Hysterectomy for endometrial hyperplasia grossing
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The protocol is for grossing a hysterectomy for endometrial hyperplasia.
Hysterectomies with biopsy proven cancer are dealt with in the hysterectomy for endometrial cancer protocol.
Introduction
This is a very common procedure as endometrial hyperplasia is common.
Sampling in these specimens is important, as one wants to identify endometrial cancer if it is present or be relatively certain it is absent.
Opening
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.
- Posterior peritoneal edge: pointy (upside down triangle).
- Tubes on anterior-lateral aspect.[1]
- Round ligaments posterior to tubes.
Protocol
Specimen:
- Hysterectomy for endometrial hyperplasia.
Dimensions:
- Uterus and cervix: ___x___x___cm.
- Specimen mass: ____grams.
- Left ovary: [___x___x___cm / not present].
- Left fallopian tube: [___x___ cm / not present].
- Right ovary: [___x___x___cm / not present].
- Right fallopian tube: [___x___ cm / not present].
Appearance:
- Shape: [pear-shaped/distorted].
- Serosal surface: [smooth shiny/
- Nodules/lesions/masses: [none/____cm in greatest dimension].
- Ectocervix: [tan-white glistening with a probe patent os of ____cm].
- Maximal myometrial wall thickness: ___cm.
Internal measures:
- Endometrial cavity (superior to inferior, cornu to cornu): ____x____cm.
- Endometrium thickness: ____cm.
- Masses: [non-identified/intramural and subserosal white, firm, and whorled nodules that range from ____to ____cm in greatest dimension without any hemorrhage or necrosis/ with hemorrahage and necrosis].
- Right and left ovaries: [tan-white and appear to be atrophic/ ____cortical cysts with/without hemorrhage]. *Right and left fallopian tubes: [unremarkable/ show paratubal cysts, ____cm in greatest dimension].
INK CODE:
- Blue - anterior serosa.
- Black - posterior serosa.
SECTION CODE:
- Anterior cervix.
- Anterior lower uterine segment.
- Posterior cervix.
- Posterior lower uterine segment.
- Anterior endomyometrium, full thickness.
- Remainder of the anterior endometrium, entirely submitted sequentially from superior to inferior [include endometrium and 5mm thick myometrium in each section, can put multiple sections in one cassette].
- Posterior endomyometrium, full thickness.
- Remainder of the posterior endometrium, entirely submitted sequentially from superior to inferior [include endometrium and 5mm thick myometrium in each section, can put multiple sections in one cassette].
- Section of firm whorled tan nodules in anterior/posterior myometrium.
- Any other lesions.
- Right ovary with hemorrhagic cortical cysts.
- Right fallopian tube [fimbria submitted entirely], with paratubal cysts.
- Left ovary.
- Left fallopian tube [fimbria submitted entirely].
Protocol notes
In BRCA1 mutation or BRCA2 mutation carriers (in addition to the endometrium and lower uterine segment), the ovaries and tubes should be submitted in total.[2]
Alternate approaches
See also
Related protocols
- Radical hysterectomy for cervical cancer.
- Hysterectomy for benign disease.
- Hysterectomy for endometrial cancer grossing.
References
- ↑ Lester, Susan Carole (2010). Manual of Surgical Pathology (3rd ed.). Saunders. pp. 425. ISBN 978-0-323-06516-0.
- ↑ 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.