FOR pathologists

1. GROSSING OF
OVARY AND FALLOPIAN
TUBE
Dr. Harshita Gupta Dr.

2. • FALLOPIAN TUBE SEGMENTS MAY BE RECEIVED
FROM
 TUBAL LIGATION STERILISATION PROCEDURES.*
 ECTOPIC PREGNANCY IN THE FALLOPIAN TUBE
 PROPHYLACTIC/RISK REDUCING - PATIENTS WITH A
F/H/O BREAST OR OVARIAN CANCER OR KNOWN BRCA
MUTATIONS.
 OVARIES MAY ALSO BE RECEIVED IN TOTAL
HYSTERECTOMY SPECIMENS WITH OR WITHOUT
ABNORMALITIES PRESENT.1,4
Salpingectomy/Oopherecto
my- Indications-

3. • OTHER CONDITIONS
 ENDOMETRIOSIS,
 CYSTS,
 HYDROSALPINX AND
 PELVIC INFLAMMATORY DISEASES.

4. FALLOPIAN TUBES
 FALLOPIAN TUBES OR OVIDUCT ARE PAIRED
STRUCTURES
 EXTEND FROM SUPERIOR ANGLE OF UTERUS
LATERALLY TO REGION OF OVARIES
 MEASURES
 7-14CM LONG

5. PARTS
• INTERSTITIAL
• ISTHMIC
• AMPULLARY
• INFUNDIBULUM

7. EXTERNAL INSPECTION
 ORIENT AND IDENTIFY THE ANATOMICAL
FEATURES OF THE SPECIMEN.
 PHOTOGRAPH THE INTACT SPECIMEN IF
REQUIRED.
 DESCRIBE THE FOLLOWING FEATURES OF THE
SPECIMEN:
• PROCEDURE-RECORD AS STATED BY THE
CLINICIAN.
• SPECIMEN LATERALITY- L/R/ B/L/UNSPECIFIED

8. SPECIMEN DIMENSIONS-
• FALLOPIAN TUBE, IN TWO DIMENSIONS-
LENGTH X DIAMETER.
• IF ABNORMAL, RECORD IN THREE DIMENSIONS.
• WITH FIMBRIAE
• WITHOUT FIMBRIAE
• OVARY- IN THREE DIMENSIONS

9. DESCRIBE THE FOLLOWING FOR BOTH FALLOPIAN
TUBE AND OVARY IF PRESENT.
• SPECIMEN INTEGRITY
• INTACT
• DISRUPTED
• FRAGMENTED
• SPECIMEN APPEARANCE
• SURFACE
• SMOOTH
• ROUGHENED
• ADHESIONS
• CYSTS
• EVIDENCE OF PREVIOUS TUBAL SURGERY (IF PRESENT)1
• CLIPSNUMBER AND LOCATION

10. FALLOPIAN TUBE-INTACT

11. INTERNAL INSPECTION
• FALLOPIAN TUBE ABNORMALITIES
• TUBAL CYST, SIZE IN MAX. DIMENSION (MM)
• TUBAL SWELLING
• PERFORATION/RUPTURE- Y/N
• CONTENTS
• FLUID
• CLOUDY
• CLEAR
• BLOOD/CLOT
• LUMEN OF FALLOPIAN TUBE- ABSENT/PRESENT

12. FALLOPIAN TUBES – LIGATION
 MEASURE THE LENGTH AND DIAMETER OF EACH
 LUMEN PATENT?
 BISECTED AND SECTION SUBMITTED

13. FALLOPIAN TUBES –
SALPINGECTOMY
 MEASURE THE LENGTH AND GREATEST DIAMETER
 SEROSA: FIBRIN? HEMORRHAGE? FIBROUS
ADHESIONS TO OVARY OR OTHER ORGANS?
 WALL: ABNORMALLY THICK? RUPTURED?
 MUCOSA: ATROPHIC? HYPERPLASTIC?
APPEARANCE OF FIMBRIATED END; INVERTED?

14.  LUMEN: PATENT? DILATED? CONTENT;
DIAMETER, IF ABNORMALLY LARGE
 MASSES: SIZE, APPEARANCE, INVASION
 CYSTS IN PARATUBAL REGION: DIAMETER,
THICKNESS OF WALL, CONTENT; SESSILE OR
PEDUNCULATED?

15. FOR INCIDENTAL TUBES
WITHOUT GROSS
ABNORMALITIES:
SECTIONS TO BE TAKEN
 THREE CROSS-SECTIONS OF EACH TUBE, FROM
THE PROXIMAL, MID, AND DISTAL PORTIONS

16. ECTOPIC PREGNANCY-
• CAREFULLY DISSECT THE SPECIMEN NOTING
THE PRESENCE OF A
 GESTATIONAL SAC, PLACENTA OR RARELY, A
FETUS.
 IF A FETUS IS PRESENT, MEASURE THE LENGTH
FROM CROWN TO RUMP AND/OR FOOT LENGTH
(MM).
 NOTE AMOUNT OF
HEMORRHAGE;
RUPTURE?

17. FOR TUBES WITH SUSPECTED
ECTOPIC PREGNANCY-
• SECTIONS TO BE TAKEN
• SUBMIT ANY TISSUE WITH GROSS
APPEARANCE OF PRODUCTS OF
CONCEPTION
• IF NONE IS GROSSLY IDENTIFIED,
SUBMIT SEVERAL SECTIONS FROM
THE WALL IN THE AREA OF
HEMORRHAGE AS WELL AS FROM
THE INTRALUMINAL CLOT

18. FOR TUBES WITH OTHER LESIONS:
 IF TUMOR IS PRESENT, AT LEAST THREE
SECTIONS MUST BE TAKEN TO INCLUDE
GROSSLY UNINVOLVED MUCOSA

19. PROPHYLACTIC/RISK REDUCING
SALPINGECTOMY
• PROPHYLACTIC SURGERY MAY BE UNDERTAKEN WHERE
THERE IS A FAMILY HISTORY OF OVARIAN, FALLOPIAN TUBE
OR BREAST CANCER OR BRCA1/BRCA2 MUTATIONS,
USUALLY WITH OOPHORECTOMY
• SUBMIT ALL TISSUE FOR PROCESSING:
• LONGITUDINAL SECTIONS OF FIMBRIAL (DISTAL 20MM) END
AT 2-3MM INTERVALS
• TRANSVERSE SECTIONS OF REMAINING TUBE1
• SUBMIT EACH SECTION IN SEQUENTIAL ORDER

20. PROTOCOL OF SEE-FIM OF FALLOPIAN
TUBE
• SECTIONING AND EXTENSIVELY EXAMINING THE
FIMBRIATED END OF FALLOPIAN TUBE
• AMPUTATION AND LONGITUDINAL SECTIONING OF
INFUNDIBULUM AND FIMBRIAL SEGMENT(DISTAL
2CM) TO ALLOW MAXIMUM EXPOSURE OF TUBAL
PLICAE
• THE ISTHMUS AND AMPULLA ARE CUT
TRANSVERSELY AT 2-3 MM

21. FALLOPIAN TUBE DEMONSTRATING
DISSECTION FOR SEE-FIM

23. OVARY
oTHE OVARIES ARE PAIRED ORGANS HANGING FROM
EITHER TUBE BY MESOVARIUM, THE LATERAL
SUSPENSORY LIGAMENT & THE OVARIAN LIGAMENT
MEASUREMENT
o2.5-5 CM LONG, 1.5-3 CM BREADTH
& 0.7-1.5CM WIDTH
WEIGHT
o4 TO 8 GRAMS

25. SPECIMENS RECEIVED:
oTOTAL / SUBTOTAL OOPHORECTOMY
oSALPINGO-OOPHORECTOMY
oHYSTERECTOMY WITH SALPINGO-OOPHORECTOMY
oPOST NEOADJUVANT CHEMOTHERAPY SPECIMEN

26. GROSSING THE OVARY:
• WEIGH & MEASURE THE OVARY
• EXAMINE THE EXTERNAL SURFACE
SMOOTH OR NODULAR
BORDER – CIRCUMSCRIBED OR IRREGULAR
ATTACHED FALLOPIAN TUBE
CYSTS
CAPSULE – INTACT, THICKENED, BREECHED
NODULAR TUMOR EXCRESCENCES

27. • ABNORMAL
• CYST
• UNILOCULAR WITHOUT SUSPICIOUS
PAPILLARY OR SOLID AREAS
• MULTILOCULAR
• FLUID
• SEROUS
• MUCINOUS
• KERATINOUS DEBRIS AND HAIR
• OLD BLOOD AND BLOOD CLOT

28. • INK THE CAPSULE
• BISECT THE OVARY BY A CUT THROUGH ITS LONGEST
DIMENSION & THE HILUM
• TUMORS: SIZE
EXTERNAL APPEARANCE: SMOOTH OR PAPILLARY?
SOLID OR CYSTIC?
CONTENT OF CYSTIC MASSES
HEMORRHAGE, NECROSIS, OR CALCIFICATION?

29. • IF CYSTIC- COLOR & CONSISTENCY OF THE
CYSTIC FLUID- SEROUS, MUCINOUS OR
HEMORRHAGIC
• EXAMINE THE SURFACE OF THE CYST FOR ANY
GRANULARITY OR PAPILLARY PROJECTIONS
• THE THICKNESS OF THE CYST WALL SHOULD BE
RECORDED
• RESIDUAL OVARIAN PARENCHYMA

30. SECTIONS TO BE TAKEN

31. NORMAL OVARY/INCIDENTAL
OOPHORECTOMY
• SUBMIT ONE OR TWO REPRESENTATIVE SECTIONS3 THAT
DEMONSTRATE
 CORTEX,
 MEDULLA AND
 HILUM.
 WHERE THE OVARY IS >25MM IN MAXIMUM DIMENSION,
MORE SECTIONS MAY BE REQUIRED TO ACHIEVE
ADEQUATE SAMPLING.

32. TERATOMA/DERMOID CYST
 SUBMIT REPRESENTATIVE SECTIONS FOCUSSING
ON SOLID AREAS AND INCLUDING BLOCKS
FROM SOLID AREAS AND THE CYST WALL

33. OVARY WITH ENDOMETRIOSIS
 SUBMIT REPRESENTATIVE SECTIONS FROM CYST
WALL, SOFT, SOLID AND PAPILLARY AREAS.
 A SECTION TAKEN IN CONTINUITY WITH THE
FALLOPIAN TUBE (IF SUBMITTED) IS VALUABLE
TO EXAMINE THE INTERVENING TISSUES FOR
ENDOMETRIOSIS

34. SIMPLE THIN WALLED CYST
 BEST PROCESSED BY SUBMITTING A PIECE OF THE WALL
IN A “SWISS ROLL” BLOCK
 COMMUNICATE INSTRUCTIONS FOR CYST WALL TO BE
EMBEDDED ON EDGE TO ENSURE SECTIONS
DEMONSTRATE THE EPITHELIAL LINING, WALL AND
STROMAL SURFACE

36. THICK WALLED CYST
 SUBMIT ENTIRE CYST IF SMALL. SUBMIT ONE
BLOCK PER 10MM OF MAXIMUM DIAMETER OF
LARGER CYSTS

37. •OVARIAN TUMOR
 3 SECTIONS OR ONE SECTION FOR EACH CM OF
TUMOR, WHICHEVER IS GREATER.
 1 SECTION SHOULD BE TAKEN FROM NON
NEOPLASTIC OVARY

41. 2014- FIGO

45. FALLOPIAN TUBE TUMORS
• FALLOPIAN TUBE NONNEOPLASTIC:CHRONIC SALPINGITIS ECTOPIC /
TUBAL PREGNANCY METAPLASTIC CHANGES METAPLASTIC PAPILLARY
TUMOR PLACENTAL SITE NODULE PROLAPSE SALPINGITIS ISTHMICA
NODOSA TUBAL HYPERPLASIA TUBO-OVARIAN ABSCESS
• FALLOPIAN TUBE TUMORS:ADENOMATOID TUMOR
• ENDOMETRIOID ADENOARCINOMA
• MALIGNANT MIXED MÜLLERIAN TUMOR
• HIGH GRADE SEROUS CARCINOMA
• SEROUS ADENOFIBROMA
• SEROUS TUBAL INTRAEPITHELIAL CARCINOMA
• BROAD LIGAMENT:DEVELOPMENTAL CYSTS FEMALE ADNEXAL TUMOR
OF PROBABLE WOLFFIAN ORIGIN MESONEPHRIC DUCT
REMNANTS PAPILLARY CYSTADENOMA OF MESOSALPINX PARATUBAL
CYSTS WALTHARD CELL NESTS
•
FALLOPIAN TUBE STAINS: KI67 P53