Vulvectomy grossing

Schematic showing what is removed in a vulvectomy.

The protocol is for vulvectomy grossing.

Introduction

This procedure is done for vulvar cancer (vulvar squamous cell carcinoma or malignant melanoma).

Protocol

• Specimen: vulvectomy.
• Overall dimesions: ___x ___x ___ cm.
• Right labium majus: ___x ___x ___cm.
• Left labium majus: ___x ___x ___ cm.
• Right labium minus: ___x ___x ___ cm.
• Left labium minus: ___x ___x ___ cm.
• Clitoris: ___x ___x ___ cm.
• Urethral orifice: ___x ___cm.
• Urethra: ___cm in length, ___cm in diameter.
• Vagina ___cm in length, ___cm in diameter.
• Perineal skin: ___x___cm.
• Anus: ___x___ cm.
• Anal canal: ___ cm in length, ____cm in diameter.
• Rectum ___cm in length, ___cm in diameter.
• Urinary bladder: ___x ___x ___ cm.
• Pelvic bone: ___x ___x ___ cm.
• Underlying soft tissue: ___x ___x ___ cm, and fascia ___x ___x ___ cm.

Tumour:

• Focality: unifocal / multifocal.
• Size: ___ x ___ cm, maximum depth: ___cm.
• Location (center of lesion): ___.
• Lesion extent: right labium majus, left labium majus, right labium minus, left labium minus, clitoris, soft tissue/fascia, urethral orifice, lower 1/3 of urethra, vagina, anal canal, rectum, pelvic bone.
• Ulceration: absent / present.
• Exophytic component: [absent / present].
• Colour and consistency: white-tan, soft.
• Borders: pushing / infiltrative, ill-defined.

Margins:

• Skin margins (clitoris or stitch = 12 o'clock):
  • 12 o’clock: ___ cm.
  • 3 o’clock: ___ cm.
  • 6 o’clock: ___ cm.
  • 9 o’clock: ___ cm.
• Deep margin: ___ cm.

Ink code:

• Blue:12-to 3-to 6 o’clock half;
• Orange: 6-to-9-to12 o’clock half;
• Black: urethral margin;
• Yellow: vaginal margin.

Section code:

• 12 o’clock tip, en face, ink-side up.
• 6 o’clock tip, en face, ink-side up.
• 3 o’clock margin, en face, ink-side up [submit perpendicular section if tumour <=1cm from margin].
• 9 o’clock margin, en face, ink-side up [submit perpendicular section if tumour <=1cm from margin].
• Tumour deepest invasion [submit three section with the greatest invasion, include soft tissue and fascia].
• Urethral margin, en face.
• Vaginal margin, en, face.
• Tumour [clitoris/right labium minus/left labium minus/right labium majus/left labium majus/urethra/vagina].
• Tumour with any other involved structure [perineum, anus, anal canal, rectum, bone, other structures].
• Lymph nodes.