Hysterectomy for fibroids grossing

A uterus with a large fibroid. (WC/Ed Uthman)

This protocol a protocol for grossing a hysterectomy for fibroids, also hysterectomy for leiomyomas.

It also covers grossing a hysterectomy for benign disease.

Introduction

This is a very common surgery. It said that approximately 40% of forty year old have fibroids. Other indications for hysterectomy are: dysfunctional uterine bleeding and hemorrhage (postpartum).

Unexpected malignancies (based on a series of 6,360 cases) are seen in approximately 2.7% of cases and include (1) endometrial carcinoma (1.02% of cases), (2) cancers of the tube, ovary and peritoneum (1.08% of cases), (3) uterine sarcoma (0.22% of cases), (4) metastatic disease (0.20% of cases) and (5) cervical cancer (0.17% of cases).

In prophylatic procedures for BRCA1 mutation or BRCA2 mutation carriers, the ovaries and tubes, endometrium, and lower uterine segment should all be submitted in total.

Protocol

Specimen type: total hysterectomy.

Dimensions:

• Uterus and cervix: ___x___x___cm, ____grams.
• Left ovary: ___x___x___cm.
• Left fallopian tube: length ___ cm, diameter ___cm.
• Right ovary: ___x___x___cm.
• Right fallopian tube: length ___ cm, diameter ____cm.
• Exocervix: diameter ___ cm.

Appearance:

• Uterine shape: pear-shaped/distorted.
• Serosal surface: smooth shiny.
• Serosa lesions: none/nodules up to ___cm in greatest dimension.
• Ectocervix: tan-white glistening with a probe patent os.

Internal dimensions:

• Endometrial cavity: ___x___cm.
• Endometrium: thickness ___cm.
• Maximal myometrial wall thickness: ___cm.
• Endocervical canal: length ___ cm, diameter ___ cm.

Internal/additional appearance:

• Left ovary: unremarkable.
• Left fallopian tube: unremarkable.
• Right ovary: unremarkable.
• Right fallopian tube: unremarkable.

Tumour(s):

• Appearance and location: intramural and subserosal white, firm, and whorled circumscribed/ill defined nodules.
• Number of tumors: ___.
• Size: range ___to ___cm in greatest dimension.
• Hemorrhage: present in ___ % of tumor / absent.
• Necrosis: present in ___ % of tumor / absent.
• Calcification: present / absent.

Additional findings: ___.

SECTION CODE:

• Anterior cervix and lower uterine segment
• Posterior cervix and lower uterine segment
• Posterior endomyometrium, full thickness
• Right ovary and , right fallopian tube [fimbria submitted entirely], with paratubal cysts
• Left ovary and left fallopian tube [fimbria submitted entirely]
• Submit sections of fibroids as per protocol (see next page).

Protocol notes

Blocking protocol

Submit sections of fibroid as follows:

1. Any suspicious areas of gross hemorrhage/ necrosis and softer consistency must be sampled.
2. Any single fibroid >5 cm --> put one section per 2 cm, with put up to 2 sections per cassette.
3. Any single fibroid >1 cm to up to 5 cm --> put one section per lesion
4. Fibroids <=1 cm, and multiple in number --> use no more than five cassettes, each cassette can contain sections from two distinct fibroids.
5. Any single fibroid >10 cm, please review the specimen with the attending pathologist.

Examples:

• 5.5 cm = 3 sections.
• 6 cm = 3 sections.
• 8 cm = 4 sections.
• 8 fibroids, all less than 1 cm = 4 cassettes, 2 sections per cassette.
• 15 fibroids = 5 cassettes, sample ten individual fibroids.

Alternate approaches

Also submit:

• Anterior endomyometrium, full thickness.

Do not submit:

• Posterior endomyometrium, full thickness.

See also

Related protocols

• Hysterectomy for endometrial hyperplasia.
• Hysterectomy for endometrial cancer.

External links

• A set of gynecologic pathology grossing notes from Michigan (umich.edu).