Extralevator abdominoperineal resections and the need for pathological assessment of fresh tissue specimens

• Published in: Journal of clinical pathology Vol. 64; no. 5; pp. 456 - 457
• Main Authors: Roxburgh, C S D, McTaggart, V, Balsitis, M, Diament, R H
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Association of Clinical Pathologists 01.05.2011; BMJ Publishing Group LTD
• Subjects: Cancer; Colorectal cancer; Colorectal Surgery - methods; Dissection; fixation; Humans; musclesurgerysurgical pathology; Neoplasm Invasiveness - diagnosis; Neoplasm Staging - methods; Proteins; Quality; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Specimen Handling; Tissue Fixation - methods
• ISSN: 0021-9746; 1472-4146
• DOI: 10.1136/jcp.2010.088013

Fixation in formalin can result in shrinkage or contraction of the tissue by up to 33%, increasing with time and occurring in both the longitudinal and the circumferential planes. 3 5 One effect of formalin is dehydration. 5 Formalin stabilises cellular structure by crosslinking proteins, glycoproteins, nucleic acids and polysaccharides, particularly at sites of primary amines such as lysine. Initial assessment should be followed by fixation for at least 48 h prior to block selection. 7 Assessment of the external contour of colorectal cancer resection specimens is recognised to provide an indication of the quality of the resection. 8 Although the effect of fixation shrinkage on microscopic measurement of the CRM is unknown, our experience confirms that photography to assess and record the quality of extralevator APE resections should be undertaken on fresh specimens, particularly to avoid erroneous recording of 'coning'.