Difference between revisions of "Hysterectomy for fibroids grossing"

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==Introduction==
==Introduction==
This is a very common surgery.
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).


==Protocol==
==Protocol==

Revision as of 06:02, 27 September 2014

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).

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

References

External links