Many of these grossing templates were made with generous help from Dr. Zarrin Hossein-Zadeh. Others are based on templates from institutions I’ve practiced at. For some, you’ll see that there are different versions/options. As with all templates, these must be customized for each case–no two cases are the same!

Appendix for appendicitis

The specimen is received in formalin labeled “***” with the patient’s name and medical record number. It consists of one appendix which measures *** cm in length and *** cm in maximum external diameter. The attached mesoappendix measures *** cm. The margin is received *** [stapled vs open] and it is inked black. The serosal surface is ***. No perforation is identified grossly. Serial sectioning reveals a luminal diameter of *** cm and contains ***. The wall thickness measures *** cm on average. The appendiceal tip is bisected and reveals no grossly apparent masses or lesions. Representative sections of appendix, including one half of tip, and mucosal margin en face, inked blue, are submitted in one cassette labeled ***.

Appendix (option 2)

Received [fresh/in formalin], labeled with the patient’s name, medical record number, and designated “***”, is [an intact / fragmented / ruptured] vermiform appendix that measures *** x *** x *** cm, with attached mesoappendix (*** x *** x *** cm). The surgical margin is inked black. The serosa is [color, congested, hemorrhagic, covered with fibrinoid exudate, mention the presence of adhesions]. The lumen [is / is not] dilated and filled with [pus / serous fluid / mucus / fecalith / soft fecal material]. The tip is [fibrotic / patent / involved by tumor]. The wall thickness ranges from *** cm to *** cm. Cut surfaces of the periappendiceal fat are unremarkable. No mass lesions, nodules or perforations are identified within the appendix. Representative sections are submitted as follows:

A1: proximal margin en face (inked black), cross sections of body and peri-appendiceal soft tissue, half of distal tip (bisected longitudinally)
[if tumor, submit remainder of specimen sequentially]

Gallbladder for cholecystitis

The [first] specimen labeled “[#####]” with the patient’s name and medical record number is received [in formalin] and consists of one gallbladder specimen measuring overall [# x # x #]. The serosal surface is [smooth/glistening/congested/bile stained] and is [intact/shows a defect measuring x] The cystic duct is [clipped/received open]. A cystic duct lymph node is identified, measuring [#####] cm. The gallbladder is opened to reveal approximately [#####] cc of [green/yellow/watery/viscous] bile and [#####] calculi which range from [#####] cm to [#####] cm. The calculi are [green/brown/black/yellow/translucent], with [smooth/granular/irregular] surfaces. The inner mucosal surface of the gallbladder is [smooth and velvety/roughened and hemorrhagic]. [Yellow flecks suggestive of cholesterosis are noted]. The gallbladder wall ranges from [#####] to [#####] cm in thickness. Representative sections of the fundus, body, and cystic duct margin en face are submitted as A1. [The cystic duct lymph node is bisected and submitted as A2.]

Colorectal

General Left Colon (Benign)

A1. Proximal margin, en face

A2. Distal margin, en face

A3-A***. Sections of *** [any lesions]

A***. Representative normal colon

A***. Candidate pericolic lymph nodes

General Right Colon (Benign)

The specimen received in formalin labeled “***” with the patient’s name and medical record number. It consists of one *** [procedure] specimen measuring *** x *** x *** cm in overall dimension including a portion of ileum, appendix, and portion of colon. The ileum measures *** cm in length by *** cm in average diameter. The appendix measures *** cm in length by *** cm in average diameter. The colon measures *** cm in length, and *** cm in average diameter. The margins are stapled. The proximal staple line measures *** and the distal staple line measures *** The outer serosal surface is *** [color] and *** [texture]. No perforations are identified grossly. The attached mesentery measures *** x *** x *** cm. The ileum and colon are opened to reveal ***. Serial sectioning of the appendix reveals no gross abnormalities. The mesentery is serially sectioned to reveal multiple candidate lymph nodes ranging in size from *** cm to *** cm in greatest dimension. Representative sections are submitted as follows:

A1. Proximal margin, en face

A2. Distal margin, en face

A3-A***. Sections of [lesions]

A***. Normal colon

A***. Normal ileum

A***. Appendix, including tip

A***. Candidate pericolic lymph nodes

Colon for Diverticulitis

Received fresh, labeled with the patient’s name “NAME” and designated “[ ]”, is a [ ] cm in length by [ ] cm in circumference colectomy specimen with attached adipose tissue ([ ] x [ ] x [ ] cm).

Both ends of the specimen are stapled/open OR the proximal end of the specimen is received open/stapled and the distal end of the specimen is received open/stapled. The proximal margin is inked blue and the distal margin is inked green. The serosa is unremarkable/shows adhesions with exudate. A defect area measuring ([ ] x [ ] x [ ] cm) is identified, located at [] from the distal/proximal margin. The tip of one/multiple diverticulum is perforated and is surrounded by a green yellow purulent exudate. It is present [ ] cm from the distal margin and [ ] cm from the proximal margin. A single/multiple diverticula are present in the [location], [ ] cm from the closest margin. No inflammation or perforation is grossly identified. The bowel wall is thickened to [ ] cm and measures a maximum of [ ] cm for a spam of [] cm. No other lesions are identified. Multiple lymph nodes are identified. Representative sections are submitted in [ ] cassettes as follows:

A1: Proximal and Distal margins

A2: Mesenteric margin (en face)

A3: Defect area

A4-A5: Representative from diverticulum

A6: Representative from Abscess/fistula/etc

A7: Representative sections from uninvolved colon, full-thickness

A8: Lymph node candidates

Specimen placed in formalin at [ ].

Right Colon for IBD

Received fresh, labeled with the patient’s name ” ” and designated “[ ]” is a right hemicolectomy specimen including the terminal ileum ([ ] cm in length and [ ] cm in circumference), cecum ([ ] cm in length and [ ] cm circumference) with an attached appendix measuring ([ ] cm in length and [ ] cm in diameter). Portion of colon measures ([ ] cm in length by [ ] cm circumference) with attached adipose tissue ([ ] x [ ] x [ ] cm). Both ends of the specimen are stapled/open OR the proximal end of the specimen is received open/stapled and the distal end of the specimen is received open/stapled; the proximal margin is inked blue and the distal margin is inked green. The serosa is tan-pink and shows no perforation or inflammatory exudates. Fat creeping/adhesions/abscess formation are present/absent. On opening, the mucosal surface of colon is dusky red and has multiple ulcers and pseudopolyps located at [site of involvement ] and the changes spam a [ length] of colon, involving approximately [%] of the specimen . No discrete lesions, nodularities, or polyps are grossly identified. An additional [polypoid] lesion ([_x_x_] cm, is located [ ] cm from the [proximal/distal] colonic margin. The remainder of the proximal mucosa is tan-brown and unremarkable. The bowel wall is thin/thickened/fibrotic and measures a maximum of [ ] cm. Multiple lymph nodes are found in the pericolonic fat ranging from [ ] to [ ] cm.

Gross photographs are taken and representative sections are submitted in [ ] cassettes:

A1: Proximal margin (inked blue)

A2: Distal margin (inked green)

A3: Mesenteric margin (en face)

A4: Appendix

A5: IC valve

A6-A10: Sequential sections (1 section per 5CM of specimen)

A11: Lymph node and lymph node candidates

Left colon for IBD

Received fresh, labeled with the patient’s name ” ” and designated “[ ]” is a left colon resection specimen/proctosigmoidectomy specimen with colon ([ ] cm in length and [ ] cm in circumference at the proximal or sigmoid margin and [ ] cm in circumference at the rectum) with attached adipose tissue ([ ] x [ ] x [ ] cm) and anus ([ ] cm in length by [ ] cm in circumference). Both ends of the specimen are stapled/open OR the proximal end of the specimen is received open/stapled and the distal end of the specimen is received open/stapled; the proximal margin is inked blue and the distal/anal margin is inked green.

A [ ] cm in length mesentery is present along the proximal [ ] cm of the colon and is absent from the distal [ ] cm. The anterior peritoneal reflection is present [ ] cm from the proximal margin and [ ] cm from distal (rectal) margin. The mesorectal envelope is [complete/nearly complete/incomplete]. The serosa is tan-pink and shows no perforation or inflammatory exudates. Fat creeping/adhesion/fistula are not identified. On opening, the mucosal surface is dusky red and has multiple ulcers and pseudopolyps. The changes are present for a [length of involvment] and involve [ %] of the colon. No discrete lesions, nodularities, or polyps are grossly identified. The bowel wall is thin/thickened/fibrotic and measures a maximum of [ ] cm.

Multiple lymph nodes are found in the pericolonic fat ranging from [ ] to [ ] cm. Gross photographs are taken and representative sections are submitted in [ ] cassettes:

A1: Proximal margin (inked blue)

A2: Distal margin (inked green)

A3: Mesenteric margin (en face)

A4-A9: Sequential sections (1 section per 5CM of specimen)

A10: Lymph node and lymph node candidates

Specimen placed in formalin at [ ].

Total Colectomy for IBD

The [first] specimen labeled “[#####]” with the patient’s name and medical record number is received [in formalin] and consists of one [total colectomy] specimen measuring overall [# x # x #] cm including [ileum, appendix, colon, and rectum]. The ileum measures [#####] in length by [#####] in average diameter. The appendix measures [#####] in length by [#####] in average diameter. The colon measures [#####] cm in length, and [#####] cm in average diameter. The portion of rectum measures [#####] cm in length by [#####] in average diameter. The margins are [stapled/open]. The proximal staple line measures [#####], and the distal staple line measures [#####]. The outer serosal surface is [pink/red] and [smooth/hemorrhagic] with areas of [congestion with adhesions/shows areas of fat wrapping/stricture] measuring [#####] cm. [No perforations are identified grossly.] The attached mesentery measures [# x # x #]. The ileum and colon are opened to reveal [describe lesions including diverticuli, ulcerations, fissures, polyps, pseudopolyps, and measure size and location]. The mesentery is serially sectioned to reveal [numerous] candidate lymph nodes ranging in size from [#####] cm to [#####] cm in greatest dimension. Representative sections are submitted as follows:

[#####] Proximal margin, en face

[#####] Distal margin, en face

The following sections are submitted from proximal to distal with [lesions] found in [#####/number]:

[#####] 10 cm

[#####] 20 cm

[#####] 30 cm

[#####] 40 cm

[#####] 50 cm

[#####] 60 cm

[#####] 70 cm

[#####] 80 cm

[#####] 90 cm

[#####] Representative sections of appendix, including tip

[#####] Candidate pericolic lymph nodes, proximal 1/3 of specimen

[#####] Candidate pericolic lymph nodes, middle 1/3 of specimen

[#####] Candidate pericolic lymph nodes, distal 1/3 of specimen

Right colon, tumor/mass

Received fresh, labeled with the patient’s name ” ” and designated “[ ]”, is a right hemicolectomy specimen including the terminal ileum ([ ] cm in length x [ ] cm in circumference), right colon ([ ] cm in length x [ ] cm in circumference) with attached adipose tissue measuring ([ ] x [ ] x [ ] cm). The appendix measuring ([ ] cm in length x [ ] cm in diameter) is present. Both ends of the specimen are stapled/open OR the proximal end of the specimen is received open/stapled and the distal end of the specimen is received open/stapled; the proximal margin is inked blue and distal margin is inked green. The serosa is unremarkable/shows an area of puckering/tattoo ink measuring ([ ] x [ ] cm).

On opening, a [pink/tan/hemorrhagic, firm, friable, polypoid, plaque-like, ulcerating, exophytic, circumferential ] mass (measuring [ ] x [ ] cm), raised [ ] cm above the mucosal surface, with serpiginous borders is present [location]. The mass is located [ ] cm from the ileocecal valve, [ ] cm from the proximal ileal margin, [ ] cm from the distal colonic margin, and [ ] cm from mesenteric margin. On sectioning, the tumor grossly appears to invade the submuosa/muscularis propria/subserosal fat. The remaining mucosa is unremarkable/ an additional [polypoid/ulcerated/erythematous] lesion (measuring [ ] x [ ] x [ ] cm, and located [ ] cm from the proximal/distal margin is identified.

Multiple lymph nodes are identified, ranging from [ ] to [ ] cm are present. Gross photographs are taken. Representative sections are submitted in [ ] cassettes:

A1: Proximal margin (inked blue)

A2: Distal margin (inked green)

A3: Mesenteric margin (en face)

A4: Section of the mass with deepest invasion

A5-A8: Representative sections of the mass (1 section/1cm of mass)

A9: Appendix

A10: IC valve

A11: Uninvolved full-thickness section

A12: Lymph node (largest lymph node, bisected)

A13 : Lymph node candidates, intact

Specimen placed in formalin at [ ].

Left Colon Cancer/Mass

The specimen received in formalin labeled “***” with the patient’s name and medical record number. It consists of one *** [procedure] specimen measuring *** x *** x *** cm in overall dimension. The colon measures *** cm in length, and *** cm in average diameter. The margins are *** [stapled/open]. The proximal staple line measures *** cm, and the distal staple line measures *** cm. The outer serosal surface is *** [color] and *** [texture]. No perforations are identified grossly. The attached mesentery measures *** x *** x *** cm. The radial margin of resection is inked black. A mass is palpable within the *** end of the specimen. The colon is opened to reveal a *** [color], *** [poorly circumscribed vs well-circumscribed] mass measuring *** cm in length, *** cm in width and *** cm in maximum depth. It is located *** cm from the proximal margin and *** cm from the distal margin. The mass grossly invades ***. The serosa overlying the mass appears ***. The mass is located *** cm from the inked radial margin of resection. The remaining mucosa shows ***. The mesentery is serially sectioned to reveal *** candidate lymph nodes ranging in size from *** cm to *** cm in greatest dimension. Representative sections are submitted as follows:

A1. Proximal margin, en face

A2. Distal margin, en face

A3-A***. Sections of mass, full thickness sections [at least 1 per cm, entirely submit if small]

A***. Section of mass in relation to adjacent normal mucosa

A***. Representative section of closest radial resection margin

A***. Sections of *** [additional lesions]

A***. Normal colon

A***. Candidate pericolic lymph nodes

Left Colon Cancer/Mass, Option 2

The [first] specimen labeled “[#####]” with the patient’s name and medical record number is received [in formalin] and consists of one [hemicolectomy] specimen measuring overall [# x # x #] cm including a portion of ileum, appendix, and portion of colon. The ileum measures [#####] in length by [#####] in average diameter. The appendix measures [#####] in length by [#####] in average diameter. The colon measures [#####] cm in length, and [#####] cm in average diameter. The margins are [stapled/open]. The proximal staple line measures [#####], and the distal staple line measures [#####]. The outer serosal surface is [pink/red] and [smooth/hemorrhagic/congested with adhesions]. [No perforations are identified grossly.] The attached mesentery measures [# x # x #]. The radial margin of resection is inked black. The colon is opened to reveal a [tan/brown/red], [poorly circumscribed/well-circumscribed], [centrally indurated] mass measuring [#####] cm in length, [#####] cm in width and [#####] cm in maximum depth. It is located [#####] cm from the [proximal/stapled/open] margin and [#####] cm from the [distal/stapled/open] margin. The mass grossly invades [describe the depth of invasion]. The serosa overlying the mass appears [smooth/roughened/grossly involved by tumor]. The mass is located [#####] cm from the inked radial margin of resection and [#####] cm from the free peritoneal margin. The remaining mucosa shows [additional lesions; state distance from margins and distance from main tumor]. The mesentery is serially sectioned to reveal [#####] candidate lymph nodes ranging in size from [#####] cm to [#####] cm in greatest dimension. Representative sections are submitted as follows:

[#####] Proximal margin, en face

[#####] Distal margin, en face

[##### at least 3] Sections of mass, full thickness sections

[#####] Section of mass in relation to adjacent normal mucosa

[#####] Representative section of closest radial resection margin

[#####] Representative section of closest free peritoneal margin

[#####] Sections of [additional lesions] [#####] Uninvolved colon and ileum

[#####] Representative sections of appendix, including tip

[#####] Candidate lymph nodes

[#####] Additional candidate lymph nodes, submitted after immersion in Carnoy’s solution

Ischemic bowel

Received fresh, labeled with the patient’s name ” ” and designated “[ ]” is a partial colectomy/small intestine resection specimen, measuring ([ ] cm in length and [ ] cm in diameter) with attached adipose tissue measuring ([ ] x [ ]x [ ] cm). Both ends of the specimen are stapled/open OR the proximal end of the specimen is received open/stapled and the distal end of the specimen is received open/stapled; the proximal margin is inked blue and the distal margin is inked green. The serosa is tan-pink/hemorrhagic, and shows [no] perforation and/or [no] inflammatory exudates.

On opening, the mucosa is dusky red, hemorrhagic/necrotic, and has ulcers/ inflammatory exudates, extending a spam of [ CM]. The resection margins appear grossly viable. The bowel wall is thin/thickened/fibrotic/necrotic and measures a maximum of [ ] cm in thickness. Thrombi are grossly present/absent in the mesenteric vessels. Specimen photographs are taken.

Representative sections are submitted in [ ] cassettes:

A1: One margin (inked blue)

A2: The other margin (inked green)

A3: Mesenteric margin (en face)

A4-A5: Section of dusky mucosa

A6: Section from area of perforation/abscess/inflammation

A7: Section from univolved mucosa

A8: Lymph nodes or lymph node candidates, intact

Specimen placed in formalin at [ ].

Left colon Volvulus

Received fresh, labeled with the patient’s name ” ” and designated”[ ]” is a left colon resection specimen/proctosigmoidectomy specimen measuring ([ ] cm in length and [ ] cm in diameter at the proximal or sigmoid margin and [ ] cm in diameter at the distal [or rectal] margin). The attached adipose tissue measures ([ ] x [ ] x [ ] cm). Both ends of the specimen are stapled/open OR the proximal end of the specimen is received open/stapled and the distal end of the specimen is received open/stapled; the proximal margin is inked blue and the distal margin is inked green. The serosa is unremarkable/is dusky and congested. The anterior/posterior peritoneal reflection is present, [ ] cm from the proximal margin and [ ] cm from distal (rectal) margin. On opening, the mucosa is tan-pink and unremarkable/shows an area of trasmural defect ([ ] x [ ] cm, inked orange), located [ ] cm from proximal margin and [ ] cm from the distal margin. The mucosal surface adjacent to the defect area is [flat, tan/pink to congested] and shows thin bowel wall up to [ ] cm in thikness. The remainder of the mucosal surface is unremarkable. The bowel thickness is upto [ ] cm.

Multiple lymph nodes are identified, ranging from [ ] cm to [ ] cm. Specimen photographs are taken. Representative sections are submitted in [ ] cassettes:

A1: Proximal margin (inked blue )

A2: Distal margin (inked green )

A3: Mesenteric margin (en face)

A4-A5: Representative sections from area of defect

A6-A7: Representative sections of colon

A8: Lymph nodes and lymph node candidates

Specimen placed in formalin at [ ].

Rectum for cancer/mass

Received fresh, labeled with the patient’s name ” ” and designated “[ ]” is a rectum/rectosigmoid colon (low anterior resection)/ abdominoperineal resection specimen measuring [ ] cm in length by [ ] cm in circumference/diameter at the proximal margin and [ ] cm in circumference/diameter at the distal margin. A [ ] x [ ] cm in length mesentery is present along the proximal [ ] cm of the colon and is absent from the distal [ ] cm. The anterior peritoneal reflection is present [ ] cm from the proximal margin and [ ] cm from distal (rectal) margin. The mesorectal envelope is [complete/nearly complete/incomplete]. The serosal surface is [unremarkable/shows an area of puckering]. The specimen is inked: proximal margin = blue, distal margin = green, radial margin = black and serosa = orange. On opening, a [ ] x [ ] x [ ] cm [pink/tan/hemorrhagic, firm, friable, polypoid, plaque-like, ulcerating, exophytic, circumferential] mass with serpiginous borders is present [entirely below/above/straddles anterior peritoneal reflection] and on is located on the anterior/posterior wall. The tumor is [ ] cm from the distal margin, [ ] cm from the proximal margin, and [ ] cm from the deep/radial margin. The tumor grossly appears to invade the [submucosa/muscularis propria/subserosa/serosa or mesorectum]. The remainder of the mucosa is unremarkable. Multiple lymph nodes are identified, ranging from [ ] cm to [ ] cm. Specimen photographs are taken. Representative sections are submitted in [ ]cassettes:

A1: Proximal margin (inked blue )

A2: Distal margin (inked greem)

A3: Mesenteric margin (en face)

A4: Section of mass with deepest invasion

A5-A9: Additional sections of mass

A10: Lymph node (Largest lymph node, bisected)

A11 : Lymph node candidates

Specimen placed in formalin at [ ].

Rectal Cancer/Mass Low Anterior Resection (LAR), Option 2

The [first] specimen labeled “[#####]” with the patient’s name and medical record number is received [in formalin] and consists of one [low anterior resection] specimen including [sigmoid colon and rectum] measuring overall [# x # x #] cm. The colon measures [#####] cm in length, and [#####] cm in average diameter. The rectum measures [#####] cm in length, and [#####] cm in average diameter. The proximal margin is [stapled], and the distal margin is received [open]. The proximal [staple line] measures [#####], and the distal [open margin] measures [#####]. The outer serosal surface is [pink/red] and [smooth/hemorrhagic/congested with adhesions]. [No perforations are identified grossly.] The attached mesentery measures [# x # x #]. The perirectal adipose tissue [is intact and does not show any irregularities or disruptions/shows a defect measuring/is fragmented], and the resection appears [complete/nearly complete/incomplete]. The radial margin of resection is inked black. The colon and rectum are opened to reveal a [tan/brown/red/pink] [ulceration/mass] measuring [# x # x #] cm, located on the [anterior/posterior/left or right lateral wall] of the rectum. It is located [#####] cm from the [proximal/stapled] margin and [#####] cm from the [distal/open] margin. The [ulceration/mass] shows [underlying fibrosis/potential invasion] to a depth of [#####] cm and is grossly located [#####] cm from the closest black inked radial margin. The remaining mucosa shows [additional lesions; state distance from margins and distance from main tumor]. The pericolonic and perirectal adipose tissues are serially sectioned to reveal [#####] candidate lymph nodes ranging in size from [#####] cm to [#####] cm in greatest dimension. Representative sections are submitted as follows:

[#####] Proximal margin, en face

[#####] Distal margin, [en face or representative perpendicular] [#####] Sections of [ulcer/mass], full thickness sections

[#####] Section of [ulcer/mass] in relation to adjacent normal mucosa

[#####] Sections of [additional lesions] [#####] Uninvolved colon

[#####] Candidate pericolic lymph nodes

[#####] Additional candidate pericolic lymph nodes, submitted after immersion in Carnoy’s solution

Abdominoperineal Resection

The [first] specimen labeled “[#####]” with the patient’s name and medical record number is received [in formalin] and consists of one [abdominoperineal resection] specimen including [sigmoid colon and rectum] measuring overall [# x # x #] cm. The colon measures [#####] cm in length, and [#####] cm in average diameter. The rectum measures [#####] cm in length, and [#####] cm in average diameter. The proximal margin is [stapled], and the distal margin is received [open]. The proximal [staple line] measures [#####], and the distal [open margin] measures [#####]. A portion of perianal skin is noted at the distal margin, ranging in width from [#####] to [#####] cm. The outer serosal surface is [pink/red] and [smooth/hemorrhagic/congested with adhesions]. [No perforations are identified grossly.] The attached mesentery measures [# x # x #]. The perirectal adipose tissue [is intact and does not show any irregularities or disruptions/shows a defect measuring/is fragmented], and appears [completely/incompletely] resected. The radial margin of resection is inked black. The distal skin margin is inked as follows, with the anterior aspect designated as 12 o’clock: 12-3 o’clock = yellow, 3-6 o’clock = blue, 6-9 o’clock = red, and 9-12 o’clock = green. The colon and rectum are opened to reveal a [tan/brown/red/pink] [ulceration/mass] measuring [# x # x #] cm, located on the [anterior/posterior/left or right lateral wall] of the rectum. It is located [#####] cm from the [proximal/stapled] margin and [#####] cm from the [distal skin] margin. The [ulceration/mass] shows [underlying fibrosis/potential invasion] to a depth of [#####] cm and is grossly located [#####] cm from the closest black inked radial margin. The remaining mucosa shows [additional lesions; state distance from margins and distance from main tumor]. The pericolonic and perirectal adipose tissues are serially sectioned to reveal [#####] candidate lymph nodes ranging in size from [#####] cm to [#####] cm in greatest dimension. Representative sections are submitted as follows:

[#####] Proximal margin, en face

[#####] Distal margin, [en face or representative perpendicular] [##### â€“at least 3, or submit WHOLE tumor area if neoadjuvant therapy] Sections of [ulcer/mass], full thickness sections

[#####] Section of [ulcer/mass] in relation to adjacent normal mucosa

[#####] Representative section of closest radial resection margin

[#####] Representative section of closest free peritoneal margin â€“ if applicable

[#####] Sections of [additional lesions] [#####] Uninvolved colon

[#####] Candidate pericolic lymph nodes

[#####] Additional candidate pericolic lymph nodes, following immersion in Carnoy’s solution

Upper GI

Gastrectomy

The [first] specimen labeled “[#####]” with the patient’s name and medical record number is received [in formalin] and consists of one [gastrectomy] specimen measuring overall [# x # x #] cm, [oriented with a stitch marking the proximal/distal margin]. The greater curvature measures [#####] cm, the lesser curvature measures [#####] cm, and the internal circumference measures [#####] cm. The serosa is [tan-pink and smooth/shows a firm area measuring] with a small amount of lesser curvature adipose tissue measuring [#####] cm and a moderate amount of greater curvature omentum measuring [#####] cm. The proximal margin is inked [blue] and the distal margin is inked [green]. The serosal surface is inked [black] at the [area of nodularity]. The specimen is opened along the [greater] curvature to reveal an [ulcerated lesion] located at the [greater curvature/lesser curvature/anterior wall/posterior wall] and measuring [#####] x [#####] cm. It is located [#####] cm from the proximal resection margin and [#####] cm from the distal resection margin. The remainder of the stomach mucosa [shows smooth rugal folds/appears roughened and hemorrhagic/appears nodular, describe extent]. Serial sections of the [ulcerated lesion] reveal tan-white, thickened cut surfaces extending to a depth of [#####] cm, with a wall thickness of [#####] cm. The mass [appears/does not appear] to involve the [black] inked serosal surface. The uninvolved mucosa shows an average wall thickness of [#####] cm. The greater curvature fat is sectioned and [#####] lymph node candidates are identified ranging from [#####] to [#####] cm in greatest dimension. The lesser curvature fat is sectioned and [#####] lymph node candidates are identified ranging from [#####] to [#####] cm in greatest dimension. Representative sections are submitted as follows, including the [ulcerated lesion] submitted entirely:

[#####] Proximal margin, [en face or representative perpendicular] [#####] Distal margin, [en face or representative perpendicular] [#####] Sections of [ulcer/mass], full thickness sections, submitted entirely

[#####] Sections of [additional lesions] [#####] Uninvolved stomach mucosa

[#####] Candidate perigastric lymph nodes from lesser curvature

[#####] Candidate perigastric lymph nodes from greater curvature

[#####] Additional candidate perigastric lymph nodes, following immersion in Carnoy’s solution

Esophagogastrectomy

The [first] specimen labeled “[#####]” with the patient’s name and medical record number is received [in formalin] and consists of one [esophagogastrectomy] specimen measuring overall [# x # x #] cm, [oriented with a stitch marking the proximal/distal margin]. The specimen consists of a portion of esophagus measuring [#####] in length and [#####] in diameter, a portion of stomach measuring [# x # x #] cm, and a small amount of attached adipose tissue measuring [# x # x #]. The serosa is [tan-pink and smooth/shows a firm area measuring]. The proximal margin is inked [blue] and the distal margin is inked [green]. The serosal surface is inked [black] at the [area of nodularity]. The specimen is opened to reveal pale tan-pink squamous mucosa extending to a length of [#####] from the proximal end, and tan-brown gastric mucosa distally. An [ulcerated lesion] is also identified measuring [# x # x #], located at the [gastroesophageal junction with greater than 50% of the ulcer involving the esophagus/stomach as measured based on the anatomic narrowing of the esophagus, NOT the transition of squamous to glandular]. It is located [at or distal to] the squamocolumnar junction, and is [#####] cm from the proximal resection margin and [#####] cm from the distal resection margin. The remainder of the stomach mucosa [shows smooth rugal folds/appears roughened and hemorrhagic/appears nodular, describe extent]. Serial sections of the [ulcerated lesion] reveal tan-white, thickened cut surfaces extending to a depth of [#####] cm, with a wall thickness of [#####] cm. The mass [appears/does not appear] to involve the [black] inked serosal surface. The uninvolved mucosa shows an average wall thickness of [#####] cm. The attached adipose tissue sectioned and [#####] lymph node candidates are identified ranging from [#####] to [#####] cm in greatest dimension. Representative sections are submitted as follows, including the [ulcerated lesion] submitted entirely:

[#####] Sections of [additional lesions] [#####] Uninvolved stomach mucosa

[#####] Candidate periesophageal and perigastric lymph nodes

[#####] Periesophageal and perigastric adipose tissue, entirely submitted

Pancreatobiliary

Whipple IPMN

On opening, the small bowel displays a tan-pink grossly unremarkable mucosa and the wall thickness is [ ] cm. The common bile duct and pancreatic ducts are obstructed/probe patent and the head of pancreas is bisected along this coronal plane into an anterior and posterior halves. The common bile duct, inked green, is [ ] cm in length and measures [ ] mm in diameter. The CBD mucosa is tan-pink and grossly unremarkable. The pancreatic duct (inked orange) displays an unremarkable mucosa. The head of pancreas contains a tan-pink, multiloculated smooth-walled cyst filled with clear watery fluid. The cyst measures [ ] x [ ] x [ ] cm (the locules range from [ ] x [ ] x [ ] cm to [ ] x [ ] x [ ] cm). The cyst is located at [ ], [ ] cm from CBD margin, [ ] cm from the pancreatic neck margin, [ ] cm from the vascular groove, [ ] cm from the uncinate margin, [ ] cm from the anterior surface of pancreas, [ ] cm from the posterior surface of pancreas, [ ] cm from the proximal small bowel margin, [ ] cm from the distal small bowel margin, and [ ] cm from the closest pancreatic duct. No areas of thickening or papillary excrescences are grossly identified. The cyst does not grossly invade into the adjacent bowel mucosa or muscularis propria. The uninvolved pancreatic parenchyma is tan-yellow, lobulated, and grossly unremarkable.

Multiple lymph nodes are identified, ranging from [ ] to [ ] cm. Gross photographs are taken. Representative sections are submitted in [ ] cassettes:

A1: Common bile duct margin, en face

A2: Pancreatic neck margin, en face

A3: Vascular margin, en face

A4-A6: Uncinate process (perpendicular and sequential section, entirely submitted

A7: Bowel proximal and distal margins

A8-A10: Pancreatic cyst (sequential sections, entirely submitted) with anterior surface (inked blue), posterior surface (inked black) and vascular groove (inked red)

A11-A12: Uninvolved pancreas

A13: Common bile duct mucosa at ampulla

A14-A15: Lymph and lymph node candidates

Specimen placed in formalin at [ ].

Whipple Cancer

Received fresh, labeled with the patient’s name ” ” and designated “[ ]” is a Whipple specimen composed of a segment of duodenum ([ ] cm in length x [ ] cm in diameter) and a [ ] x [ ] x [ ] cm head of pancreas. The proximal and distal small bowel margins are stapled closed; the proximal margin is inked blue and the distal margin is inked green. The serosa is pink-red and smooth. The head of pancreas is inked as follows: Anterior surface = blue, posterior surface = black, pancreatic neck margin = orange, uncinate process = green and vascular groove = red. On opening, the small bowel displays a tan-pink grossly unremarkable mucosa and the wall thickness is [ ] cm. The common bile duct and pancreatic ducts are obstructed/probe patent and the head of pancreas is bisected along this coronal plane into an anterior and posterior half. The common bile duct, inked green, is [ ] cm in length and measures [ ] mm in diameter. The CBD mucosa is tan-pink and grossly unremarkable. The pancreatic duct (inked orange) displays an unremarkable mucosa.

The head of pancreas reveals a white firm mass. The mass measures [ ] x [ ] x [ ] cm. The mass is located/grossly abuts [ structure], and is located [ ] cm from CBD margin, [ ] cm from the pancreatic resection margin, [ ] cm from the vascular groove, [ ] cm from the uncinate process, [ ] cm from the anterior surface of pancreas, [ ] cm from the posterior surface of pancreas, [ ] cm from the proximal small bowel margin, [ ] cm from the distal small bowel margin, and [ ] cm from the closest pancreatic duct. No areas of thickening or papillary excrescences are grossly identified. The mass does not grossly invade into the adjacent bowel mucosa or muscularis propria. The uninvolved pancreatic parenchyma is tan-yellow, lobulated, and grossly unremarkable.

Multiple lymph nodes are identified, ranging from [ ] to [ ] cm. Gross photographs are taken. Representative sections are submitted in [ ] cassettes:

A1: Common bile duct margin, en face

A2: Pancreatic neck margin, en face

A3: Vascular margin, en face

A4-A6: Uncinate process (perpendicular and sequential section, entirely submitted)

A7: Bowel proximal margin (inked blue)

A8: Bowel distal margin (inked green)

A9-A12: Pancreatic mass (Full-face of the mass, separated into 4 cassettes)

A13: Anterior surface (inked blue, closest to mass)

A14: Posterior surface (inked black, closest to mass)

A15: Vascular groove and pancreatic duct (inked red, closest to mass)

A16: Bowel wall (closest to mass)

A17: CBD (closest to mass)

A18: Uninvolved pancreas

A19: Common bile duct mucosa at ampulla

A20: Lymph node and lymph node candidates

Specimen placed in formalin at [ ].

Whipple, Option 3

The [first] specimen labeled “[#####]” with the patient’s name and medical record number is received [in formalin] and consists of one Whipple specimen measuring overall [#####]. The specimen is inked as follows: the bile duct margin is inked green, the pancreatic neck margin is inked yellow, the uncinate margin is inked blue, the vascular groove is inked red, and the posterior soft tissue is inked black. The duodenum measures [#####] cm in length, and [#####] cm in average diameter. The proximal margin measures [#####] cm, and the distal margin measures [#####] cm. The common bile duct is identified [by a suture or staple/is received open] and the lumen measures [#####] cm in diameter. [Stent placed in bile duct?] The staple lines are shaved off, and the duodenum is opened along the anti-pancreatic aspect. The duodenal mucosa is [describe mucosa/mass if present]. The ampulla of Vater is [probe patent/stenotic]. The pancreatic neck margin and uncinate margin are taken and the pancreas is serially sectioned to reveal a [tan/white], [poorly circumscribed/well-circumscribed] mass measuring [#####] cm. The mass is located in the [head of the pancreas/uncinate process/pancreatic neck/ampulla of Vater]. The mass is located [#####] cm from the uncinate margin, [#####] cm from the pancreatic neck margin, and [#####] cm from the posterior soft tissue edge. The tumor grossly invades [describe involvement of peripancreatic fat and/or duodenum]. The remainder of the pancreas appears [grossly normal with lobulated cut surfaces/atrophic/shows fat necrosis]. The peripancreatic fat is sectioned to reveal multiple candidate lymph nodes ranging in size from [#####] cm to [#####] cm in greatest dimension. The remaining peripancreatic fat is shaved off and submitted entirely. [Specimen photographs are taken.]

[#####] Proximal duodenal margin, en face

[#####] Distal duodenal margin, en face

[#####] Common bile duct margin, en face

[#####] Pancreatic neck margin, perpendicular sections, entirely submitted

[#####] Uncinate margin, perpendicular sections, entirely submitted

[#####] Sections of mass in relation to [#####] margin

[#####] Section of mass in relation to ampulla

[#####] Sections of [additional lesions] [#####] Uninvolved duodenum

[#####] Candidate peripancreatic lymph nodes

[#####] Remaining peripancreatic fat, submitted entirely

Distal Pancreatectomy

The [first] specimen labeled “[#####]” with the patient’s name and medical record number is received [in formalin] and consists of one distal pancreatectomy specimen measuring overall [#####] cm and weighing [#####] cm. It consists of a portion of pancreas with attached spleen. The portion of pancreas measures [#####] cm and the spleen measures [#####] cm. The proximal pancreatic resection margin is [stapled /identified] and measures [#####] cm; it is inked green. The anterior surface is inked blue and the posterior surface is inked black. The pancreas is serially sectioned in the sagittal plane to reveal a mass measuring [#####] cm, located [#####] cm from the proximal resection margin, [#####] cm from the anterior blue inked surface, and [#####] cm from the posterior black inked surface. The mass appears [homogeneous/well-circumscribed/tan-yellow/tan-red] on cut surface. The remaining pancreatic parenchyma is [unremarkable and appears tan-yellow and lobulated].

The spleen is serially sectioned to reveal [dark red-brown cut surfaces with unremarkable appearing red and white pulp].

Examination of the peripancreatic fat reveals [#####] candidate lymph nodes measuring up to [#####] cm in greatest dimension.

Representative sections are submitted as follows:

[#####] Proximal pancreatic margin, perpendicular sections, entirely submitted

[#####] Representative sections of mass

[#####] Section of mass in relation to [#####] margin

[#####] Section of mass in relation to uninvolved pancreatic parenchyma

[#####] Representative section of spleen

[#####] Candidate peripancreatic lymph nodes

Liver

Partial Hepatectomy

The [first] specimen labeled “[#####]” with the patient’s name and medical record number is received [in formalin] and consists of one partial hepatectomy specimen measuring overall [# x # x #] and weighing [#####] grams. The capsular surface is [red-brown/purple/tan] and is [smooth or describe disruption]. The resection surface measures [#####] x [#####] cm and shows [multiple undesignated sutures and clips]. The resection margin is inked [black]. The liver is serially sectioned to reveal a [well-circumscribed], [tan-white/tan-red/heterogenous/hemorrhagic/friable/firm] mass measuring [# x # x #]. It is located [#####] cm from the resection margin at its closest approach. It is located [#####] cm from the capsular surface. The remainder of the liver shows [red-brown, smooth cut surfaces without any grossly apparent masses or lesions]. Representative sections of the mass are submitted as [#####], including closest approach to resection margin found in [#####], and tumor in relation to uninvolved liver in [#####]. One section of uninvolved liver parenchyma is submitted as [#####].

Liver Explant

The [first] specimen labeled “[#####]” with the patient’s name and medical record number is received [in formalin] and consists of one liver explant specimen measuring overall [# x # x #] and weighing [#####] grams. The gallbladder is [absent/attached and measures]. The outer capsular surface of the liver appears [smooth/nodular/yellow/green/brown]. Multiple tied and sutured hilar structures are noted, and include the bile duct, hepatic artery, and hepatic vein. A shave of the hilar structures, including the bile duct is taken and is submitted en face as [#####]. The underlying intrahepatic portion of the hilar vascular structures is also shaved and this tissue is submitted en face as [#####].

[The gallbladder is removed and is opened to revealâ€¦use gallbladder template]

The liver is serially sectioned from [anterior to posterior] to reveal [diffusely nodular/unremarkable tan-brown] cut surfaces and [describe masses or lesions with size, location, and distance from hilar vascular margin].

Representative sections are submitted as follows:

[#####] Shave of hilar structures

[#####] Shave of intrahepatic hilar structures, immediately underlying section in [#####] [#####] Sections of [mass/lesion] [#####] Sections of [mass/lesion] [#####] Representative section of grossly uninvolved liver, left lobe

[#####] Representative section of grossly uninvolved liver, right lobe

[#####] Gallbladder

GI Grossing Templates

Colorectal

Upper GI

Pancreatobiliary

Liver