Lymph node staging in colorectal cancer: Old controversies and recent advances

Figure 1 Manual dissection with subsequent histological assessment based on routinely hematoxylin and eosin stained slides is the standard approach in the examination of regional lymph nodes in cancer specimens. A: Rectum cancer specimen of a 56-year-old female; B: Ulcerated primary tumor, measuring 5 cm in largest diameter; C: After preparation of the primary tumor (including the fatty tissue underneath the lesion and the circumferential margin) the remaining perirectal/mesocolic fatty tissue is carefully removed; D: Specimen for subsequent manual lymph node dissection; E: 36 presumed lymph nodes are isolated, of which the largest four are cut into halves and embedded on their own, respectively (lower right); F: 31 lymph nodes are confirmed on hematoxylin and eosin stained slides, one of which with metastatic cancer tissue (encircled).