Grossing of the

Gastrointestinal Tract

Dr. H. Subramanya
Professor of Pathology,
MVJ Medical College & Research
Hospital
 Objectives
• Specimen : Type of surgery
• Identification of organs
• Gross features
• Bits
• Correct legend of sections
Grossing of Stomach
 Ulcers
Benign
• Peptic ulcer
• Curlings
• Cushing Ulcer
• Stress ulcer
• NSAIDs ulcer
• Malignant
 Benign vs malignant ulcer
Benign ulcer Malignant ulcer
• Location : along lesser • Along lesser and greater
curvature commonly curvature
• Size : < 2cms • > 2 cms
• Margins : sharp, • Everted , rugae stop short
rugae come upto the edge of the margin due to
tumour infiltrates
• Floor : clean • Dirty
• Base : mobile to firm • Fixed
• Micro : 4 zones • Glandular neoplasm
 Gastrectomy specimen – peptic ulcer

A,B,C,D - Ulcer
E - Lessor Curvature
F - Greater Curvature
G - Duodenum
H- Normal Mucosa
J - Lymph nodes
Normal gastric mucosa Benign Gastric Ulcer

Gastric erosions Perforated gastric ulcer

Trichobezoar
 Malignant ulcer

Depressed / Flat Linitis Plastica

Adenocarcinoma
Gastrectomy for malignancy
 Polypoidal growths of stomach

GIST

Malignant lymphoma

Carcinoid
Pancreatic Hetrotrophy- Stomach
Grossing of Esophagus
 Oesophagus

Radial surgical margin to be given for organs without serosa

Oesophagus
A - Tumor depth

B, C - Tumor with

interphase mucosa

D - Normal Mucosa

E - GE junction

F, G - Recected
margin

H - Radial margin

K,L - Lymph nodes

Tumour at the GE junction Bits
A,B,C- Tumor

D - Esophagus

D - Normal Mucosa

E - tumor with GE junction

F, - Recected margin
Esophagus

G - Gastric Rescted margin

H – Radial margin

J – Random bits stomach

K, L, M - Lymph nodes
Esophageal varices
 Oesophagus
Adenocarcinoma with
Barrett Oesophagus extension into the cardia.

Velvety mucosa distinct from

the pale squamous mucosa
 Squamous cell Carcinoma
Oesophagus

Flat Superficial Polypoidal Polypoidal with

surface ulceration
Squamous cell Ca Adenocarcinoma Malignant melanoma
Grossing of Small Intestine
Small intestine
Meckel’s Diverticulum: The blind pouch is located on the antimesenteric side of
the small bowel.
 intussuscipiens

intussusceptum
Ischemia Jejunal resection
with dusky serosa
 Typhoid Ulcer
Typhoid Ulcer

Ulcers have a longitudinal orientation as they are located over Peyer's patches.
Tuberculosis Ulcer

Belt like ulcer

Grossing of Large Intestine
 Large intestine

Radial margin should be taken in rectal tumours (no serosa)

Carcinoma Colon
A, B, C - Tumor with
adjacent mucosa &
serosa,

D - Normal Mucosa

E – Other lesion( polyp )

F, G – Recected margins

H - appendix ( R )
Anorectal Jn ( L)

J, K, L - Lymph nodes

M – Vascular pedicle
Colon Diverticulosis
 Sigmoid
colon

Rectum

Hirschsprung disease showing constricted rectum and dilated sigmoid colon

Large Intestine- Ulcerative Colitis

Pseudopolys
A. Small-intestinal stricture. B. Cobblestone appearence

Crohn
disease C. Linear mucosal ulcers
and thickened intestinal
wall.
Villous adenoma Tubular adenoma

Juvenile polyp Hyperplastics polyps

Familial adenomatous polyposis. A, Hundreds of small polyps are
present throughout this colon with a dominant polyp
A B

Colorectal carcinoma A. Ulcerative

2. Polypoidal
3. Tumor infilrating submucosa
Solitary rectal ulcer Amoebic colitis
Multiple, undermined
mucosal ulcers in caecum &
ascending colon.
Grossing of Appendix
Appendix
mucocoele

carcinoid
All of us are greatly indebited to this great Anatomical Pathologist

Carl Von Rokitansky

References & Images from :

1.Google Images

2. Surgical Pathology Dissection by William H. Westra et al.

3. Fundamentals of Surgical Pathology by shameem Sharif

4. Rubins Pathology

5. WHO : Pathology and Genetics of Tumours of the

Digestive System
Thank You