Radical hysterectomy for cervical cancer grossing

This protocol is for grossing a radical hysterectomy for cervical cancer.

The cervical cancers done for this type of surgery are advanced. Smaller cancers are dealt with by cervical conization.

Introduction

Three types of surgeries for cervical cancers:

1. Simple: only uterus is removed with the cervix
2. Extended type II: resects medial portion of the parametria (cardinal ligament), uterosacral ligaments and superior part of the vagina, pelvic lymph nodes (the iliacs, and obturator).
3. Extended type III: Resects majority of the parametria and uterosacral ligament and superior part of vagina. Pelvic lymphadenopathy is routinely performed.

Protocol

Specimen type:

• Radical hysterectomy.

Dimensions - exterior:

• 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.
• Vaginal cuff/vaginal - (axial) length: ___ cm, wall thickness: ___cm.
• Left parametrial soft tissue: ___x___x___cm.
• Right parametrial soft tissue: ___x___x___cm.

Serosal surface of the uterus:

• Appearance: smooth shiny.
• Presence of lesion/mass: [none / present, ____cm in greatest dimension].

Dimensions - internal:

• Endometrial cavity: ___x___ cm.
• Maximal myometrial wall thickness: ____ cm.
• Endometrial thickness: ___ cm.
• Endocervical canal - length ___ cm, diameter ___ cm.

Tumour:

• Appearance: [white-tan / firm / ill-defined / hemorrhagic / ulcerated].
• Dimensions: ___x___x___ cm.
• Location of tumour/tumour center: ___.
• Extent (involvement):
  • Ectocervix: [yes/no/suspicious].
  • Endocervix: [yes/no/suspicious].
  • Cervical stroma: [yes/no/suspicious]
  • Parametrial soft tissue: [yes/no/suspicious]
  • Vaginal cuff: [yes/no/suspicious].
  • Upper vagina: [yes/no/suspicious/not applicable].
  • Lower vagina: [yes/no/suspicious/not applicable].
  • Endometrium: [yes/no/suspicious]
  • Myometrium: [yes/no/suspicious]
• Margins:
  • Closest vaginal cuff margin ___cm.
  • Right parametrial margin ____cm.
  • Left parametrial margin ___ cm.

Appearance and additional findings:

• Myometrium: [unremarkable/white whorled well-circumscribed lesion without hemorrhage & necrosis measuring __x___x___ cm].
• Left ovary: [atrophic/functional cyst/none].
• Left fallopian tube: [unremarkable/benign paratubal cyst/none].
• Right ovary: [atrophic/functional cyst/none].
• Right fallopian tube: [unremarkable/benign paratubal cyst/none].

Ink code:

• Orange - anterior.
• Blue - posterior.
• Black - vaginal/vaginal cuff margin.

Section code:

• Right parametrial margin in total.
• Left parametrial margin in total.
• Vaginal margin en face, four quadrant in four cassettes (12 to 3 in one cassette, 3 to 6 in one cassette, 6 to 9 in one cassette, 9 to 12 in one cassette.
• Tumour and adjacent tissue, full thickness of cervical wall (1 block per cm of tumour).
• Cervix and lower uterine segment.
• Anterior endomyometrium.
• Posterior endomyometrium.
• Right adnexa.
• Left adnexa.

Protocol notes

Procedural notes

1. Cervix is ampuated after painting.
2. Cervix is opened at 3 o'clock.
3. Block diagram for cervix is sketched on requisition.

Special situations

If no tumour present:

• Submit entire cervix as a cone specimen radially from 12 o'clock - see cervical cone.

If tumour involves the vagina/vaginal cuff:

• Submit a section to document this.

See also

• Gynecologic pathology.

Related protocols

• Cervical cone.