Berho Mariana, Bejarano Pablo A
Department of Pathology, Cleveland Clinic Florida, Weston, FL, USA -
Department of Pathology, Cleveland Clinic Florida, Weston, FL, USA.
Minerva Chir. 2018 Dec;73(6):534-547. doi: 10.23736/S0026-4733.18.07739-8. Epub 2018 Apr 13.
Examination of the rectum by pathologists is instrumental in the management of patients affected by rectal carcinoma. That role includes evaluation of multiple gross and microscopic features that convey prognostic implications. The analysis is based on the authors' experience handling rectal specimens along with review of the pertinent literature in these areas: margins of excision, quality of the mesorectum, diligence and techniques to sample lymph nodes, tumor budding, grading of residual amount of carcinoma after preoperative therapy, vascular/perineural invasion, and staging the tumor. Pathologists must communicate the findings in a clear manner. Evaluation of margins and completeness of mesorectum are markers of the quality of surgical excision. The number of lymph nodes obtained and examined is dependent in great part on the diligence of the pathologist finding them in the mesenteric adipose tissue. There are grades for budding and response to prior chemoradiation therapy. The location of vascular invasion (extramural vs. intramural) may predict aggressive behavior. Pathologists proactively are to choose sections of tumor for molecular testing. Meticulous macro- and microscopic evaluation of specimens for rectal carcinoma by pathologist is needed to determine an accurate assessment of staging and other prognostic factors. The modern pathologists play a pivotal part in the care and management of patients suffering from rectal adenocarcinoma. That role goes from the initial histological diagnosis to the gross and microscopic examination of the excised specimens. Based on that examination pathologists issue statements that not only evaluate the quality of the surgical procedure, but also through the application of molecular tests they give light on prognostic factors and information for therapeutic purposes.
病理学家对直肠进行检查有助于直肠癌患者的治疗。该作用包括评估多种具有预后意义的大体和微观特征。分析基于作者处理直肠标本的经验以及对这些领域相关文献的回顾：切缘、直肠系膜质量、淋巴结取样的勤勉程度和技术、肿瘤芽生、术前治疗后癌残留量的分级、血管/神经周围侵犯以及肿瘤分期。病理学家必须以清晰的方式传达检查结果。切缘评估和直肠系膜完整性是手术切除质量的标志。获取并检查的淋巴结数量在很大程度上取决于病理学家在肠系膜脂肪组织中找到它们的勤勉程度。有芽生分级和对先前放化疗的反应分级。血管侵犯的位置（壁外与壁内）可能预示侵袭性行为。病理学家应主动选择肿瘤切片进行分子检测。病理学家需要对直肠癌标本进行细致的大体和微观评估，以准确评估分期和其他预后因素。现代病理学家在直肠腺癌患者的护理和治疗中发挥着关键作用。该作用从最初的组织学诊断到切除标本的大体和微观检查。基于该检查，病理学家发布的报告不仅评估手术操作的质量，还通过应用分子检测揭示预后因素和治疗目的的信息。
