PubMed · 14385828
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V BUSH. 1955-07-15. Improved automatic microtome.. https://doi.org/10.1126/science.122.3159.119
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Even though the technique of total mesorectal excision has been widely used, there have been few detailed descriptions of the distribution of lymph nodes within the rectal mesentery. We describe the results of our anatomic study of lymph node size and distribution within the mesorectum and pelvic side-wall tissue using a fat-clearing solvent in seven male cadavers, and we used a similar technique to examine the mesorectum in a patient who underwent total mesorectal excision after preoperative chemoradiation for a uT3 rectal cancer. In both the cadavers and our patient, the majority of lymph nodes were located within the posterior upper two-thirds of the mesorectum. Few lymph nodes were located in the distal mesorectum or anteriorly. In the cadavers, the majority of lymph nodes were less than 3 mm in diameter. In the patient who had received preoperative chemoradiation, routine tissue processing yielded only four lymph nodes, whereas processing in fat-clearing solvent yielded 25 additional nodes. The majority of these nodes, in contrast to those observed in cadavers, were less than 1 mm in diameter. The majority of mesorectal lymph nodes were located within the upper two-thirds of the posterior mesorectum. Complete removal of nodes in this area may, in part, explain the superior results of total mesorectal excision with respect to local recurrence.
The imposition of laboratory cost containment, often from external forces, dictates the necessity to develop strategies to meet laboratory cost savings. In addition, the national and worldwide shortage of anatomical pathologists makes it imperative to examine our current practice and laboratory set-ups. Some of the strategies employed in other areas of pathology and laboratory medicine include improvements in staff productivity and the adoption of technological developments that reduce manual intervention. However, such opportunities in anatomical pathology are few and far between. Centralisation has been an effective approach in bringing economies of scale, the adoption of 'best practices' and the consolidation of pathologists, but this has not been possible in anatomical pathology because conventional histoprocessing takes a minimum of 14 hours and clinical turnaround time requirements necessitate that the laboratory and pathologist be in proximity and on site. While centralisation of laboratories for clinical chemistry, haematology and even microbiology has been successful in Australia and other countries, the essential requirements for anatomical pathology laboratories are different. In addition to efficient synchronised courier networks, a method of ultra-rapid tissue processing and some expedient system of returning the prepared tissue sections to the remote laboratory are essential to maintain the turnaround times mandatory for optimal clinical management. The advent of microwave-stimulated tissue processing that can be completed in 30-60 minutes and the immediate availability of compressed digital images of entire tissue sections via telepathology completes the final components of the equation necessary for making centralised anatomical pathology laboratories a reality.
We present a simple way of orientating large specimens being sent to the laboratory for histopathological examination by supplementing the pinning of the specimen on a cork board with Polaroid photographs of the specimen and numbered tags.