Difference between revisions of "Hysterectomy for endometrial hyperplasia grossing"

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Sampling in these specimens is important, as one wants to identify [[endometrial cancer]] if it is present or be relatively certain it is absent.
Sampling in these specimens is important, as one wants to identify [[endometrial cancer]] if it is present or be relatively certain it is absent.
==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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===Protocol notes===
===Protocol notes===
In [[BRCA|BRCA1 mutation or BRCA2 mutation carriers]] (in addition to the endometrium and lower uterine segment), 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===


Line 61: Line 71:
*[[Radical hysterectomy for cervical cancer]].
*[[Radical hysterectomy for cervical cancer]].
*[[Hysterectomy for benign disease]].
*[[Hysterectomy for benign disease]].
*[[Hysterectomy for endometrial cancer grossing]].


==References==
==References==
 
{{Reflist|1}}
==External links==
==External links==


[[Category:Gynecologic pathology]]
[[Category:Gynecologic pathology]]
[[Category:Gross pathology]]
[[Category:Gross pathology]]

Latest revision as of 17:11, 15 October 2021

The protocol is for grossing a hysterectomy for endometrial hyperplasia.

Hysterectomies with biopsy proven cancer are dealt with in the hysterectomy for endometrial cancer protocol.

Introduction

This is a very common procedure as endometrial hyperplasia is common.

Sampling in these specimens is important, as one wants to identify endometrial cancer if it is present or be relatively certain it is absent.

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 hyperplasia.

Dimensions:

  • Uterus and cervix: ___x___x___cm.
  • Specimen mass: ____grams.
  • Left ovary: [___x___x___cm / not present].
  • Left fallopian tube: [___x___ cm / not present].
  • Right ovary: [___x___x___cm / not present].
  • Right fallopian tube: [___x___ cm / not present].

Appearance:

  • Shape: [pear-shaped/distorted].
  • Serosal surface: [smooth shiny/
  • Nodules/lesions/masses: [none/____cm in greatest dimension].
  • Ectocervix: [tan-white glistening with a probe patent os of ____cm].
  • Maximal myometrial wall thickness: ___cm.

Internal measures:

  • Endometrial cavity (superior to inferior, cornu to cornu): ____x____cm.
  • Endometrium thickness: ____cm.
  • Masses: [non-identified/intramural and subserosal white, firm, and whorled nodules that range from ____to ____cm in greatest dimension without any hemorrhage or necrosis/ with hemorrahage and necrosis].
  • Right and left ovaries: [tan-white and appear to be atrophic/ ____cortical cysts with/without hemorrhage]. *Right and left fallopian tubes: [unremarkable/ show paratubal cysts, ____cm in greatest dimension].

INK CODE:

  • Blue - anterior serosa.
  • Black - posterior serosa.

SECTION CODE:

  • Anterior cervix.
  • Anterior lower uterine segment.
  • Posterior cervix.
  • Posterior lower uterine segment.
  • Anterior endomyometrium, full thickness.
  • Remainder of the anterior endometrium, entirely submitted sequentially from superior to inferior [include endometrium and 5mm thick myometrium in each section, can put multiple sections in one cassette].
  • Posterior endomyometrium, full thickness.
  • Remainder of the posterior endometrium, entirely submitted sequentially from superior to inferior [include endometrium and 5mm thick myometrium in each section, can put multiple sections in one cassette].
  • Section of firm whorled tan nodules in anterior/posterior myometrium.
  • Any other lesions.
  • Right ovary with hemorrhagic cortical cysts.
  • Right fallopian tube [fimbria submitted entirely], with paratubal cysts.
  • Left ovary.
  • Left fallopian tube [fimbria submitted entirely].

Protocol notes

In BRCA1 mutation or BRCA2 mutation carriers (in addition to the endometrium and lower uterine segment), the ovaries and tubes should be submitted in total.[2]

Alternate approaches

See also

Related protocols

References

  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.

External links

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