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Volume 67 - 2004 - Fasc.1 - Guidelines

Guidelines for adequate histopathological reporting of pancreatic ductal adeno- carcinoma resection specimens

More than 90% of all malignant tumours of the pan- creas are exocrine carcinomas and, of these, 95% are ductal adenocarcinomas (1-2). Since a cure is possible only in case of complete resection of the primary tumour, including its local and regional extensions, the arrival of a resected pancreas in the surgical pathology laboratory is a quite common but for many pathologists stressful event, due to the complexity of the anatomy and the importance of a good dissection in establishing the correct diagnosis and staging. However, a simple, logical approach to the dissection and histopathological reporting can avoid many problems.



Gastrointestinal cancer is an important health problem. In 1998, 5089 new cases of colorectal cancer (2667 male) and 1095 new cases of gastric cancer (637 male) were diagnosed in Belgium. Gastrointestinal cancer still carries a high morbidity and mortality rate. In 1997, 3059 patients died of colorectal cancer. Secondary prevention with early diagnosis and proper surgical treatment, including adjuvant treatment with chemotherapy or radiotherapy for more advanced cases are therefore very important. The therapeutic strategy depends partly upon the information provided by the pathologists examining surgical resection specimens. This implies analysis of these specimens according to generally accepted criteria. The Belgian Club for Digestive Pathology has organized a working party for the design of guidelines for adequate reporting of resec- tion specimens of gastrointestinal cancer.


Histopathological reporting of resected carcinomas of the oesophagus and gastro-oesophageal junction

In 1999, the Institute of Medicine (IOM) published a report entitled 'To err is human' regarding medical error and its effects on patient's safety in the United States (1). The 287-page report stated that medical errors cause a large number of deaths in American hospitals and that physicians have been rather complacent about iatrogenic injury. The report also formulated measures to reduce future medical errors. The more recent IOM report sin- gles out physicians 'irrational variation' as a major con- tributor to the 'quality chasm' (2).


Recommendations for pathological examination and reporting for colorectal cancer Belgian Consensus

For over years, numerous studies have demonstrated the utmost importance of pathological examination in assessing prognosis for cancer patients. For colorectal cancer, it has been shown that the depth of invasion, the presence of lymph node metastases, their number and localisation, the presence of tumour at the surgical margins and the presence of vascular invasion need to be assessed. These data are indicative in the choice for additional treatment. Therefore standardisation of pathological examination is important for the quality of care of the patient. The Belgian Club for Digestive Pathology has attempted to reach a National consensus on pathological examination and reporting. To start with J-P. Bogers and C. Sempoux analysed the literature and compared American, English and French data concer- ning standardisation for colorectal cancer (1,2,3,4,5). The authors concluded that unanimity exist for certain features to be included whilst others are still under deba- te (6). Therefore a group of Belgian pathologists* met to debate on these data and issues and to present a check- list that would help pathologists


Critical review in the surgical pathology of carcinoma of the stomach

Further to a thorough analysis of the management of the surgical specimen for gastric carcinomas, guidelines were defined following several recommendations including informative gross and micro- scopic descriptions associated to a final correct staging of the tumour, according to the TNM classification and must at least include tumour penetration, nodal or distant metastases.


BASL guidelines for the surveillance, diagnosis and treatment of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a primary tumour of the liver. Its behaviour is rather peculiar with progno- sis made out not only by the tumoural disease but also by the severity of the underlying liver disease. Worldwide it is a major problem. In the West, however, the prevalence is lower than in developing countries. However due to a rise in HCV induced liver cirrhosis, HCC becomes more prevalent in Belgium. In the HepCar registry (a Belgian registry where on a voluntary basis, patients with HCC are reported), 70 patients (51 male / 19 female) were reported between January 2003 and September 2003. Median age was 62 years ± 12. Underlying liver disease was HCV in 29 patients, HBV in 14 patients, alcoholic liver disease in 16 patients and miscellaneous in 12 patients. Diagnosis was made by surveillance in 27 patients. There was a clear tenden- cy for incidental diagnosis in patients with alcoholic liver disease.