slide describing the gross processing of uterus with attached fallopian tubes.

1. Hysterectomy and Salpingo-
Oophorectomy.
PRESENTED BY- Dr.Ayushi Agarwal
GUIDED BY- DR.AMBRISH KUMAR SIR

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ANATOMY OF UTERUS

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).

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6. The type of hysterectomy (total or radical) and the
disease (benign or malignant) determine the
method for processing the specimen. Specimens
fall into three categories:
1. Total hysterectomies for benign conditions
(e.g., prolapse or fibroids).
2. Total hysterectomies for malignant conditions
(e.g., endometrial carcinoma).
3.Radical hysterectomies for malignant conditions
(e.g., cervical carcinoma) that include vaginal cuff,
parametrium, and regional lymph nodes.
Gravid hysterectomies are rarely performed.
These specimens are unusual and may have
medicolegal implications.
Caption

7. • Proceeding anterior to posterior are the
round ligament, the fallopian tube, the
ovary, and finally, the ovarian ligament.
• The peritoneal reflection is lower on the
posterior surface and often comes to a
point.
• It is higher and blunter on the anterior
surface where the bladder has been
dissected away.
• If a specimen cannot be oriented,
designate the two sides “A” and “B” when
submitting sections.
ORIENTATION OF HYSTERECTOMIES
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10. • Weigh the specimen.
• Orient the specimen as to anterior and posterior.
• Examine the serosal surface for adhesions, endometriosis, tumor implants, or inflammation and describe.
• Record the overall dimensions of the uterus (three dimensions), tubes (length and diameter), and ovaries
(three dimensions).
• Record the dimensions of the exocervix (two dimensions) and the diameter and shape (round or slit-like) of
the external os.
• Describe the appearance (smooth, white, glistening) and any lesions of the cervix (ulcerated, irregular,
granular).
• In cases of uterine prolapse, a vaginal cuff may be present and should be described.
• Specimens received as supracervical hysterectomies should be documented grossly, and the resection
margin should be inked prior to opening the uterus.
UTERUS-PROCESSING THE SPECIMEN

11. • Open the uterus with scissors, along the lateral margins from the external os to the
cornu. Never use a scalpel. It is useful to use a probe within the os to guide the scissors.
• Make transverse incisions through the entire mucosa to, but not through, the serosa. Do
not abrade the mucosa or wash with water.
• Describe the endometrial cavity and lining including size (cornu to cornu, fundus to
endocervical canal), distortion (by leiomyomas), color (tan, hemorrhagic), thickness, and
any lesions.
• If lesions are present, describe location (anterior or posterior), size, color, consistency,
and depth of invasion into myometrium.
• Describe the endocervix including size (length and width), color, normal herringbone
pattern, and any lesions.

12. • Describe the myometrium including average thickness, normal trabeculated pattern, or adenomyosis
(coarse trabeculations or cystic hemorrhagic areas).
• If leiomyomas are present describe number, size (or range in size if many), location (subserosal, mural,
submucosal, anterior or posterior), color, presence of hemorrhage or necrosis or variation in pattern.
• Describe each fallopian tube.
• Describe each ovary.
Caption

13. MICROSCOPIC SECTIONS
•Cervix: Anterior and posterior cervix taken, to include both exo- and endocervix and the transformation
zone.
•Lower uterine segment: One transmural section from each of the anterior and posterior sides.
•Endometrium and myometrium: Two transmural endometrial sections from anterior and posterior walls;
if the myometrium is very thick, include only a portion of wall. Sample any lesions (e.g., polyps).
If leiomyomata are present, section through each one and examine grossly. Take up to three represen-
tative sections TOTAL. More sections are taken if there are areas of necrosis, hemorrhage, or areas of
unusual appearance.
If the hysterectomy is supracervical, take a section perpendicular to the resection margin (after inking) to
determine at what level (endocervix or lower uterine segment) the resection was performed. If all
endometrium is not removed, the patient may be at risk for developing carcinoma and decisions
concerning hormonal treatment could be affected.

14. •Serosa: If serosa is not included in the sections of endometrium, submit a separate section.
•Fallopian tubes: Amputate the fimbria and serial section the remainder of the tube. Submit the entire
fimbria as the representative section in all benign cases (including hysterectomies for leiomyomata).
Submit the entire tube in any uterine and pelvic epithelial malignancy, or in any case with a positive
family history for breast or ovarian cancer, or otherwise risk-reducing salpingo-oophorectomy, using
the SEE FIM protocol (see under “Fallopian Tube”). Submit right and left tubes in separate desig-
nated cassettes.
•Ovary: Serially section the ovaries transversely to the long axis and submit one representative section
from each ovary including the capsule. This section can be submitted with the fallopian tube in the same
cassette.

15. FALLOPIAN TUBE PROCESSING THE SPECIMEN
• Describe the size (length and diameter), and the presence or absence of a fimbriated end.
• Check for patency with a probe. A plastic ring may be present if there has been a prior tubal ligation.
• Describe the serosal surface (normal = smooth and glistening) including adhesions, paratubal cysts,
purulent or fibrinous exudates, and ruptures.
• Make cross-sections across the tube. Note any luminal contents (purulent exudate, hemorrhage, pla-
cental or fetal tissue or membranes).
• Submit three sections in one cassette including the fimbriated end, mid portion, and cornual portion of
the tube. Additional cassettes can be used to document any gross lesions.
• In cases of ectopic pregnancy, also sample blood clot as this may contain the products of conception.
• If the procedure was a tubal ligation, instruct the histology laboratory to embed the specimen as cross
sections. A complete cross-section of the tube is necessary to document that a sterilizing procedure
was performed.

16. • Record the overall dimensions of the ovary and describe the outer surface including color (white), surface (smooth or convoluted,
adhesions, papillary projections), simple cysts (thin-walled without a solid component).
• Avoid rubbing or abrading the outer surface in order to preserve the delicate (and very fragile) epithelial lining.
• If any abnormality is present (e.g., cysts, papillary projections), ink the outer surface.
• Serially section the ovary, parallel to the short axis.
• Describe the ovary including color and presence of corpus luteum and corpora albicantia.
• If cysts are present describe number, size, unilocular vs. multilocular, lining (smooth, irregular, papillary projections, velvety as in
endometriotic cyst), thickness of wall, contents (fluid vs. keratinaceous material and hair as in mature teratoma, serous vs. mucinous,
hemorrhagic), calcified areas or bone.
• The usual unremarkable ovary with only small simple cysts can be sampled with one section demonstrating any features noted above.
• If the ovary was removed as a prophylactic procedure in a woman with a personal or family history of ovarian or breast carcinoma or who
has a known BRCA mutation, the entire specimen (ovary, fallopian tube, and adnexal soft tissue) is examined histologically.
• Large thin-walled cysts can be rolled into a “jelly roll” and fixed in formalin overnight. Submit transverse sections of the roll. Try to submit a
section of the residual ovary.
• If there is any suspicion of malignancy (e.g., mucinous cyst, complex cyst, papillary projections, solid areas) additional sections must be
taken to document these areas and any extension into adjacent tissues
OVARY-PROCESSING THE SPECIMEN

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