Grossing of Uterus in Carcinoma

Cervix
Presented by:
Jayesh Saha
Moderated by:
Ranjana Solanki maam
 Types of Specimens
Total hysterectomy Uterus with cervix is removed
Subtotal hysterectomy Uterus and part of cervix is removed, cervical stump is left
behind
Pan-hysterectomy Uterus with cervix and bilateral adnexae are removed

Radical hysterectomy types

Class I Extrafascial No vagina, parametria removed; no ureteric mobilisation.

Done for FIGO stage IA1 with LVI
Class II Modified radical Mid portion of uterosacral ligament, parametria to the
level of ureter and 1 cm vaginal margin are removed. Done
for FIGO stage IA2, IA1 with LVI

Class III - Radical All of uterosacral ligament, parametria to the origin of

uterine artery and 1/3rd of of vagina are removed. Done for
FIGO stage IB-IIA. Most commonly performed surgery.

Class IV Radical 3/4th of vagina is removed, superior vesicle artery is

sacrificed and ureter is completely dissected from pubo-
vesical ligament. Done for recurrent disease

Class V - Radical Resection includes portion of distal ureter and bladder.

Done for recurrent disease
 RECEIVING AND IDENTIFICATION OF
SPECIMENS AND REJECTION

Confirm that patient identification information on the

requisition form and specimen container match.
Pathology number generated should be affixed on the
requisition form and the container.
Note the condition in which specimen is received: fixed and
unfixed, fixed in inadequate or adequate formalin, or
autolysed.
If there is incorrect or no identification number, mismatch in
number of specimens mentioned and received then specimens
are returned with details including reason for rejection.
 ORIENTATION OF HYSTERECTOMIES

Preceding from anterior to posterior are:

A. ROUND LIGAMENT
B. FALLOPIAN TUBE
C. OVARY
D. OVARIAN LIGAMENT

The peritoneal reflection is lower on the

posterior side and often comes to a point.
It is higher and blunter on anterior surface.
Anterior surface is convex
Posterior surface is flatter
 ANTERIOR

ROUND LIGAMENT
FALLOPIAN TUBE

OVARY
POSTERIOR

ORIENTATION OF
SPECIMEN
Grossing
Measure and weigh the specimen.
Examine the serosal surface : adhesions, tumour implants or
direct invasion by tumour.
Record overall dimensions of the uterus, tubes, and ovaries.
Record the dimensions of exocervix, diameter and shape of
external os
Describe the appearance and any lesions of cervix
Vaginal reflection at the cervix should be examined for tumour
implants
State in description if specimen was received intact or was
previously opened.
Ink the parametrial surgical margins and vaginal/cervical
margin.
Opening And Fixation Of
Specimen
There is no one right technique of opening the uterus.
Various methods are:
o Y- shaped incision on the anterior surface or even can be
bisected and sectioned.
o Open uterus by cutting with scissors, along the lateral walls
from the external os to the uterine cornua.
Make serial transverse incisions with a larger blade not
with scissors or scalpel from mucosal surface to but not
through serosal surface at 1.0 cm intervals beginning at
the upper level of endocervical canal
Dont abrade the mucosa or wash with water.

FIX THE SPECIMEN OVERNIGHT IN FORMALIN. SECTIONS

ARE TAKEN THE FOLLOWING DAY.
 Take radial vaginal cut margins anterior, right lateral, posterior, left
lateral
Describe the tumour in the cervix location, endophytic or exophytic,
tumour dimensions
Mention the depth of invasion in the cervical stroma (less than half or
more than half). The tumour free cervical stromal thickness in mm is to
be given.
If the hysterectomy is for cervical tumour, and no lesion can be seen
grossly, then the ENTIRE CERVIX should be submitted for histology
Mention and sample any other lesion (polyp, fibroid)
Examine the endomyometrium and give its thickness. Give atleast one
section from it.
Examine each ovary by serially slicing them. Mention the dimensions,
cut surface and appearance.
Examine the tubes, give their length, presence of any paratubal cysts
etc.
Both sided parametria are to be examined in toto. The tissue is
submitted separately.
Sections to be submitted
Four sections of the tumour
Vaginal cut margins (anterior, right lateral,
posterior, and left lateral)
Endomyometrium 2 sections
Any other uterine pathology (polyp, fibroid etc.)
Right tube, ovary, parametrium
Left tube, ovary, parametrium
Bilateral pelvic nodes
 GROSS DESCRIPTION
Specimen: (Please mention type of surgery) _______________________________________
The uterus with cervix measures ____ X ____ X _____ cm.
An ulceroproliferative tumour is seen in the anterior lip / posterior lip / circumferentially / ______
________________________________________ measuring ____ X ____ cm with thickness of _____ cm. The tumour invades less than / more than half the
thickness of the cervical stroma. The vagina is macroscopically not involved / involved.
The tumour free cervical adventitial margin is _____ cm.
The various vaginal cut margins are: anterior - _____ cm, posterior - _____ cm, right lateral - _____ cm and left lateral - _____ cm.
Length of the anterior vaginal fornix is _____ cm and the posterior vaginal fornix is _____ cm.

The endometrium measures _____ cm in thickness and is ______________________________

The myometrium measures _____ cm in thickness and is ______________________________
The right ovary measures ____ X ____ X ____ cm and is ______________________________
The right fallopian tube is _____ cm long and is ______________________________________
The left ovary measures ____ X ____ X ____ cm and is _______________________________
The left fallopian tube is _____ cm long and is _______________________________________
Right parametrium measures ____ X ____ X ____ cm and is ___________________________.
Left parametrium measures ____ X ____ X ____ cm and is ____________________________

Lymph nodes:

Sections:

 Staging
Many patients are treated with radiation therapy and
never undergo surgical pathologic staging
Thus, AJCC prefers clinical staging (FIGO staging) of all
patients for uniformity
Clinical stage should be determined prior to start of
definitive therapy and not be altered because of
subsequent findings once treatment has started
Pathologic findings should be recorded as pT, pN or pM
but should not change the clinical staging
In AJCC 7th edition, TNM has changed to reflect FIGO
2008
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