GROSSING TECHNIQUES

1. GROSSING OF UTERUS, CERVIX &
OVARY EXCLUDING GRAVID
UTERUS
DR.SURUCHI GAIKWAD

2. ANATOMY OF UTERUS, CERVIX AND OVARIES

3. • THE UTERUS HAS FOUR MAJOR REGIONS: THE FUNDUS IS THE BROAD
CURVED UPPER AREA IN WHICH THE FALLOPIAN TUBES CONNECT TO
THE UTERUS; THE BODY, THE MAIN PART OF THE UTERUS, STARTS
DIRECTLY BELOW THE LEVEL OF THE FALLOPIAN TUBES AND CONTINUES
DOWNWARD UNTIL THE UTERINE WALLS AND CAVITY BEGIN TO
NARROW; THE ISTHMUS IS THE LOWER, NARROW NECK REGION; AND
THE LOWEST SECTION, THE CERVIX, EXTENDS DOWNWARD FROM THE
ISTHMUS UNTIL IT OPENS INTO THE VAGINA. THE UTERUS IS 6 TO 8 CM
(2.4 TO 3.1 INCHES) LONG; ITS WALL THICKNESS IS APPROXIMATELY 2
TO 3 CM (0.8 TO 1.2 INCHES). THE WIDTH OF THE ORGAN VARIES; IT IS
GENERALLY ABOUT 6 CM WIDE AT THE FUNDUS AND ONLY HALF THIS
DISTANCE AT THE ISTHMUS. THE UTERINE CAVITY OPENS INTO THE
VAGINAL CAVITY, AND THE TWO MAKE UP WHAT IS COMMONLY
KNOWN AS THE BIRTH CANAL.

9. INTRODUCTION:
•WE RECEIVED SPECIMEN OF SIMPLE HYSTERCTOMY FOR
NON ONCOLOGICAL INDICATIONS SUCH AS
MENORRHAGIA , FIBROID ,POLYP
•FOR CARCINOMA OF CERVIX
•FOR CARCINOMA OF ENDOMETRIUM

10. GROSS EXAMINATION TISSUE SAMPLING :-
• 1.ENDOMETRIAL BIOPSY AND CURETTAGE SAMPLE –OBTAINED
FROM CERVICAL DILATION AND CURRETAGE
• DIMENTIONS –RANGE OF LARGEST TISSUE FRAGMENT OR
AGGREGATE OF ALL TISSUE FRAGMENT
• COLOUR
• CONSISTENCY
• ENTIRE SPECIMEN SHOULD BE SUBMITTED.

11. GROSS EXAMINATION TISSUE SAMPLING :-
• 2PRODUCTS OF CONCEPTION–OBTAINED BY CURRETAGE
• DIMENTIONS –DIMENSTION OF THE TISSUE FRAGMENT IN
AGGREGATE
• COLOUR
• CONSISTENCY
• ATLEAST 3 CASSETTES SHOULD BE SUBMITTED

12. UTERUS-
BENIGN CONDITIONS
• ENDOMETRIOSIS
• ADENOMYOSIS
• ENDOMETRIAL HYPERPLASIA
•MALIGNANT TUMOURS:-
• ENDOMETRIAL CARCINOMA
• MALIGNANT MIXED MULLERIAN TUMOUR
•TUMOURS OF MYOMETRIUM
• LEIOMYOMA
• LEIOMYOSARCOMA

13. GROSS EXAMINATION TISSUE SAMPLING :-
• HYSTERECTOMY SPECIMEN –
• TYPES:-
• TOTAL HYSTERECTOMY-UTERUS WITH CERVIX
• SUBTOTAL-UTERUS WITH PART OF CERVIX AND CERVICAL STUMP IS LEFT
BEHIND
• PANHYSTERECTOMY-UTERUS WITH CERVIX AND BILATERAL ADNEXAE
[OVARIES AND FALLOPIAN TUBE]
• RADICAL HYSTERECTOMY- UTERUS WITH CERVIX ALONG WITH NEAR BY
TISSUE WITH PART OF VAGINA

14. • TOTAL HYSTERECTOMY-UTERUS WITH
CERVIX
• SUBTOTAL-UTERUS WITH PART OF
CERVIX AND CERVICAL STUMP IS LEFT
BEHIND
• PANHYSTERECTOMY-UTERUS WITH
CERVIX AND BILATERAL ADNEXAE
[OVARIES AND FALLOPIAN TUBE]
• RADICAL HYSTERECTOMY- UTERUS
WITH CERVIX ALONG WITH NEAR BY
TISSUE WITH PART OF VAGINA

17. THERE IS NO RIGHT TECHNIQUES OF OPENING THE UTERUS . IT
CAN BE OPENED IN ‘Y’ SHAPED INCISION ON ANTERIOR SURFACE
OR EVEN CAN BE BISECTED

18. UTERUS-BENIGN
• WEIGH SPECIMEN AND MEASURE:
• 3 DIMENSIONS OF UTERUS
• DIMENSIONS OF CERVIX ( LENGTH)
• OVARIES (3D) AND FALLOPIAN TUBES (2D), IF PRESENT
• IDENTIFY ANTERIOR AND POSTERIOR SIDES AND NOTE
QUALITY OF SEROSA:
• POSTERIOR SURFACE IS FLATTER THAN ANTERIOR
• THE PERITONEAL REFLECTION EXTENDS FURTHER
INFERIORLY ON THE POSTERIOR SIDE AND IS POINTED.
• THE PERITONEAL REFLECTION ON THE ANTERIOR SIDE IS
ROUNDED.
• INSERTION OF FALLOPIAN TUBE OVARY ARE SEEN ON
POSTERIORLY
• THE TUBE IS ANTERIOR TO THE OVARY.

19. • BISECT UTERUS
• MEASURE ENDOCERVICAL CANAL AND
ENDOMETRIAL CAVITY AND
THICKNESS OF ENDOMETRIUM AND
MYOMETRIUM.
• MEASURE ANY LESIONS (WHORLED
NODULES, POLYPS, ETC).
• MOST OF THESE CASES SHOULD BE
GROSSED ON SAME DAY OF RECEIP

20. UTERUS-BENIGN
• TRANSVERSELY SECTION THE ENDOMYOMETRIUM AND
TAKE 2 FULL-THICKNESS SECTIONS
• 2SECTIONS TAKEN CLOSE TO FUNDUS INCLUDING
ENDOMETRIUM , GOOD PORTION OF MYOMETRIUM
• SERIALLY SECTION ANY NODULES AND LOOK FOR AREAS
OF NECROSIS (OPAQUE YELLOW-WHITE), HEMORRHAGE, OR
SOFTENING.
• FOR NORMAL-APPEARING WHORLED NODULES (FIRM, WHITE-
TAN, WELL-CIRCUMSCRIBED):
1-2 SECTIONS GIVEN.
IF MULTIPLE LESIONS IDENTIFIED THEN
1-2 SECTIONS FROM LARGEST LESION
1-2 FROM REMAINING AREAS

21. UTERUS-BENIGN
• FOR ATYPICAL-APPEARING WHORLED NODULES (HEMORRHAGE,
NECROSIS, SOFTENING, DISCOLORATION, INFILTRATION)
SUBMIT 1 SECTION PER CM OF THE ATYPICAL NODULE, 2-3
SECTIONS.
• ENDOMETRIAL POLYPS- 1 SECTION ALONG WITH STALK
AND 1 SECTION FROM THE POLYP
• 1 SECTION INCLUDING INTERFACE WITH UNDERLYING
ENDOMETRIUM.
• SUBMIT REPRESENTATIVE SECTIONS OF OVARIES, IF PRESENT.
• ONE SECTION FROM EACH OVARIES
• FOR FALLOPIAN TUBES, IF PRESENT: SUBMIT ENTIRE FIMBRIAE
(LONGITUDINALLY SECTIONED) AND 2 REPRESENTATIVE
TUBAL CROSS-SECTIONS. SUBMIT REPRESENTATIVE
SECTIONS OF FALLOPIAN TUBES, IF PRESENT. EACH
FALLOPIAN TUBE SHOULD BE SAMPLED AND SUBMITTED IN
ITS OWN CASSETTE.
• TAKE 2 LONGITUDINAL SECTIONS THROUGH

22. UTERUS-
• CERVIX-2 SECTIONS-
• ONE FROM- TRANSVERSE SECTION
OF ENDOCERVIX /PARAMETRIAL
TISSUE /PARA CERVICAL TISSUE
• OTHER FROM- LONGITUDINAL
SECTION OF ENDOCERVIX AND
TRANSFORMATION ZONE

23. UTERUS-ENDOMETRIAL CANCER
• MEASURE DEEPEST AREA OF TUMOR INVASION AND
THICKNESS OF WALL.
• INCLUDE 4 SECTIONS
• TUMOUR SECTION
• TUMOUR SECTION WITH MAXIMUM INVASION IN MYOMETRIUM
• TUMOUR WITH ADJACENT AREA
• TUMOUR WITH NORMAL APPEARING MYOMETRIUM
• SUBMIT ANY ADDITIONAL PATHOLOGY (LEIOMYOMAS,
POLYPS, ETC).
• SUBMIT 1 SECTION OF UNINVOLVED ENDOMETRIUM.

24. UTERUS-ENDOMETRIAL CANCER
• PARAMETRIAL TISSUE IS USUALLY NOT PRESENT IN
HYSTERECTOMIES FOR ENDOMETRIAL CANCER.
HOWEVER, IF PRESENT, SERIALLY SECTIONING DONE AND
SUBMIT ENTIRELY FROM MEDIAL TO LATERAL, NOTING
RIGHT AND LEFT. IF GROSSLY INVOLVED, INCLUDE 1
SECTION WITH ADJACENT OUTER CERVICAL WALL
• FOR ALL OTHER TYPES, SUBMIT ADNEXA AS FOLLOWS:
• 2 REPRESENTATIVE SECTIONS OF EACH OVARY.
• ENTIRE FIMBRIAE (LONGITUDINALLY SECTIONED) AND 2
REPRESENTATIVE CROSS-SECTIONS ON EACH SIDE.

25. ENDOMETRIAL CARCINOMA
• LYMPH NODES (SENTINEL AND NON-SENTINEL)
• FOR LYMPH NODES < 1CM, SUBMIT INTACT.
• FOR LYMPH NODES > 1CM, SERIALLY SECTION PERPENDICULAR TO THE LONG
AXIS
• IF NO GROSS TUMOR, SUBMIT ENTIRELY.
• IF GROSSLY POSITIVE, SUBMIT 1-2 REPRESENTATIVE SECTIONS SHOWING THE
GREATEST TUMOR DIMENSION AND EXTRANODAL FAT.

26. OVARY-

27. • THE OVARIES ARE CONSIDERED THE FEMALE GONADS.[2] EACH OVARY IS
WHITISH IN COLOR AND LOCATED ALONGSIDE THE LATERAL WALL OF
THE UTERUS IN A REGION CALLED THE OVARIAN FOSSA. THE OVARIAN
FOSSA IS THE REGION THAT IS BOUNDED BY THE EXTERNAL ILIAC
ARTERYAND IN FRONT OF THE URETER AND THE INTERNAL ILIAC
ARTERY. THIS AREA IS ABOUT 4 CM X 3 CM X 2 CM IN SIZE.[3][4] THE
OVARIES ARE SURROUNDED BY A CAPSULE, AND HAVE AN OUTER
CORTEX AND AN INNER MEDULLA.[4]
• USUALLY, OVULATION OCCURS IN ONE OF THE TWO OVARIES
RELEASING AN EGG EACH MENSTRUAL CYCLE; HOWEVER, IF THERE
WAS A CASE WHERE ONE OVARY WAS ABSENT OR DYSFUNCTIONAL
THEN THE OTHER OVARY WOULD CONTINUE PROVIDING EGGS TO BE
RELEASED WITHOUT ANY CHANGES IN CYCLE LENGTH OR FREQUENCY.
• THE SIDE OF THE OVARY CLOSEST TO THE FALLOPIAN TUBE IS
CONNECTED TO IT BY INFUNDIBULOPELVIC LIGAMENT,[3] AND THE
OTHER SIDE POINTS DOWNWARDS ATTACHED TO THE UTERUS VIA
THE OVARIAN LIGAMENT.

28. OVARY –BENIGN AND MALIGNANT
• BENIGN LESIONS ARE USUALLY TREATED BY SIMPLE OOPHORECTOMY.
• MALIGNANT LESIONS ARE USUALLY TREATED BY TAH, BSO AND PERIAORTIC
NODE SAMPLING.
• BORDERLINE LESIONS ARE TREATED DEPENDING ON AGE AND DESIRE FOR
PRESERVED FERTILITY.

29. OVARY –BENIGN AND MALIGNANT
• MEASURE PRIOR TO OPENING.
• MEASURE LENGTH AND DIAMETER OF FALLOPIAN TUBE (IF ATTACHED).
• DOCUMENT IF OVARY WAS RECEIVED INTACT VS. DISRUPTED/PREVIOUSLY
OPENED.
• INK THE OUTER PERITONEAL SURFACE OF THE OVARY FOR ALL TUMOR / POSSIBLE
TUMOR CASES (THE PERITONEAL SURFACE IS NOT A MARGIN, BUT MAY AID IN
HISTOLOGIC IDENTIFICATION OF SURFACE INVOLVEMENT BY TUMOR).
• AFTER EXAMINATION OF EXTERNAL SURFACE 'INCLUDING CAPSULE, CUT OPEN
THE SPECIMEN ALONG ITS LARGEST DIMENSION.
• OPEN LARGE OR CYSTIC STRUCTURES OVER SINK.
• DESCRIBE CONTENTS (SEROUS/MUCOID, CLEAR OR BLOOD-TINGED FLUID, HAIR,
OLD HEMORRHAGE, ETC.) AND THE AMOUNT OF FLUID.
• NOTE WHETHER CYST IS UNILOCULAR OR MULTILOCULAR.
• DESCRIBE INTERNAL LINING SURFACE (SMOOTH, PLAQUE-LIKE THICKENINGS,
PAPILLARY EXCRESCENCES, ETC.).
• STATE WHETHER ANY PORTION OF NORMAL OVARY IS RECOGNIZED.
• NOTE AVERAGE THICKNESS OF CYST WALL OR VARIATIONS OF THICKNESS.
• DESCRIBE (AND SUBSEQUENTLY SECTION) ANY AREAS OF SOLID TISSUE OR RAISED

30. OVARY –BENIGN AND MALIGNANT
• SIMPLE SEROUS CYST: IF OVARIAN PARENCHYMA IS RECOGNIZED IN
THE WALL, TWO SECTIONS WILL CONFIRM THE DIAGNOSIS, I.E. ONE
OF CYST WALL AND ONE OF WALL WITH OVARIAN STROMA.
• DERMOID CYST (TERATOMA): AREAS OF THICKENING IN THE WALL
MAY CONTAIN TISSUES OF VARIOUS GERM-CELL LAYERS AND
IMMATURE ELEMENTS. SAMPLE THICKENED / SOLID AREAS
THOROUGHLY (1 SECTION PER CM).
• ENDOMETRIOTIC CYST: THE MOST DIAGNOSTIC SECTIONS WILL
COME FROM THOSE AREAS OF THE WALL WHERE THE SURFACE
LINING SHOWS EVIDENCE OF OLD HEMORRHAGE, SINCE THE
PRESENCE OF HEMOSIDERIN-LADEN MACROPHAGES HELPS FOR
HISTOLOGICALLY DIGNOSIS
• CYSTS WITH PAPILLARY EXCRESCENCES: THESE REQUIRE GENEROUS
SAMPLING OF THE CYST WALL WITH THE PAPILLARY LESIONS TO
DISTINGUISH BETWEEN BENIGN, BORDERLINE, AND MALIGNANT.

31. SECTIONS TO BE GIVEN
• FOR OOPHORECTOMIES- ONE SECTION FROM EACH
OVARIES
• FOR CYST – UPTO 3 SECTIONS OF CYST WALL
• FOR TUMOURS-3 SECTIONS GIVEN IF TUMOUR <5CM
• IF >5CM ONE BLOCK PER ONE CM ACROSS ITS
GREATEST DIMENSTION

32. • SECTIONS TO BE SUBMITTED ARE: A. IDEALLY SUBMIT A
SINGLE SECTION PER 1 CM OF THE OVARIAN MASS IN THE
LARGEST DIMENSION. THIS IS SUBJECT TO VARIATION IN
CASES OF VERY LARGE TUMOURS OR TUMOURS WITH
HOMOGENOUS APPEARANCE
• B. SECTIONS FROM THE NORMAL OVARY, IF IDENTIFIED C.
SAMPLE TUMOUR ADHESIONS, SITES OF RUPTURE, AND
RESECTION MARGINS, IF PERTINENT, AND LABEL THESE
SPECIFICALLY FOR MICROSCOPIC IDENTIFICATION
• D. IN CASE LYMPH NODES ARE SUBMITTED, PROCESS THESE
ENTIRELY IF THESE ARE GROSSLY UNREMARKABLE
• NOTEWORTHY, IN CASES OF POST NEOADJUVANT
CHEMOTHERAPY (NACT) OVARIAN SPECIMENS, WHEN THE
SIZE OF THE OVARY IS SMALL, AS WELL AS IN CASES OF A
SUSPECTED PRIMARY PERITONEAL SEROUS CARCINOMA,
SUBMIT THE OVARY IN ITS ENTIRETY.
• ADDITIONAL SAMPLING OF A TUMOR THAT POSES
PROBLEMS IN DIFFERENTIAL DIAGNOSIS IS MORE
INFORMATIVE THAN SPECIAL STUDIES. THIS IS ESPECIALLY
SIGNIFICANT IN BORDERLINE OVARIAN SEROUS PAPILLARY
TUMOURS WITH MICROPAPILLARY PATTERN OR MICRO
INVASION, WHEREIN EXTENSIVE SAMPLING IS NECESSARY

33. OVARY –BENIGN AND MALIGNANT
• DOCUMENT INVOLVEMENT OF OVARIAN
SURFACE.
• DOCUMENT INVOLVEMENT OF FALLOPIAN
TUBE.
• DOCUMENT UTERINE SEROSAL.
• FOR ALL OVARIAN
CARCINOMAS, COMPLETELY SUBMIT THE
FALLOPIAN TUBE:
• BODY OF TUBE TRANSVERSELY
SECTIONED.
• FIMBRIATED END OF TUBE RADIALLY
SECTIONED (PLACE NO MORE THAN 2-3
SECTIONS IN A CASSETTE TO ENSURE
PROPER ORIENTATION).

34. OVARY –BENIGN AND MALIGNANT
Gross Appearance
Most Likely Histologic
Diagnosis 2-3 Sections to be submitted from
Smooth-walled cyst with liquidy or
viscous contents
Serous or Mucinous
cystadenoma
Representative wall
Cyst with thick bloody contents Endometriosis Representative wall
Cyst with hair, teeth, chalky material Teratoma (dermoid cyst) Representative wall, especially
thick or solid area (to look for
immaturity)
Cyst with shaggy lining, papillary
excrescences
"Borderline" tumor or
carcinoma
Representative excrescences or
solid area
Solid, cauliflower-like Carcinoma Representative viable, fleshy, solid
area
Solid, fibrous Fibroma / Thecoma Representative

35. OVARY –BENIGN AND MALIGNANT
Solid, fibrous with
mucinous cysts
Brenner tumor Representative junction between
fibrous/cystic areas
Bilateral fibrous Metastatic carcinoma (any
primary)
Representative
Bilateral mucinous Metastatic carcinoma (GI
primary)
Representative

36. FALLOPIAN TUBE:
• MEASURE LENGTH AND DIAMETER.
• DESCRIBE SEROSAL SURFACE (INTACT,
GLISTENING, HEMORRHAGIC) AND NOTE
ANY LESIONS (PARATUBAL CYSTS, TUMOR
NODULES).
• MENTION FRIMBRIATED END RECEIVED OR
NOT
• IF FOR TUMOR, FIX IN FORMALIN.
• IF FOR BENIGN, CAN GROSS SAME-DAY.

37. FALLOPIAN TUBE-
• IF FOR STERILIZATION, SERIALLY SECTION AND DESCRIBE
LUMINAL DIAMETER/WALL THICKNESS. SUBMIT AT LEAST 2
SECTIONS IN ORDER TO ENSURE FULL CROSS SECTION. IF
BILATERAL TUBES ARE SUBMITTED IN THE SAME CONTAINER,
DO NOT SUBMIT BOTH IN THE SAME CASSETTE; SUBMIT
SECTIONS FROM EACH TUBE IN 2 DIFFERENT CASSETTES.
• IF FOR ECTOPIC, SERIALLY SECTION AND PAY ATTENTION TO
DILATED SEGMENT / IMPLANTATION SITE. ALSO, SUBMIT
REPRESENTATIVE SECTION OF THE BLOOD CLOT EVEN IF
DETACHED (IT OFTEN CONTAINS VILLI).
• IF FOR PID, TUBE MAY COME WITH AN OVARY. GROSS
DESCRIPTION IS CRUCIAL. MEASURE AND NOTE DILATION
AND TORTUOSITY, TYPE OF CONNECTION TO OVARY (TUBE
AND OVARY MATTED BY INFLAMMATORY ADHESIONS VS
TUBO-OVARIAN ABSCESS WITH COMMUNICATING CHANNEL
BETWEEN THE TWO STRUCTURES); CONTENT OF TUBE
(HEMATOSALPINX VS PYOSALPINX VS HYDROSALPINX).

38. FALLOPIAN TUBE
• N THE ABOVE CASES, IF FIMBRIATED END IS PRESENT,
SUBMIT REPRESENTATIVE RADIAL SECTION FROM
FIMBRIATED END (2-3 IN ONE CASSETTE).
• SEE-FIM PROTOCOL: IF FOR PROPHYLACTIC
SALPINGOOOPHORECTOMY FOR BRCA MUTATION OR
OTHER REQUESTED CLINICALLY, SUBMIT THE
ENTIRE SPECIMEN AS FOLLOWS:
• OVARY SERIALLY SECTIONED.
• BODY OF TUBE TRANSVERSELY SECTIONED.
• FIMBRIATED END OF TUBE RADIALLY SECTIONED (PLACE NO
MORE THAN 2-3 SECTIONS IN A CASSETTE TO ENSURE
PROPER ORIENTATION).
• ALL OF ASSOCIATED SOFT TISSUE.
• NOTE: PLEASE SPREAD THE SECTIONS OUT
INTO MULTIPLE CASSETTES SO THAT EACH PORTION CAN BE
ADEQUATELY EVALUATED.

40. CERVIX:-
• THESE SPECIMENS SHOULD BE RADICAL HYSTERECTOMIES, WHICH HAVE
CONNECTED PARACERVICAL AND PARAMETRIAL TISSUE DISSECTIONS AS
WELL AS VAGINAL CUFF.
• WEIGH SPECIMEN AND MEASURE:
• 3 DIMENSIONS OF UTERUS (CORNU-CORNU, FUNDUS-LUS, ANTERIOR-
POSTERIOR)
• 3 DIMENSIONS OF CERVIX ( LENGTH)
• WIDTH OF VAGINAL CUFF
• BILATERAL OVARIES (3D) AND FALLOPIAN TUBES (2D), IF PRESENT
• PARACERVICAL/PARAMETRIAL TISSUE ON EITHER SIDE (BASE X HEIGHT OF
TRIANGLE)
• IDENTIFY ANTERIOR AND POSTERIOR SIDES AND NOTE QUALITY OF
SEROSA. (THE PERITONEAL REFLECTION EXTENDS FURTHER AND IS
POINTED INFERIORLY ON THE POSTERIOR SIDE; THE TUBE IS ANTERIOR
TO THE OVARY).
• INK THE CERVIX, UTERUS, AND PARACERVICAL/PARAMETRIAL TISSUES:
ANTERIOR-BLUE, POSTERIOR-BLACK.
• PARACERVICAL/PARAMETRIAL TISSUE:

41. CERVIX:-• .
• IF THERE IS NO VISIBLE LESION, SUBMIT THE ENTIRE SQUAMO-
COLUMNAR JUNCTION RADIALLY AROUND CERVIX
• CERVIX-2 SECTIONS-
• ONE FROM- TRANSVERSE SECTION OF ENDOCERVIX
/PARAMETRIAL TISSUE /PARA CERVICAL TISSUE
• OTHER FROM- LONGITUDINAL SECTION OF ENDOCERVIX AND
TRANSFORMATION ZONE
• SUBMIT REPRESENTATIVE SECTIONS OF FALLOPIAN TUBES, IF
PRESENT. EACH FALLOPIAN TUBE SHOULD BE SAMPLED AND
SUBMITTED IN ITS OWN CASSETTE. AN APPROPRIATE CASSETTE
WILL CONTAIN ONE SECTION FROM THE ISTHMUS, ONE
SECTION FROM THE AMPULLA, AND A
REPRESENTATIVE RADIAL SECTION FROM THE FIMBRIATED END.

42. CERVIX :- INK THE VAGINAL CUT ENDS AND THE
PARACERVICAL TISSUE.
6. FIRST, TAKE RADIAL VAGINAL CUT MARGINS
(ANTERIOR, RIGHT LATERAL , POSTERIOR ,LEFT
LATERAL)
7 . DESCRIBE THE TUMOUR IN THE CERVIX
. A. LOCATION (ANTERIOR LIP, POSTERIOR LIP)
B. ENDOPHYTIC OR EXOPHYTIC
C. TUMOUR DIMENSIONS
8. MENTION THE DEPTH OF INVASION IN 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

43. • IF THE HYSTERECTOMY IS FOR CERVICAL TUMOUR OR A DIAGNOSIS OF HIGH GRADE CIN, AND
NO LESION CAN BE SEEN ON THE CERVIX GROSSLY, THEN THE ENTIRE CERVIX SHOULD BE
SUBMITTED FOR HISTOLOGY.
• IF TUMOR IS GROSSLY CLOSE TO VAGINAL CUFF MARGIN, INK THE EDGE OF THE CUFF AND
SUBMIT SECTIONS PERPENDICULAR TO MARGIN.
SERIALLY SLICE THE TUMOR USING FULL-THICKNESS RADIAL SECTIONS AROUND THE CERVIX.
MEASURE DEPTH OF INVASION OF TUMOR AND DISTANCE FROM NEAREST INKED MARGIN.
• APART FROM THE MAIN TUMOUR, MENTION IF THERE IS ANY OTHER LESION ( E.G. POLYP,
BLOOD CLOT) 11. EXAMINE THE ENDOMYOMETRIUM AND GIVE THE THICKNESS OF EACH.
TAKE AT_ LEAST ONE SECTION FROM THE ADJACENT ENDOMYOMETRIM;
• 12. EXAMINE EACH OVARY BY SERIALLY SLICING THEM. MENTION THE DIMENSIONS, CUT
SURFACE AND APPEARANCE.
• 1 3. EXAMINE THE TUBES, GIVE THEIR LENGTH, PRESENCE OF ANY PARATUBAL CYSTS, ETC.
• BOTH SIDED PARAMETRIA ARE TO BE EXAMINED IN TOTO. THE TISSUE IS SUBMITTED
SEPARATELY
• 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 NGDES ARE OFTEN FATTY AND LARGE AND TRIMMING MAY BE
NECESSARY. IT IS ALSO TO BE REMEMBERED THAT PARAMETRIUM CAN SHOW TINY

44. SECTIONS TO BE GIVEN FROM• 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

45. SUMMARY:
• MEASURE THE ENTIRE SIZE OF THE SPECIMEN ALONG
WITH CERVIX
• LENGTH OF CERVIX
• IF B/L ADNEXA REMOVED- SIZE OF EACH OVARY
• LENGTH OF EACH FALLOPIAN TUBE
• MENTION ANY ANAMOLY , POLYP IF IDENTIFIED
• IT IS OPTIONAL TO APPLY INK ON POSTERIOR SURFACE
MERELY FOR IDENTIFICATION OR ORIENTATION

46. STEPS IN GROSSING:-
• THERE IS NO RIGHT TECHNIQUES OF OPENING THE UTERUS . IT CAN BE
OPENED IN ‘Y’ SHAPED INCISION ON ANTERIOR SURFACE OR EVEN CAN BE
BISECTED
• ON CUT SECTION-
• SEE FOR ENDOMETRIAL CAVITY
• MEASUTRE MYOMETRIAL THICKNESS
• ANY FIBROID OR ADENOMYOSIS OR POLYP OR GROWTH
• ANY AREAS OF NECROSIS / HEMORRAHGIC SPOT
• MENTION ANY LESION IN ENDOMETRIAL CAVITY

47. • SECTIONS TO BE SUBMITTED:-
• 2- SECTIONS FROM ENDOMYOMETRIUM
• 2-3 SECTIONS FROM FIBROID /POLYP
• SECTION FROM EACH OVARY
• SECTION FROM BOTH FALLOPIAN TUBE
• SECTION FROM CERVIX

48. HYSTERECTOMY FOR CARCINOMA
ENDOMETRIUM
• MENTION THE DIMENSION OF TUMOUR
• EXACT SITE
• LOCATION
• APPEARANCE-EXOPHYTIC , INFILTRATIVE
• MENTION THE DEPTH OF INVASION IN MYOMETRIUM [LESS THAN HALF
OR MORE THAN HALF
• THE TUMOUR FREE MYOMETRIUM THICKNESS IN MM IS TO BE GIVEN
• THE MAIN AIM IS TO DETECT MAXIMUM INVASION INTO THE
MYOMETRIUM
• UTERINE SEROSAL SURFACE MAY BE MARKED BY INK .
• APART FROM MAIN TUMOUR MENTON IF THERE IS ANY OTHER LESION
[POLYP ,BLOOD CLOT]
• GIVE- ONE SECTION ENDOMETRIUM
• MENTION ANY LESION ON CERVIX
• OVARY AND FALLOPIAN TUBE – SIZE CUT SURFACE

49. SECTIONS TO BE
SUBMITTED
• TUMOUR- 4 SECTION GIVEN
• ONE FROM ADJACENT
ENDOMETRIUM
• 2 SECTION FROM GROSSLY
UNREMARKABLE CERVIX
• RIGHT FALLOPIAN TUBE AND
OVARY
• LEFT FALLOPIAN TUBE AND
OVARY

50. • FOR FIBROID- MENTION NUMBERS OF
FIBROID
• SITE OF FIBROID
• IF MULTIPLE FIBROIDS IDENTIFIED –MENTION
TOTAL NUMBERS OF FIBROISD AND SIZE OF
LARGEST AND SMALLEST FIBROID
• COMMENT ON CUT SURFACE OF FIBROID

51. SECTIONS TO BE SUBMITTED
• FOR ENDOMETRIAL POLYP-3 SECTIONS
GIVEN
• POLYPS APPEAR AS BROAD BASED TO
PEDUNCULATEDS LESION
• MAY EXTEND INTO ENDOCERVICAL
CANAL

52. CERVIX-SECTIONS TO BE
GIVEN
• A-B-TUMOUR SECTIONS
• D-E-F- ENDOMETRIUM
SECTIONS
• G-NORMAL APPEARING
ENDOMETRIUM
• L-M-N-K- VAGINAL CUFF
MARGINS-

53. • 0. OVARY -THE SECTIONS TO BE
SUBMITTED ARE:
• FOR OOPHORECTOMIES- ONE SECTION FROM EACH
OVARIES
• FOR CYST – UPTO 3 SECTIONS OF CYST WALL
• FOR TUMOURS-3 SECTIONS GIVEN IF TUMOUR <5CM
• IF >5CM ONE BLOCK PER ONE CM ACROSS ITS GREATEST
DIMENSTION

54. GROSS PICTURES

56. MULTIPLE FIBROID ATROPHIC
UTERUS

57. STEPS IN GROSSING:-
• FOR ADENOMYOSIS-

62. CORPUS LEUTAL CYST

63. PARATUBAL CYST TUBAL
ECTOPIC