Hysterectomy for fibroids grossing - Revision history

Michael: /* Protocol */

2021-10-15T17:11:38Z

Protocol

← Older revision		Revision as of 17:11, 15 October 2021
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	In prophylatic procedures for [[BRCA\|BRCA1 mutation or BRCA2 mutation carriers]], the ovaries and tubes, endometrium, and lower uterine segment should all be [[submitted in total]].<ref name=pmid24495259>{{Cite journal \| last1 = Downes \| first1 = MR. \| last2 = Allo \| first2 = G. \| last3 = McCluggage \| first3 = WG. \| last4 = Sy \| first4 = K. \| last5 = Ferguson \| first5 = SE. \| last6 = Aronson \| first6 = M. \| last7 = Pollett \| first7 = A. \| last8 = Gallinger \| first8 = S. \| last9 = Bilbily \| first9 = E. \| title = Review of findings in prophylactic gynaecological specimens in Lynch syndrome with literature review and recommendations for grossing. \| journal = Histopathology \| volume = 65 \| issue = 2 \| pages = 228-39 \| month = Aug \| year = 2014 \| doi = 10.1111/his.12386 \| PMID = 24495259 }}</ref>		In prophylatic procedures for [[BRCA\|BRCA1 mutation or BRCA2 mutation carriers]], the ovaries and tubes, endometrium, and lower uterine segment should all be [[submitted in total]].<ref name=pmid24495259>{{Cite journal \| last1 = Downes \| first1 = MR. \| last2 = Allo \| first2 = G. \| last3 = McCluggage \| first3 = WG. \| last4 = Sy \| first4 = K. \| last5 = Ferguson \| first5 = SE. \| last6 = Aronson \| first6 = M. \| last7 = Pollett \| first7 = A. \| last8 = Gallinger \| first8 = S. \| last9 = Bilbily \| first9 = E. \| title = Review of findings in prophylactic gynaecological specimens in Lynch syndrome with literature review and recommendations for grossing. \| journal = Histopathology \| volume = 65 \| issue = 2 \| pages = 228-39 \| month = Aug \| year = 2014 \| doi = 10.1111/his.12386 \| PMID = 24495259 }}</ref>
			==Opening==
			===Orientation of hysterectomies===
			*Less peritoneum on anterior (as the [[urinary bladder]] is there).
			**'''P'''osterior '''p'''eritoneal edge: '''p'''ointy (upside down triangle).
			***Anterior peritoneal edge: rounded/non-pointy.
			*Tubes on anterior-lateral aspect.<ref>{{Ref Lester3\|425}}</ref>
			**Round ligaments posterior to tubes.

	==Protocol==		==Protocol==
	Specimen type: total hysterectomy.		Specimen type: total hysterectomy.

Michael: /* Protocol notes */

2018-06-06T19:45:47Z

Protocol notes

← Older revision		Revision as of 19:45, 6 June 2018
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	===Protocol notes===		===Protocol notes===
			In prophylatic procedures for [[BRCA\|BRCA1 mutation or BRCA2 mutation carriers]], the ovaries and tubes, endometrium, and lower uterine segment should all be [[submitted in total]].<ref name=pmid24495259>{{Cite journal \| last1 = Downes \| first1 = MR. \| last2 = Allo \| first2 = G. \| last3 = McCluggage \| first3 = WG. \| last4 = Sy \| first4 = K. \| last5 = Ferguson \| first5 = SE. \| last6 = Aronson \| first6 = M. \| last7 = Pollett \| first7 = A. \| last8 = Gallinger \| first8 = S. \| last9 = Bilbily \| first9 = E. \| title = Review of findings in prophylactic gynaecological specimens in Lynch syndrome with literature review and recommendations for grossing. \| journal = Histopathology \| volume = 65 \| issue = 2 \| pages = 228-39 \| month = Aug \| year = 2014 \| doi = 10.1111/his.12386 \| PMID = 24495259 }}</ref>

	====Blocking protocol====		====Blocking protocol====
	Submit sections of fibroid as follows:		Submit sections of fibroid as follows:

Michael at 19:44, 6 June 2018

2018-06-06T19:44:35Z

← Older revision		Revision as of 19:44, 6 June 2018
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	Unexpected malignancies (based on a series of 6,360 cases) are seen in approximately 2.7% of cases and include (1) endometrial carcinoma (1.02% of cases), (2) cancers of the tube, ovary and peritoneum (1.08% of cases), (3) uterine sarcoma (0.22% of cases), (4) metastatic disease (0.20% of cases) and (5) cervical cancer (0.17% of cases).<ref name=pmid25569001>{{Cite journal \| last1 = Mahnert \| first1 = N. \| last2 = Morgan \| first2 = D. \| last3 = Campbell \| first3 = D. \| last4 = Johnston \| first4 = C. \| last5 = As-Sanie \| first5 = S. \| title = Unexpected gynecologic malignancy diagnosed after hysterectomy performed for benign indications. \| journal = Obstet Gynecol \| volume = 125 \| issue = 2 \| pages = 397-405 \| month = Feb \| year = 2015 \| doi = 10.1097/AOG.0000000000000642 \| PMID = 25569001 }}</ref>		Unexpected malignancies (based on a series of 6,360 cases) are seen in approximately 2.7% of cases and include (1) endometrial carcinoma (1.02% of cases), (2) cancers of the tube, ovary and peritoneum (1.08% of cases), (3) uterine sarcoma (0.22% of cases), (4) metastatic disease (0.20% of cases) and (5) cervical cancer (0.17% of cases).<ref name=pmid25569001>{{Cite journal \| last1 = Mahnert \| first1 = N. \| last2 = Morgan \| first2 = D. \| last3 = Campbell \| first3 = D. \| last4 = Johnston \| first4 = C. \| last5 = As-Sanie \| first5 = S. \| title = Unexpected gynecologic malignancy diagnosed after hysterectomy performed for benign indications. \| journal = Obstet Gynecol \| volume = 125 \| issue = 2 \| pages = 397-405 \| month = Feb \| year = 2015 \| doi = 10.1097/AOG.0000000000000642 \| PMID = 25569001 }}</ref>

			In prophylatic procedures for [[BRCA\|BRCA1 mutation or BRCA2 mutation carriers]], the ovaries and tubes, endometrium, and lower uterine segment should all be [[submitted in total]].<ref name=pmid24495259>{{Cite journal \| last1 = Downes \| first1 = MR. \| last2 = Allo \| first2 = G. \| last3 = McCluggage \| first3 = WG. \| last4 = Sy \| first4 = K. \| last5 = Ferguson \| first5 = SE. \| last6 = Aronson \| first6 = M. \| last7 = Pollett \| first7 = A. \| last8 = Gallinger \| first8 = S. \| last9 = Bilbily \| first9 = E. \| title = Review of findings in prophylactic gynaecological specimens in Lynch syndrome with literature review and recommendations for grossing. \| journal = Histopathology \| volume = 65 \| issue = 2 \| pages = 228-39 \| month = Aug \| year = 2014 \| doi = 10.1111/his.12386 \| PMID = 24495259 }}</ref>
	==Protocol==		==Protocol==
	Specimen type: total hysterectomy.		Specimen type: total hysterectomy.

Michael at 13:30, 10 March 2016

2016-03-10T13:30:44Z

← Older revision		Revision as of 13:30, 10 March 2016
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	[[Image:Leiomyoma of the Uterus.jpg\|thumb\|300px\|A uterus with large fibroid. (WC/Ed Uthman)]]		[[Image:Leiomyoma of the Uterus.jpg\|thumb\|300px\|A uterus with a large fibroid. (WC/Ed Uthman)]]
	This protocol a protocol for grossing a '''hysterectomy for [[fibroids]]''', also '''hysterectomy for leiomyomas'''.		This protocol a protocol for grossing a '''hysterectomy for [[fibroids]]''', also '''hysterectomy for leiomyomas'''.

Michael at 13:30, 10 March 2016

2016-03-10T13:30:34Z

← Older revision		Revision as of 13:30, 10 March 2016
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			[[Image:Leiomyoma of the Uterus.jpg\|thumb\|300px\|A uterus with large fibroid. (WC/Ed Uthman)]]
	This protocol a protocol for grossing a '''hysterectomy for [[fibroids]]''', also '''hysterectomy for leiomyomas'''.		This protocol a protocol for grossing a '''hysterectomy for [[fibroids]]''', also '''hysterectomy for leiomyomas'''.

Michael: /* External links */

2016-03-10T13:28:59Z

External links

← Older revision		Revision as of 13:28, 10 March 2016
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	==External links==		==External links==
			*[https://www.pathology.med.umich.edu/gynonc/PDF/GynGrossing_NoPlacentaOLD.PDF A set of gynecologic pathology grossing notes from Michigan (umich.edu)].

	[[Category:Gynecologic pathology]]		[[Category:Gynecologic pathology]]
	[[Category:Gross pathology]]		[[Category:Gross pathology]]

Michael: /* Introduction */

2015-07-24T03:22:13Z

Introduction

← Older revision		Revision as of 03:22, 24 July 2015
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	==Introduction==		==Introduction==
	This is a very common surgery. It said that approximately 40% of forty year old have fibroids. Other indications for hysterectomy are: [[dysfunctional uterine bleeding]] and hemorrhage (postpartum).		This is a very common surgery. It said that approximately 40% of forty year old have fibroids. Other indications for hysterectomy are: [[dysfunctional uterine bleeding]] and hemorrhage (postpartum).

			Unexpected malignancies (based on a series of 6,360 cases) are seen in approximately 2.7% of cases and include (1) endometrial carcinoma (1.02% of cases), (2) cancers of the tube, ovary and peritoneum (1.08% of cases), (3) uterine sarcoma (0.22% of cases), (4) metastatic disease (0.20% of cases) and (5) cervical cancer (0.17% of cases).<ref name=pmid25569001>{{Cite journal \| last1 = Mahnert \| first1 = N. \| last2 = Morgan \| first2 = D. \| last3 = Campbell \| first3 = D. \| last4 = Johnston \| first4 = C. \| last5 = As-Sanie \| first5 = S. \| title = Unexpected gynecologic malignancy diagnosed after hysterectomy performed for benign indications. \| journal = Obstet Gynecol \| volume = 125 \| issue = 2 \| pages = 397-405 \| month = Feb \| year = 2015 \| doi = 10.1097/AOG.0000000000000642 \| PMID = 25569001 }}</ref>

	==Protocol==		==Protocol==

Michael: twea

2014-09-27T06:02:36Z

twea

← Older revision		Revision as of 06:02, 27 September 2014
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	==Introduction==		==Introduction==
	This is a very common surgery.		This is a very common surgery. It said that approximately 40% of forty year old have fibroids. Other indications for hysterectomy are: [[dysfunctional uterine bleeding]] and hemorrhage (postpartum).

	==Protocol==		==Protocol==

Michael at 06:00, 27 September 2014

2014-09-27T06:00:23Z

← Older revision		Revision as of 06:00, 27 September 2014
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	This protocol a protocol for grossing a '''hysterectomy for [[~~fibroid~~]]s''', also '''hysterectomy for leiomyomas'''.		This protocol a protocol for grossing a '''hysterectomy for [[fibroids]]''', also '''hysterectomy for leiomyomas'''.

	It also covers grossing a '''hysterectomy for benign disease'''.		It also covers grossing a '''hysterectomy for benign disease'''.

Michael: create

2014-09-27T05:59:13Z

create

New page

This protocol a protocol for grossing a '''hysterectomy for [[fibroid]]s''', also '''hysterectomy for leiomyomas'''.

It also covers grossing a '''hysterectomy for benign disease'''.

==Introduction==
This is a very common surgery.

==Protocol==
Specimen type: total hysterectomy.

Dimensions:
*Uterus and cervix: ___x___x___cm, ____grams.
*Left ovary: ___x___x___cm.
*Left fallopian tube: length ___ cm, diameter ___cm.
*Right ovary: ___x___x___cm.
*Right fallopian tube: length ___ cm, diameter ____cm.
*Exocervix: diameter ___ cm.

Appearance:
*Uterine shape: pear-shaped/distorted.
*Serosal surface: smooth shiny.
*Serosa lesions: none/nodules up to ___cm in greatest dimension.
*Ectocervix: tan-white glistening with a probe patent os.

Internal dimensions:
*Endometrial cavity: ___x___cm.
*Endometrium: thickness ___cm.
*Maximal myometrial wall thickness: ___cm.
*Endocervical canal: length ___ cm, diameter ___ cm.

Internal/additional appearance:
*Left ovary: unremarkable.
*Left fallopian tube: unremarkable.
*Right ovary: unremarkable.
*Right fallopian tube: unremarkable.

Tumour(s):
*Appearance and location: intramural and subserosal white, firm, and whorled circumscribed/ill defined nodules.
*Number of tumors: ___.
*Size: range ___to ___cm in greatest dimension.
*Hemorrhage: present in ___ % of tumor / absent.
*Necrosis: present in ___ % of tumor / absent.
*Calcification: present / absent.

Additional findings: ___.

SECTION CODE:
* Anterior cervix and lower uterine segment
* Posterior cervix and lower uterine segment
* Posterior endomyometrium, full thickness
* Right ovary and , right fallopian tube [fimbria submitted entirely], with paratubal cysts
* Left ovary and left fallopian tube [fimbria submitted entirely]
* Submit sections of fibroids as per protocol (see next page).

===Protocol notes===
====Blocking protocol====
Submit sections of fibroid as follows:
#Any suspicious areas of gross hemorrhage/ necrosis and softer consistency must be sampled.
#Any single fibroid >5 cm --> put one section per 2 cm, with put up to 2 sections per cassette.
#Any single fibroid >1 cm to up to 5 cm --> put one section per lesion
#Fibroids <=1 cm, and multiple in number --> use no more than five cassettes, each cassette can contain sections from two distinct fibroids.
#Any single fibroid >10 cm, please review the specimen with the attending pathologist.

Examples:
*5.5 cm = 3 sections.
*6 cm = 3 sections.
*8 cm = 4 sections.
*8 fibroids, all less than 1 cm = 4 cassettes, 2 sections per cassette.
*15 fibroids = 5 cassettes, sample ten individual fibroids.

===Alternate approaches===
Also submit:
*Anterior endomyometrium, full thickness.

Do not submit:
*Posterior endomyometrium, full thickness.

==See also==
===Related protocols===
*[[Hysterectomy for endometrial hyperplasia]].
*[[Hysterectomy for endometrial cancer]].
==References==
{{Reflist|1}}

==External links==

[[Category:Gynecologic pathology]]
[[Category:Gross pathology]]