The document describes the anatomy of the uterus including its location, structure, and features. It is divided into the cervix and corpus, and has a triangular uterine cavity lined by endometrium and surrounded by a thick muscular layer. The document also provides details on the gross examination and sectioning of hysterectomy specimens for both non-malignant and malignant conditions. Key areas are examined and minimum sections are outlined based on whether the specimen is for conditions such as fibroids or carcinoma of the endometrium or cervix.

1. ANATOMY OF UTERUS

2. NULLIPAROUS UTERUS
• A hollow, pear-shaped organ
• Situated in the centre of the pelvis between the
rectum (posteriorly) and the urinary bladder
(anteriorly).
• Weighs 40–80 gms
• Measures 7–8 cm along its longest axis

3. • Divided into the cervix and corpus
• The two lateral regions of the fundus associated with
the intramural portion of the fallopian tubes are
referred to as the cornua

4. UTERINE CAVITY
• Triangular shape
• Length of approximately 6 cm
• lined by the endometrial mucosa
• Inner layer - endometrium
• Surrounded by a thick muscular layer (myometrium)
• Serosal covering, the latter extending to the point of
peritoneal reflection

5. • Useful features to distinguish the anterior from the
posterior side of a hysterectomy specimen at time of gross
examination are :
• 1) The point of peritoneal reflection is seen to dip down
more inferiorly on the posterior surface of the uterus than
anterior surface
• (2) The fact that the uterine insertion of the fallopian tube
is posterior to the insertion of the round ligament.

6. • 3. The ovaries are on the posterior side.
• 4. The posterior surface is flatter than the
anterior surface, which is convex.

7. UTERINE LYMPHATICS
• Drain into pelvic and paraaortic nodes.
• For carcinoma endometrium the inguinal lymph nodes,
intra-abdominal lymph nodes other than paraaortic or
pelvic nodes are considered
• Cervix
• The regional nodes include paracervical, parametrial,
hypogastric (internal iliac, obturator), common and
external iliac, presacral and lateral sacral. The paraaortic
nodes are considered M1

8. GROSSING
• Types of Specimens :
• Total hysterectomy
• Subtotal hysterectomy
• Pan-hysterectomy
• Radical hysterectomy

9. Non- Malignant Conditions
• Measure and weigh the specimen.
• Optional to apply ink on the posterior surface
of the uterus
• It can be opened in a 'Y' shaped incision on the
anterior surface or even can be bisected and
sectioned.
• Fix the specimen overnight in adequate
amount of formalin.

10. • Note the endometrial and myometrial
thickness.
• Mention if there is any lesion (e.g. polyp, blood
clot) in the endometrial cavity.
• In case fibroids are seen, give the location-
submucosal, intramural, sub-serosal fibroids.
• If many fibroids, mention the range in size,
including diameter of the largest one

11. • Mention whether cut surface is whorled
trabeculated, or if there is any unusual feature
such as necrosis or Haemorrhage.
• If both adenexae are removed, mention
dimensions of each ovary, its cut surface;
length of the Fallopian ttibes and any presence
of paratubal cyst.

12. Sections
• Two to three sections from the endomyometrium.
• Two to three sections of leiomyoma as
appropriate.
• In case of fibroid uterus, section each fibroid if
there are up to three fibroids.
• In case there are more than three fibroids, then
section the largest three fibroids with usual
appearance.
• Besides, any grossly visible abnormal area should
be sectioned.

13. • Right ovary and transverse section of the tube
• Left ovary and transverse section of the tube.

14. Malignant Conditions
• Measure and weigh the specimen.
• Mention the dimensions of the endometrial tumour, its
exact location, appearance (exophytic, infiltrative)
• Mention the depth of invasion in myometrium (less than
half or more than half).
• The tumour free myometrial thickness in mm is to be
given.
• The main aim is to detect maximum invasion into the
myometrium and section that appropriate area. Hence,
adequate sectioning/ slicing of the tumour is important.

15. • The uterine serosal surface may be marked by ink in
the given section for comment on the serosal
involvement.
• Apart from the main tumour, mention if there is any
other lesion (e.g. polyp, blood clot).
• Take at least from the, uninvolved
endomyometrium.
• Mention any lesion/pathology in the cervix.
• Examine each ovary, mention cut surface
appearance and dimensions, tube and its length any
cysts

16. SECTIONS FOR TUMOUR
• Four sections of the tumour
• One from adjacent endometrium
• Two sections from the grossly unremarkable
cervix (anterior and posterior lips)
• Right tube, ovary, parametrium
• Left tube, ovary, parametrium
• Bilateral pelvic nodes or sent as per the nodal
stations

17. • Examine the fimbrial ends of the tube in toto
(by serial transverse sections and embedding it
completely) for any cytological abnormality.
• This is an area of study currently in cases of
BRCA I and BRCA II associated tumours (SEE
FIM protocol).

18. Hysterectomy for Carcinoma
Cervix
• A radical hysterectomy specimen with vaginal
cuff and parametria, as well as lymph nodes is
received.
• First, take radial vaginal cut margins (anterior,
right lateral, posterior, left lateral)

19. • Describe the tumour in the cervix
• a.Location (anterior lip, posterior lip)
• b.Endophytic or exophytic
• c.Tumour dimensions

20. • The cervical stroma (less than half or more
than half the thickness).
• The tumour free cervical stromal thickness in
mm is to be given.
• The main aim is to detect maximum invasion
into the stroma and section that appropriate
area

21. • Mention the depth of invasion
• The ink on the paracervical tissue helps In
detecting the microscopic extension into the
paracervical tissue.

22. • Adequate sectioning/ slicing of the tumour is important.
• All the nodes have to be examined histologically. They are
submitted as separate stations, or as they have been
sent.
• A minimum of 15 lymph nodes are desirable in radical
hysterectomy specimen.
• The pelvic nodes are often fatty and large and trimming
may be necessary.
• It is also to be remembered that parametrium can show
tiny lymph nodes.

23. • Sections to be submitted
• a. Four sections of the tumour.
• b. Vaginal cut margins (anterior, right lateral, posterior
and left lateral)
• c.One endomyometrium (if grossly normal).
• d. Any other uterine pathology (polyp, fibroid etc)
• e. Right tube, ovary, parametrium.
• f. Left tube, ovary, parametrium.
• g. Bilateral pelvic nodes or sent as per the nodal stations