The document provides guidance on grossing techniques for ovary and testis specimens. For ovaries, it describes examining the external surface and capsule before cutting the specimen open and identifying normal versus abnormal tissue. Sections should be submitted from the tumor, normal ovary, fallopian tubes, and other relevant areas. For testes, it involves measuring the cord and testis, examining the tunica, bisecting the testis, describing the tumor, and submitting representative sections of the tumor and its relationship to surrounding structures. Accurate gross examination is important for pathological staging and diagnosis.

1. GROSSING TECHNIQUE OF
OVARY
and Testis
Moderator
Dr. Yogendra Narayan Verma Sir
Present by
Rajneesh kumar srivastava

2. Types of Specimens
1. Total Oophorectomy.
2. Subtotal/Partial Oophorectomy.
3. Salpingo-Oophoerectomy.
4. Hysterectomy with salpingo-Oophorectomy.
5. Post-neoadjuvant chemotherapy(NACT)
specimen.

3. Steps in Grossing
1. Weigh and then measure the ovarian mass in three dimensions.
Identify the laterality and 'match' it with the requisition form.
2. Examine and note the external surface (smooth or nodular), border
(circumscribed or irregular) and the attached fallopian tube,
including its length.
It is noteworthy that patients undergoing prophylactic
oophorectomy
because of a family history of breast and / or ovarian cancer
might
have a small focus of carcinoma on the ovarian surface.
Therefore
examination of external surface is vital.

4. • 3. Carefully examine the external capsular surface and document whether it is intact; thickened or
"breached".
• 4. Note, if any surface growth is identified.
5. It is optional to ink the capsular surface. For those who prefer this, it is meant for easy
identification of capsular
blocks and capsular integrity.
• 6. After examination of external surface including capsule, cut open the specimen along its largest
dimension.
It is useful to photograph the specimen at this time and keep it for records.
• 7. Identify the normal ovarian parenchyma, including cortex and medulla, if present.
• 8. In case of cystic masses, document the cyst contents if identified, measure thickness of the cyst
wall during serial cutting and note whether it is uni- or multicystic with septae.
• 9. Identify and document solid areas,including papillary excrescences,necrotic, haemmorrhagic
areas or calcification.

5. • 10. The 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 (Figure
1)
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. Sections from the attached fallopian tube, including the fimbrial end as per Sectioning
and Extensively Examining the Fimbriated End (SEE-FIM) protocol.
e. Sections from hilum of the ovary or mesovarium, if identifiable
f. In case omentum is submitted,submit representative sections.
In case lymph nodes are submitted, process these entirely if these are grossly
unremarkable

6. Figure 1- Pictorial representation of sections to be taken in
an ovarian tumour

7. SEE-FIM protocol for grossing of risk-reducing salpingo-oophorectomy (RRSO) specimens. A: Serial
sectioning of the fallopian tube at 2-mm intervals. The distal (fimbriated) end should be sectioned parallel to the long
axis of tubal fimbria. The remaining mid and proximal portions are to be sectioned perpendicular to the lumen. B: The
ovary should be sectioned at 2 mm intervals. C and D: Macroscopic images of glass slides showing the serially
sectioned and entirely submitted fallopian tube from an RRSO specimen. C, fimbriated end; D, mid and proximal
portion.

8. Noteworthy, in cases of post neoadjuvantchemotherapy (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 to rule out a low-grade serous
carcinoma.
Intra-operative Assessment (Frozen-section)
There is a considerable challenge in diagnosing ovarian tumors on frozen sections.
Nonetheless, it is vital. This should be taken as an opportunity for documentation of
capsular status. Even if the capsule is ruptured during intraoperative handling, it upstages
the tumor to PT1c [1C]. Available radiological details should be noted in terms of solid and
cystic components of the tumor. A complex solid/cystic mass has more chances of being
borderline or malignant type.
Presence of any 'implants' and tumor marker levels, if available, may be noted.
During intraoperative assessment,
• a. Cut open the tumor and document the type of fluid{in case of cystic masses)
• b. Sample the most representative solid areas within the tumor (if cystic and solid)
• c. Cytological 'Imprints' may be made for assessment of cellular atypia in epithelial or
other tumors

9. Figure 2- : A. Predominantly cystic ovarian adenocarcinoma with
multiple solid and cystic depositsin omentum B. Mature teratoma. C.
Cut surface of a borderline papillary seromucinous tumor of ovary
diagnosed during intraoperative frozen section assessment.

10. • Noteworthy,
a. In cases of borderline epithelial tumors, the intraoperative tumor staging, similar to a malignant
tumor, is performed and a limited resection (fertility conserving surgery) suffices
b. In case of a resectable high-grade adenocarcinoma, a radical excision including a total
hysterectomy with a bilateral saplingo-oophorectomy may be undertaken
c. Diagnosis of a mucinous tumor is indicative of an appendicectomy
d. Once diagnosis of an adenocarcinoma is made, an attempt should be made to differentiate primary
vs. secondary adenocarcinoma. A ready access to the patients' full details during that time would be
contributory
e. Identification of endometriosis and granulomas possibly due to Mycobacterial infections could spare
a patient from a major surgery
f. In cases of incidental oophoerectomy, submit a tumor section representative of the entire ovarian
cut surface. Included a section from fallopian tube. Note the corpus luteum or any cyst,measure it and
document its contents(Figure 2)

11. SEE-FIM protocol for grossing of risk-reducing salpingo-oophorectomy (RRSO) specimens. A: Serial sectioning of
the fallopian tube at 2-mm intervals. The distal (fimbriated) end should be sectioned parallel to the long
axis of tubal fimbria. The remaining mid and proximal portions are to be sectioned perpendicular to the lumen. B:
The ovary should be sectioned at 2 mm intervals. C and D: Macroscopic images of glass slides showing the serially
sectioned and entirely submitted fallopian tube from an RRSO specimen. C, fimbriated end; D, mid and proximal
portion.

12. Grossing techniques of testis
Surgical Anatomy
• The testes are two glandular organs, which secrete the
semen. They are suspended in the scrotum by the
spermatic cords. The tunica vaginalis (tunica vaginalis
propria testis) is the serous covering of the testis.The
tunica albuginebluish-white color, composed of bundles
of white fibrous tissue which interlace in every direction.
It is covered by the tunica vaginalis, except at the points
of attachment of the epididymis to the testis. The
anterior border and lateral surfaces, as well as both
extremities of the organ are convex, free, smooth, and
invested by the visceral layer of the tunica vaginalis.

13. • The posterior border, to which the cord is attached, receives only a
partial investment from this membrane. Lying upon the lateral edge
of this posterior border is a long, narrow, flattened body, named the
epididymis. The epididymis consists of a central portion or body; an
upper enlarged extremity, the head; and a lower pointed extremity,
the tail, which is continuous with the ductus deferens.
Rationale
With respect to GCTs, the prognostic importance of
histopathology is mainly confined to stage I disease. A
patient with stage I non-seminomatous germ cell tumour
(NSGCT), including embryonal carcinoma, with or without
evidence of a is the fibrous covering of the testis. It is a
dense membrane of a vascular invasion will be offered high
surveillance or low dose chemotherapy, respectively.
Whereas a patient with stage I seminoma will undergo

14. Types of Specimens
• The commonest received specimen for testicular tumor is a high
inguinal orchidectomy specimen. A bilateral orchiectomy
specimen is received as a part of hormonal ablation treatment
in case of prostate cancer.
Fixation
• Once removed the specimen should be either transferred
immediately to the pathology department, fresh ,for the removal
of tissue for future studies or placed in adequate formalin to fix.
The urologist should not incise the specimen as the formalin
fixation causes the specimen to evert, making assessment of
the relationship of the tumour to the rete or the tunica difficult
and may result in tumor contamination of the resection margins.

15. • Steps in Grossing
1. Measure the length of spermatic cord.
2. Ink the cord cut margin from the tip of the spermatic cord and
place en face section (shave) down in a cassette (before incising
the tumour, to prevent knife carry over of tumor).
3. Reflect parietal tunica-note hydrocele, adhesions.
4. Measure the testis.
5. Comment on any tumor extension through the tunica.
6. Bivalve testis through rete and epididymis.

16. • 7. Describe the tumour as follows:
a. Tumour location (i.e. upper/lower pole, middle)
b. Color and consistency (solid/cystic)
c. The presence of cartilaginous areas, hair, tooth, etc. in
teratomas
d. The presence of hemorrhage and necros is ( likely to represent
mixed GCT)
8. Note the relationship of tumour with tunica, rete (may not be
identifiable),
epididymis and the spermatic cord.
• (Figures 1 & 2)

17. Figure 1: Cut surface of a testicular tumor showing a variegated tumor
involving the epididymis (thick arrow). Note the thickened cord
structures also (thin arrow)

18. Figure 2: Photograp h showing relation of testicular tumor (thick
white arrow) to native testis (thin white arrow) and the thickened
layers of tunica (black arrow)

19. 9. Sections to be submitted (Figure 3):
a. Tumour from different macroscopic areas;
hemorrhagic areas to look for trophoblastic
elements and mixed GCT
b. Tumour edge and adjacent testis to facilitate
assessment of
lymphovascular invasion
c. Area of tumour closest to tunica,rete, epididymis
and cord. To
look for their involvement
d. Testis away from tumour to assess intratubular
germ cell
neoplasia (ITGCN), atrophy and presence or

20. Figure 3 : A schematic representation of the sections to be taken in a testicular tumor. 1.
Different areas of testicular tumour (4 sections).
2. Tumour with layers of tunica. 3. Native testis
to look for ITGCN. 4. Epididymis (or tumor with
epididymis). 5. Base of cord section. 6. Cord cut
margin

21. THANK YOU