Hysterectomy for fibroids grossing

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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).[1]

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.[2]

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

  1. Mahnert, N.; Morgan, D.; Campbell, D.; Johnston, C.; As-Sanie, S. (Feb 2015). "Unexpected gynecologic malignancy diagnosed after hysterectomy performed for benign indications.". Obstet Gynecol 125 (2): 397-405. doi:10.1097/AOG.0000000000000642. PMID 25569001.
  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