Case -T7-2C PATHOLOGY REPORT

Essay

Case
-T7-2C PATHOLOGY REPORT
LOCATION: Inpatient, Hospital
PATIENT: Cecil Graft
SURGEON: Gary Sanchez, MD
ATTENDING PHYSICIAN: Gary Sanchez, MD
PATHOLOGIST: Morton Monson, MD
CLINICAL HISTORY: Right colon resection
SPECIMEN RECEIVED: Right hemicolectomy, hepatic flexure tumor
GROSS DESCRIPTION: Received in a container labeled "extended right colon hepatic flexure" are two segments of colon. One segment includes the cecum and ascending colon and measures 10 cm (centimeter) in length. A segment of terminal ileum measuring 6 cm in length is present. The appendix, which appears normal, is also present and measures 5 cm in length and 0.6 cm in diameter. Abundant mesocolon is present. The specimen is opened and demonstrates a granular green-tan mucosa, which is intact. A small polyp is present in the cecal pouch. This has a nodular appearance and measures 1.3 1 1 cm. The ileocecal valve is unremarkable, and the remainder of the mucosa shows no abnormalities.
A second segment of colon measuring 9 cm in length is present. This has been opened, and a tumor that encircles the majority of the circumference of the lumen is present. The tumor is raised nodular and tan-brown to green. It measures 5 3.5 1.4 cm in greatest dimension. On sectioning, it appears to involve the wall. The specimen is sectioned, and multiple representative portions of the tumor are submitted as 1 to 6. The margins of resection about the tumor are submitted as 7 and 9. The polypoid lesion in the cecum is submitted as 8. The mesocolon is dissected, and lymph nodes are submitted as 10 to 13. Sections of the ileum are submitted as 14, and the appendix is submitted as 15.
MICROSCOPIC DESCRIPTION: The hepatic flexure of the colon demonstrates an invasive tumor consisting of complex glands lined by moderately differentiated pleomorphic epithelial cells. The tumor infiltrates through the muscular wall into the adjacent mesocolon. An abundant mucinous component is present near the deeply invasive portions. The surgical margins of resection are free of tumor. The terminal ileum shows normal morphology. The appendix shows normal morphology. Six lymph nodes of the mesocolon are negative for tumor. The cecum contains a polyp with adenomatous epithelial features.
DIAGNOSIS:
Colon, including cecum, ascending colon, and hepatic flexure, excision: Adenocarcinoma, moderately differentiated, infiltrating through muscular wall into mesocolon (hepatic flexure). Adenomatous polyp (cecum).
Terminal ileum, 6 cm (centimeter): No pathologic diagnosis.
Appendix: No pathologic diagnosis.
Lymph nodes, mesocolic, six: Negative for tumor (no pathologic diagnosis).
COMMENT: The NCCTG modification of Dukes' staging is B2.
T7-2C:
SERVICE CODE(S): ___________________________________________________
ICD-10-CM DX CODE(S): ______________________________________________