What this test measures
Major organ / tumour resection specimens. Comprehensive grossing (description, measurement, orientation, margin inking, sectioning into multiple blocks per CAP / RCPath protocols), then full processing, embedding, sectioning, H&E staining + IHC + molecular as needed. Reports cover diagnosis, grade, full TNM staging, all margins, lymph node count + positivity, lymphovascular and perineural invasion, hormonal receptor and molecular markers, adjacent tissue findings.
Why it matters
Large specimens carry the highest clinical stakes — full TNM staging guides adjuvant chemotherapy, radiation, hormonal therapy, and prognosis. Indian Cancer registries report rising rates of breast, colorectal, prostate, lung, oral, and cervical cancers. Each large specimen report drives the multidisciplinary team's plan for: adjuvant chemotherapy decisions, radiation field planning, targeted therapy eligibility (HER-2, EGFR, ALK, BRAF, MSI), prognosis discussion, and surveillance scheduling.
How to prepare
Surgical prep — usually general anaesthetic, 1-3 day admission depending on procedure. Disclose anticoagulation, allergies, current medications. Specimen handling: surgical team orients and ink-marks specimen at OT (especially margins, sutures); transports in 10% formalin (volume ≥ 10x tissue) to pathology.
Markers & reference ranges
Reference ranges below are typical adult values. Your lab's reported range may differ slightly based on the assay platform and patient demographics — always read your report against the range printed on it.
| Marker | Normal range | If low | If high |
|---|---|---|---|
| Histopathology + Staging + Molecular (Descriptive + TNM stage + IHC + molecular)[1][2] | Benign with clear margins (no malignancy) | Benign — incidental findings; routine follow-up. | Malignant — diagnosis, grade, full pT N M stage, all margins (inked), lymph nodes (count examined + positive), lymphovascular / perineural invasion, hormone receptors (breast: ER/PR/HER-2; gynae: ER/PR; gastric: HER-2), molecular markers (KRAS, NRAS, BRAF, MSI for colorectal; EGFR / ALK / ROS1 / PD-L1 for lung; BRCA for ovarian / breast). Synoptic reporting (structured CAP-style summary) supports MDT decision-making. |
Common large resection specimens
| Specimen | Key reporting |
|---|---|
| Colectomy (cancer) | TNM, MSI, KRAS/NRAS/BRAF, LN count ≥ 12 |
| Mastectomy | TNM, ER/PR/HER-2, lymphovascular, axillary LN |
| Hysterectomy (endometrial) | TNM, depth of myometrial invasion, lymphovascular, MMR/MSI |
| Nephrectomy | Tumour type, ISUP grade, TNM, renal vein, IVC, Gerota |
| Prostatectomy | Gleason / ISUP grade, % core involved, margins, lymph nodes |
| Lobectomy (lung) | TNM, EGFR / ALK / ROS1 / PD-L1, pleural / visceral involvement |
Frequently asked questions
How long does the report take?
Routine major resection: 7-14 days. Complex cases needing molecular testing: 2-3 weeks. Frozen section (intraoperative): same-day result.
Why so many tests on one specimen?
Modern cancer treatment depends on multiple data points — TNM stage (guides chemo / radiation), receptor status (hormone / targeted therapy), molecular profile (immunotherapy, targeted drugs). Each test informs a treatment decision.
What is synoptic reporting?
Structured CAP-style report with all required elements in a standardised format — ensures nothing is missed and supports tumour-board decisions.
How many lymph nodes should be examined?
Minimum standards: colorectal ≥ 12, gastric ≥ 16, breast (axilla) ≥ 10, lung ≥ 6 stations. Higher counts associated with better staging accuracy.
What is MSI / MMR for colorectal?
Microsatellite Instability / Mismatch Repair status — identifies Lynch syndrome (hereditary) and predicts immunotherapy response (immunotherapy works in MSI-high tumours).
Should I get a second opinion?
For unusual / complex / borderline malignant diagnoses before major treatment, a second pathology opinion is reasonable — discuss with your oncologist.
Related Histopathology / Cytology tests
Tests commonly ordered alongside HISTOPATH (LARGE), or that help interpret an unexpected result.
Sources & references
- Royal College of Pathologists — Specimen Handling · accessed 2026-05-30T00:00:00.000Z
- CAP — Cancer Protocols · accessed 2026-05-30T00:00:00.000Z
- Indian Association of Pathologists · accessed 2026-05-30T00:00:00.000Z
- WHO Classification of Tumours · accessed 2026-05-30T00:00:00.000Z
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