Hysterectomy for endometrial cancer grossing

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Gross image of endometrial adenocarcinoma.

The protocol is for grossing a hysterectomy for endometrial cancer.

Hysterectomies with endometrial hyperplasia are dealt with in the hysterectomy for hyperplasia protocol.


This is a very common procedure as endometrial cancer.


Orientation of hysterectomies

  • Less peritoneum on anterior (as the urinary bladder is there).
    • Posterior peritoneal edge: pointy (upside down triangle).
      • Anterior peritoneal edge: rounded/non-pointy.
  • Tubes on anterior-lateral aspect.[1]
    • Round ligaments posterior to tubes.



  • Hysterectomy for endometrial cancer.

External measures:

  • Uterus and cervix: ___x___x___cm
  • Specimen mass: ____grams.
  • Left ovary: ___x___x___cm.
  • Left fallopian tube ___x___cm.
  • Right ovary: ___x___x___cm.
  • Right fallopian tube: ___x___cm.
  • Exocervix: ___cm.
  • Cervical os: ___cm, round/slit-like, probe patent.


  • Shape: [pear-shaped/distorted].
  • Serosal surface: [smooth, shiny, powder-burn lesions].
  • Serosa nodules/lesion/mass: [none, present ___cm in greatest dimension].
  • Ectocervix: tan-white glistening.
  • Left ovary: [unremarkable / atrophic / cortical cysts].
  • Left fallopian tube: [unremarkable / paratubal cysts].
  • Right ovary: [unremarkable / atrophic / cortical cysts].
  • Right fallopian tube: [unremarkable / paratubal cysts].

Internal measures:

  • Endometrial cavity: ____x____cm.
  • Myometrial wall thickness (maximum): ____cm.


  • Dimension: ___x___x___cm.
  • Location: [fundus/body, involves anterior and/or posterior wall, lower uterine segment, cervix].
  • Appearance: [ill-defined, soft, friable, polypoid-shape, tan-white].
  • Maximum depth of invasion: ___cm.
  • Myometrial thickness: ___cm.
  • Grossly normal endometrium - maximum thickness: ___cm.

Other findings:

  • Myometrial tumour(s):
    • Location: intramural / subserosal.
    • Appearance: white, firm, whorled.
    • Size range: ___-___cm in greatest dimension.
    • Other features:
      • Hemorrhage: absent.
      • Necrosis: absent.

Inking code:

  • Green - anterior serosa.
  • Black - posterior serosa.

Representative sections:

  • Anterior cervix.
  • Anterior lower uterine segment.
  • Posterior cervix.
  • Posterior lower uterine segment.
  • Tumour and anterior endomyometrium with greatest depth of invasion, full thickness sections [submit two full thickness section of deepest invasion from each involved wall of the myometrium with inked serosa].
  • Tumour and posterior endomyometrium with greatest depth of invasion, full thickness sections.
  • Additional sections of the tumour [for a total of at least one section/cm of tumour].
  • Section of firm whorled tan nodules in anterior/posterior myometrium.
  • Any other lesions.
  • Right ovary.
  • Right fallopian tube [fimbria submitted entirely].
  • Left ovary.
  • Left fallopian tube [fimbria submitted entirely].

Protocol notes

In BRCA1 mutation or BRCA2 mutation carriers, the ovaries and tubes should be submitted in total.[2]

Alternate approaches

See also

Related protocols


External links

  1. Lester, Susan Carole (2010). Manual of Surgical Pathology (3rd ed.). Saunders. pp. 425. ISBN 978-0-323-06516-0.
  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.