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Hysterectomy for fibroids grossing (view source)
Revision as of 17:11, 15 October 2021
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[[Image:Leiomyoma of the Uterus.jpg|thumb|300px|A uterus with a large fibroid. (WC/Ed Uthman)]] | |||
This protocol a protocol for grossing a '''hysterectomy for [[fibroids]]''', also '''hysterectomy for leiomyomas'''. | This protocol a protocol for grossing a '''hysterectomy for [[fibroids]]''', also '''hysterectomy for leiomyomas'''. | ||
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==Introduction== | ==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). | 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).<ref name=pmid25569001>{{Cite journal | last1 = Mahnert | first1 = N. | last2 = Morgan | first2 = D. | last3 = Campbell | first3 = D. | last4 = Johnston | first4 = C. | last5 = As-Sanie | first5 = S. | title = Unexpected gynecologic malignancy diagnosed after hysterectomy performed for benign indications. | journal = Obstet Gynecol | volume = 125 | issue = 2 | pages = 397-405 | month = Feb | year = 2015 | doi = 10.1097/AOG.0000000000000642 | PMID = 25569001 }}</ref> | |||
In prophylatic procedures for [[BRCA|BRCA1 mutation or BRCA2 mutation carriers]], the ovaries and tubes, endometrium, and lower uterine segment should all 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> | |||
==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 prophylatic procedures for [[BRCA|BRCA1 mutation or BRCA2 mutation carriers]], the ovaries and tubes, endometrium, and lower uterine segment should all 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> | |||
====Blocking protocol==== | ====Blocking protocol==== | ||
Submit sections of fibroid as follows: | Submit sections of fibroid as follows: | ||
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==External links== | ==External links== | ||
*[https://www.pathology.med.umich.edu/gynonc/PDF/GynGrossing_NoPlacentaOLD.PDF A set of gynecologic pathology grossing notes from Michigan (umich.edu)]. | |||
[[Category:Gynecologic pathology]] | [[Category:Gynecologic pathology]] | ||
[[Category:Gross pathology]] | [[Category:Gross pathology]] | ||