The document provides guidance on grossing specimens of the uterus, cervix, ovaries, and related structures. It describes the anatomy of these organs and discusses the typical gross examination process. This includes examining, measuring, and sampling tissues based on the clinical history and gross findings. Appropriate tissue sampling is emphasized to provide histologic diagnosis and assess important prognostic factors like tumor size, depth of invasion, and involvement of resection margins.
This is a presentation on the topic of cytology of the breast, prepared by Dr Ashish Jawarkar, he is MD in pathology and a teacher at Parul institute of Medical sciences and research Vadodara.
This is a presentation on the topic of cytology of the breast, prepared by Dr Ashish Jawarkar, he is MD in pathology and a teacher at Parul institute of Medical sciences and research Vadodara.
Histopathological Grossing of Kidney Tumors with the common gross differentials encountered,
reference - TATA memorial grossing techniques , Rosai and ackerman surgical pathology , Fletcher , Springer histopathology Specimen
An excellent ppt on basics of bone marrow morphology and examination which i came accross on the internet.. Not my creation.. Full credit to the author..
This presentation in mainly focused of understanding of automation and its utility in cytopathology. It will be very usefull for postgraduate in pathology, cytopathologist and cytotechnicians.
Histopathological Grossing of Kidney Tumors with the common gross differentials encountered,
reference - TATA memorial grossing techniques , Rosai and ackerman surgical pathology , Fletcher , Springer histopathology Specimen
An excellent ppt on basics of bone marrow morphology and examination which i came accross on the internet.. Not my creation.. Full credit to the author..
This presentation in mainly focused of understanding of automation and its utility in cytopathology. It will be very usefull for postgraduate in pathology, cytopathologist and cytotechnicians.
different type of lower limb amputation with indication, peri-operative care, surgical steps, post op care complication and different type of prosthesis
PHYSICAL PROPERTIES
CHEMICAL PROPERTIES
STRUCTURE OF ENAMEL
DEVELOPMENT OF ENAMEL
EPITHELIAL ENAMEL ORGAN
AMELOGENESIS
LIFE CYCLE OF AMELOBLASTS
AGE CHANGES IN ENAMEL
DEFECTS OF AMELOGENESIS
CLINICAL IMPLICATIONS
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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.
4.
5.
6.
7.
8.
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
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
15.
16.
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.
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.
39.
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