style="font-family: Times New Roman, serif;"><span style="font-size: x-small;">Journal of Diagnostic Pathology 2012 (7); 1: 33-41</span></span>

Better retrieval of lymph nodes in colorectal resection specimens by pathologists’ assistants

BackgroundErrors in surgical pathology are partly due to the increasing workload of pathologists. To reduce this workload, ‘pathologists’ assistants’ (PAs) have been trained to take over some of the pathologists’...