Difference between revisions of "Hysterectomy for endometrial cancer grossing"

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==Introduction==
==Introduction==
This is a very common procedure as [[endometrial cancer]].
This is a very common procedure as [[endometrial cancer]].
==Opening==
===Orientation of hysterectomies===
*Less peritoneum on anterior (as the [[urinary bladder]] is there).
**'''P'''osterior '''p'''eritoneal edge: '''p'''ointy (upside down triangle).
***Anterior peritoneal edge: rounded/non-pointy.
*Tubes on anterior-lateral aspect.<ref>{{Ref Lester3|425}}</ref>
**Round ligaments posterior to tubes.


==Protocol==
==Protocol==
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***Necrosis: absent.  
***Necrosis: absent.  


INK CODE:   
Inking code:   
*Green - anterior serosa.  
*Green - anterior serosa.  
*Black - posterior serosa.
*Black - posterior serosa.


SECTION CODE:   
Representative sections:   
* Anterior cervix.  
* Anterior cervix.  
* Anterior lower uterine segment.  
* Anterior lower uterine segment.  
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===Protocol notes===
===Protocol notes===
In [[BRCA|BRCA1 mutation or BRCA2 mutation carriers]], the ovaries and tubes should be [[submitted in total]].<ref name=pmid24495259>{{Cite journal  | last1 = Downes | first1 = MR. | last2 = Allo | first2 = G. | last3 = McCluggage | first3 = WG. | last4 = Sy | first4 = K. | last5 = Ferguson | first5 = SE. | last6 = Aronson | first6 = M. | last7 = Pollett | first7 = A. | last8 = Gallinger | first8 = S. | last9 = Bilbily | first9 = E. | title = Review of findings in prophylactic gynaecological specimens in Lynch syndrome with literature review and recommendations for grossing. | journal = Histopathology | volume = 65 | issue = 2 | pages = 228-39 | month = Aug | year = 2014 | doi = 10.1111/his.12386 | PMID = 24495259 }}</ref>
===Alternate approaches===
===Alternate approaches===


Latest revision as of 17:11, 15 October 2021

Gross image of endometrial adenocarcinoma.

The protocol is for grossing a hysterectomy for endometrial cancer.

Hysterectomies with endometrial hyperplasia are dealt with in the hysterectomy for hyperplasia protocol.

Introduction

This is a very common procedure as endometrial cancer.

Opening

Orientation of hysterectomies

  • Less peritoneum on anterior (as the urinary bladder is there).
    • Posterior peritoneal edge: pointy (upside down triangle).
      • Anterior peritoneal edge: rounded/non-pointy.
  • Tubes on anterior-lateral aspect.[1]
    • Round ligaments posterior to tubes.

Protocol

Specimen:

  • Hysterectomy for endometrial cancer.

External measures:

  • Uterus and cervix: ___x___x___cm
  • Specimen mass: ____grams.
  • Left ovary: ___x___x___cm.
  • Left fallopian tube ___x___cm.
  • Right ovary: ___x___x___cm.
  • Right fallopian tube: ___x___cm.
  • Exocervix: ___cm.
  • Cervical os: ___cm, round/slit-like, probe patent.

Appearance:

  • Shape: [pear-shaped/distorted].
  • Serosal surface: [smooth, shiny, powder-burn lesions].
  • Serosa nodules/lesion/mass: [none, present ___cm in greatest dimension].
  • Ectocervix: tan-white glistening.
  • Left ovary: [unremarkable / atrophic / cortical cysts].
  • Left fallopian tube: [unremarkable / paratubal cysts].
  • Right ovary: [unremarkable / atrophic / cortical cysts].
  • Right fallopian tube: [unremarkable / paratubal cysts].

Internal measures:

  • Endometrial cavity: ____x____cm.
  • Myometrial wall thickness (maximum): ____cm.

Tumour:

  • Dimension: ___x___x___cm.
  • Location: [fundus/body, involves anterior and/or posterior wall, lower uterine segment, cervix].
  • Appearance: [ill-defined, soft, friable, polypoid-shape, tan-white].
  • Maximum depth of invasion: ___cm.
  • Myometrial thickness: ___cm.
  • Grossly normal endometrium - maximum thickness: ___cm.

Other findings:

  • Myometrial tumour(s):
    • Location: intramural / subserosal.
    • Appearance: white, firm, whorled.
    • Size range: ___-___cm in greatest dimension.
    • Other features:
      • Hemorrhage: absent.
      • Necrosis: absent.

Inking code:

  • Green - anterior serosa.
  • Black - posterior serosa.

Representative sections:

  • Anterior cervix.
  • Anterior lower uterine segment.
  • Posterior cervix.
  • Posterior lower uterine segment.
  • Tumour and anterior endomyometrium with greatest depth of invasion, full thickness sections [submit two full thickness section of deepest invasion from each involved wall of the myometrium with inked serosa].
  • Tumour and posterior endomyometrium with greatest depth of invasion, full thickness sections.
  • Additional sections of the tumour [for a total of at least one section/cm of tumour].
  • Section of firm whorled tan nodules in anterior/posterior myometrium.
  • Any other lesions.
  • Right ovary.
  • Right fallopian tube [fimbria submitted entirely].
  • Left ovary.
  • Left fallopian tube [fimbria submitted entirely].

Protocol notes

In BRCA1 mutation or BRCA2 mutation carriers, the ovaries and tubes should be submitted in total.[2]

Alternate approaches

See also

Related protocols

References

External links

  1. ↑ Lester, Susan Carole (2010). Manual of Surgical Pathology (3rd ed.). Saunders. pp. 425. ISBN 978-0-323-06516-0.
  2. ↑ Downes, MR.; Allo, G.; McCluggage, WG.; Sy, K.; Ferguson, SE.; Aronson, M.; Pollett, A.; Gallinger, S. et al. (Aug 2014). "Review of findings in prophylactic gynaecological specimens in Lynch syndrome with literature review and recommendations for grossing.". Histopathology 65 (2): 228-39. doi:10.1111/his.12386. PMID 24495259.
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