Gynecologic Pathology Grossing Guidelines

CERVIX

Specimen Type: ENDOCERVICAL CURRETTINGS (ECC)

Gross Template:Labeled with the patient’s name (last name, first name), medical record number (#), designated “[***]”, and received [fresh/in formalin] is a [***x***x***] cm aggregate of minute red-tan tissue fragments admixed with blood clot. The specimen is entirely submitted [describe cassette summary].

Cassette Submission: All tissue submitted

-Note: If received on Teflon or gauze, carefully scrape with a CLEAN blade onto tissue wrap. If free floating in formalin, pour through a nylon biopsy bag

Specimen Type: CERVICAL BIOPSY

Gross Template:Labeled with the patient’s name (last name, first name), medical record number (#), designated “[***]”, and received [fresh/in formalin] are multiple [color, consistency] portions of tissue measuring [***x***x***] cm in aggregate and ranging from [***] cm to [***] cm in greatest dimension. The specimen is entirely submitted in [describe cassette summary].

Cassette Submission: All tissue submitted

-If necessary section of cervix is taken parallel to the axis of the cervical canal to include squamo-columnar junction. Submit entire specimen.

-If specimens are labeled with specific identification (e.g., anterior lip, posterior lip), submit separately.

Specimen Type: CERVICAL CONE

Gross Template:Labeled with the patient’s name (last name, first name), medical record number (#), designated “[***]”, and received [fresh/in formalin] is a cervical cone biopsy measuring [***x***x***cm]. [Provide orientation if designated]. The external os measures [***cm] in diameter and is [patent, stenotic]. Theendocervical canal measures [***cm] in length. The transformation zone is [distinct, not distinct]. The ectocervical mucosa is [red-brown, smooth,granular]. Sectioning reveals [a tan-white cut suface, presence of lesions]. The specimen is entirely submitted in [describe cassette submission].

Ink key:

Blue-endocervical margin

Black-ectocervical and deep (stromal) margin

Cassette Submission: All tissue submitted

-Embed separately (1 radial section per cassette), or up to 4 sections per cassette.

-Label sections in a clockwise manner and maintain the same orientation throughout. (Sections from 12:00 - 3:00; 3:00 - 6:00; 6:00 - 9:00; 9:00 - 12:00)

Specimen Type: LEEP (Loop Electrodiathermy Excisional Procedure)

Gross Template:Labeled with the patient’s name (last name, first name), medical record number (#), designated “[***]”, and received [fresh/in formalin] is aleepconization of the [cervix, endocervix-sometimes refered to as “top hat”] measuring [***x***x***cm]. [Provide orientation if designated]. The external os measures [***cm] in diameter and is [patent, stenotic]. Endocervical tissue [is/is not] identified. Theendocervical canal measures [***cm] in length. The transformation zone is [distinct, not distinct, not recognized]. The ectocervical mucosa is [red-brown, smooth,granular]. Sectioning reveals [a tan-white cut suface, presence of lesions]. The specimen is entirely submitted in [describe cassette submission].

Ink key:

Blue-endocervical margin

Black-ectocervical and deep (stromal) margin

Cassette Submission: All tissue submitted

-Embed separately (1 radial section per cassette), or up to 4 sections per cassette.

-Label sections in a clockwise manner and maintain the same orientation throughout. (Sections from 12:00 - 3:00; 3:00 - 6:00; 6:00 - 9:00; 9:00 - 12:00)

-Note: Usually, three parts consisting of an exocervical portion, an endocervical (“top hat”) portion, and an ECC are included in the specimen, and will not always be oriented.

FALLOPIAN TUBE

Specimen Type: LIGATION

Gross Template:Labeled with the patient’s name (last name, first name), medical record number (#), designated “[***]”, and received [fresh/in formalin] is a segement of fallopian tube measuring [***cm] in length x [***cm] in diameter. Fimbriae are [present/absent]. The lumen is patent and measures up to [***cm] in diameter. No lesions are identified. Representative sections are submitted [describe cassette submission].

Cassette Submission: 1 cassette

-Submit at least 2 complete cross sections, if able

-If you do not identify a lumen, submit the entire specimen

-If the specimen does not appear to be fallopian tube (i.e. blood vessel or round ligament) verify attending pathologist immediately.

Specimen Type: ECTOPIC/TUBAL PREGNANCY

Gross Template:Labeled with the patient’s name (last name, first name), medical record number (#), designated “[***]”, and received [fresh/in formalin] is a [disrupted/intact] salpingectomy measuring [***cm] in length x [***cm] in diameter. Fimbriae are [present/absent]. The lumen is patent and ranges from [***] to [***cm] in diameter. There is a [describe rupture- (measure length and width), note associated hemorrhage, blood clot]. The lumen contains [blood, embryo, chorionic vili, other-weigh and measure if appropriate]. Representative sections are submitted [describe cassette submission].

Cassette Submission: 3-4 cassettes

-Submit cross sections to demonstrate site of rupture, perpendicular sections

-Submit cross sections to demonstrate uninvolved fallopian tube

-If no gestational sac is grossly identified, submit the entire fallopian tube sequentially

Specimen Type: SALPINGECTOMY (non-neoplastic resection)

Gross Template:Labeled with the patient’s name (last name, first name), medical record number (#), designated “[***]”, and received [fresh/in formalin] is a [disrupted/intact] salpingectomy measuring [***cm] in length x [***cm] in diameter. Fimbriae are [present/absent]. The external surface of the fallopian tube is remarkable for [color, texture, adhesions, paratubal cysts]. The specimen issectioned to reveal [describe luminal contents]. Representative sections are submitted [describe cassette submission].

Cassette Submission: 1-2 cassettes

-Grossly unremarkable – submit one representative cross section from proximal, mid, and distal portion and longitudinally bisected fimbriated end

-Adhesions present – submit one section to include adhesions

-Sample cystic areas (if present)

-BRCA or breast cancer- entirely embed using SEE-FIM protocol

Specimen Type: SALPINGECTOMY (neoplastic resection)

Gross Template:Labeled with the patient’s name (last name, first name), medical record number (#), designated “[***]”, and received [fresh/in formalin] is a [disrupted/intact] salpingectomy measuring [***cm] in length x [***cm] in diameter. Fimbriae are [present/absent]. The external surface of the fallopian tube is remarkable for [color, texture, adhesions, paratubal cysts]. The specimen issectioned to reveal [describe lesion-location, focality, color, circumscription, extension (transmural, % of lumen involved, layers of wall involved]. The remaining mucosa is [describe cut surface]. No additional lesions or masses are identified. Representative sections are submitted [describe cassette submission].

Cassette Submission: 8-10 cassettes

-Representative sections of tumor, if present, including one of grossly involved mucosa and one of uninvolved mucosa.

-Representative sections of any cystic lesions.

-In a case of primary adenocarcinoma of the fallopian tube, if the tube is intact, submit section representing deepest invasion in/through wall.

-Submit the surgical margin in a separately designated cassette.

-Take gross photographs

-BRCA or breast cancer- entirely embed using SEE-FIM protocol

OVARY

Specimen Type: SALPINGO-OOPHRECTOMY (non-neoplastic)

Gross Template:Labeled with the patient’s name (last name, first name), medical record number (#), designated “[***]”, and received [fresh/in formalin] is a [disrupted/intact] [***gram] salpingo-oophrectomy. The ovary measures [***x***x***cm]. The fallopian tube measures [***cm] in length x [***cm] in diameter. Fimbriae are [present/absent].

The ovarian capsule is [smooth, tan-yellow, not extensive tubo-ovarian adhesions if present]. Sectioning the ovary reveals [color/cysts/lining/projections/describe contents/thickness of wall, atrophic changes]. The external surface of the fallopian tube is remarkable for [color, texture, adhesions, paratubal cysts].Representative sections are submitted [describe cassette submission].

Cassette Submission: 2-3 cassettes

-1 cassette of ovary

-1 cassette of fallopian tube

-BRCA- entirely embed, using SEE-FIM protocol

  • If ovary is replaced by a large cyst- submit 1 section per 1 cm of the greatest dimension of the ovary

Specimen Type: SALPINGO-OOPHRECTOMY (neoplasm/cysts)

Gross Template:Labeled with the patient’s name (last name, first name), medical record number (#), designated “[***]”, and received [fresh/in formalin] is a [disrupted/intact] [***gram] salpingo-oophrectomy. The ovary measures [***x***x***cm]. The fallopian tube measures [***cm] in length x [***cm] in diameter. Fimbriae are [present/absent].

The ovary is [partially, entirely] replaced by a [solid, cystic-unilocular, multicolular-give range and overall size of locules] mass. The mass is approximately [%] solid and [%] cystic. [Cystic component- internal cyst lining, cyst contents, cyst wall thickness]. [Solid component- color, consistent, configuration]. [Describe necrosis, hemorrhage, calcification].

Residual ovarian parenchyma [is/is not] identified [describe if identified]. [Describe fallopian tube if present]. Representative sections are submitted [describe cassette submission].

Cassette Submission: 10-12 cassettes

-One section for each 1 cm of maximum tumor diameter (For mucinous neoplasms, submit 2 sections for each 1 cm of maximum tumor diameter).

-With cystic lesions, section solid or papillary growths on inside and outside of the cyst wall.

-Section of solid tumor at capsular surface.

-Include sections demonstrating relationship of tumor to attached structures and sections of uninvolved ovarian tissue.

UTERUS

Specimen Type: ENDOMETRIAL BIOPSY/CURRETAGE (EMC/EMB)

Gross Template:Labeled with the patient’s name (last name, first name), medical record number (#), designated “[***]”, and received [fresh/in formalin] is a [***x***x***cm] aggregate of minute red-tan tissue fragments admixed with [blood clot/blood-tinged mucus]. The specimen is entirely submitted [describe cassette summary].

Cassette Submission: All tissue submitted

-Note: If received on Teflon or gauze, carefully scrape with a CLEAN blade onto tissue wrap. If free floating in formalin, pour through a nylon biopsy bag

-If curettage is submitted for incomplete abortion, describe recognizable placental tissue (hydropic villi), fetal parts or degenerate decidua. If the microscopic sections do not show products of conception, submit all tissue.

Specimen Type: MYOMECTOMY (morcellated/laparoscopic)

Gross Template:Labeled with the patient’s name (last name, first name), medical record number (#), designated “[***]”, and received [fresh/in formalin] is a [***gram], [***x***x***cm] aggregate of pink-tan, semi-firm irregularly shaped tissue fragments. The fragments range from [***]-[***]cm in maximum dimension. There are no areas of hemorrhage, necrosis, or calcification. Representative sections are submitted [describe cassette submission].

Cassette Submission: 3 cassettes

-Focus on yellow, calcified, or hemorrhagic areas

-If small enough-entirely embed

Specimen Type: MORCELLATED LAPRASCOPIC HYSTERECTOMY

Gross Template:Labeled with the patient’s name (last name, first name), medical record number (#), designated “[***]”, and received [fresh/in formalin] is a [***gram] morcellated [total/ supracervical hysterectomy] received in multiple portions. The portions range from [***]-[***]cm in maximum dimension and amount in aggregate to [***x***x***cm]. The [cervix/endocervical stump] measures [***cm] in length x [***cm] in diameter. There is a [***cm] average endometrial thickness. Portions with enodmetirum and serosa have a [***] cm average myometrial thickness.

Identifiable serosa is [pink, smooth, glistening]. Identifiable endometrium is [red and thickened, yellow and atrophic, denuded]. The myometrium is [pink-tan, trabeculated, remarkable for cystic spaces (adenomyosis), leiyomyomas-number, size, % the fibroids account for of the total specimen, hemorrhage, necrosis, calcification, location)]. unremarkable/remarkable for leiomyomata]. No lesions or masses are identified. Representative sections are submitted [describe cassette submission].

Cassette Submission: 7-8 cassettes

-3 cassettes of leiyomyoma if grossly unremarkable

  • You can add 3 pieces in 1 cassette

-2 cassettes of endometrium/myometrium/serosa

-Anteiror and posterior cervix/upper endocervical stump, perpendicular

Specimen Type: TOTAL HYSTERECTOMY and SALPINGO-OOPHRECTOMY (benign)

Gross Template: Labeled with the patient’s name (last name, first name), medical record number (#), designated “[***]”, and received [fresh/in formalin] is a [***gram] [intact/previously incised/disrupted] [total/ supracervical hysterectomy/ total hysterectomy and bilateral salpingectomy, hysterectomy and bilateral salpingo-oophrectomy]. The uterusweighs [***grams] and measures [***cm (cornu-cornu) x ***cm (fundus-lower uterine segment) x *** cm (anterior - posterior)]. The cervix measures [***cm] in length x [***cm] in diameter. The endometrial cavity measures [***cm] in length, up to [***cm wide]. The endometrium measures [***cm] in average thickness. The myometrium ranges from [***]-[***] cm in thickness. The right ovary measures [***x***x*** cm]. The left ovary measures [***x***x*** cm]. The right fallopian tube measures [***cm] in length [with/with out] fimbriae x [***cm] in diameter, with a [***cm] average luminal diameter. The left fallopian tube measures [***cm] in length [with/with out] fimbriae x [***cm] in diameter, with a [***cm] average luminal diameter.

The serosa is [pink, smooth, glistening, unremarkable/has adhesions]. The endometrium is [tan-red, unremarkable, describe presence of lesions/polyps]. The myometrium is [tan-yellow, remarkable for trabeculations, cysts, leiyomoma-(location, size)]. The leiyomyoma are sectioned to reveal [smooth/whorled/nodular cut surfaces, with/without areas of hemorrhage, necrosis, or calcification]. The right and left fallopian tubes are [grossly unremarkable, remarkable for adhesions, show evidence of prior tubal ligation, etc]. The cervix is [grossly unremarkable, presence of Nabothian cysts, lesions].The right and left ovary are [unremarkable, show atrophic changes, describe presence of lesions]. No lesions or masses are grossly identified. Representative sections are submitted [describe cassette submission].

Cassette Submission:

Benign conditions (prolapse, fibroids, adenomyosis): 5-8 cassettes

-Anterior cervix

-Posterior cervix

-Anterior uterine corpus full thickness (include leiomyomata if present)

-Posterior uterine corpus full thickness (include leiomyomata if present)

-Right and left fallopian tube

  • Two cross sections and fimbriated end

-Right and left ovary

-If any polyps are present, submit in entirety

  • If you need to transect, keep the relationship of base of the polyp to the endometrium to assess for invasion, if malignant

-Representative sections of leiyomyoma (use judgement)

  • 3 cassettes if all are grossly unremarkable
  • Sample as many myomas as possible with emphasis on larger myomas.
  • Sections should include periphery of myoma. If submucosal should include endometrium in section of myoma.
  • If myomas do not have characteristic appearance and have any change in color or consistency, should be brought to attention of the pathologist and additional sampling is indicated.

-Note: Supracervical hysterectomy - Ink the resection margin section of lower uterine segment at the line of excision.

Specimen Type: TOTAL HYSTERECTOMY and SALPINGO-OOPHRECTOMY (for TUMOR)

Gross Template: Labeled with the patient’s name (last name, first name), medical record number (#), designated “[***]”, and received [fresh/in formalin] is a [***gram] [intact/previously incised/disrupted] [total/ supracervical hysterectomy/ total hysterectomy and bilateral salpingectomy, hysterectomy and bilateral salpingo-oophrectomy]. The uterusweighs [***grams] and measures [***cm (cornu-cornu) x *** cm (fundus-lower uterine segment) x *** cm (anterior - posterior)]. The cervix measures [***cm] in length x [***cm] in diameter. The endometrial cavity measures [***cm] in length, up to [***cm wide]. The endometrium measures [***cm] in average thickness. The myometrium ranges from [***]-[***cm] in thickness. The right ovary measures [***x***x***cm]. The left ovary measures [***x***x***cm]. The right fallopian tube measures [***cm] in length [with/with out] fimbriae x [***cm] in diameter, with a [***cm] average luminal diameter. The left fallopian tube measures [***cm] in length [with/with out] fimbriae x [***cm] in diameter, with a [***cm] average luminal diameter.

The serosa is [pink, smooth, glistening, unremarkable/has adhesions]. The endometrium is tan-red and remarkable for [describe lesion- location (fundus, corpus, lower uterine segment); size (***x***cm in area); color; consistency; configuration (solid, papillary, exophytic, polypoid)]. Sectioning reveals the mass has a [describe cut surface-solid, cystic, etc.]. The mass extends [less than/ greater than] 50% into the myometrium (the mass involves [***cm] of the wall where the wall measures [***cm] in thickness, in the [location]). The mass [does/does not] involve the lower uterine segement and measures [***cm] from the cervical mucosa.

The myometrium is [tan-yellow, remarkable for trabeculations, cysts, leiyomoma-(location, size)]. The leiyomyoma are sectioned to reveal [smooth/whorled/nodular cut surfaces, with/without areas of hemorrhage, necrosis, or calcification]. The cervix is [grossly unremarkable, presence of Nabothian cysts, lesions].The right and left ovary are [unremarkable, show atrophic changes, describe presence of lesions]. The right and left fallopian tubes are [grossly unremarkable, remarkable for adhesions, show evidence of prior tubal ligation, etc].

No additional lesions or masses are grossly identified. Representative sections are submitted [describe cassette submission].

Ink Key:

Black-right paracervical soft tissue

Blue-left paracervical soft tissue

Cassette Submission:

-Endometrial hyperplasia: 12-15 cassettes

  • Anterior cervix
  • Posterior cervix
  • Anterior uterine corpus, full thickness
  • Posterior uterine corpus, full thickness
  • 1 section of fundus
  • Anterior/posterior uterus
  • If previous material revealed only simple or cystic hyperplasia, submit sections of endometrium, including one full thickness section of uterine wall (3 from each wall).
  • If previous material revealed complex or atypical simple or complex hyperplasia, submit entire endometrium, including one full thickness of anterior uterine wall and one full thickness of posterior uterine wall
  • Right fallopian tube and right ovary (include fimbriae)
  • Left fallopian tube and left ovary (include fimbriae)

-Malignant conditions (endometrial carcinoma): 15-20 cassettes

  • Shave and submit right and left parametrial margins if tumor is > 1cm from margins. Submit perpendicular section of parametrial margins if tumor is < 1cm from margin.
  • Anterior cervix
  • Posterior cervix
  • 2 sections of anterior uterine corpus full thickness (showing depth of invasion)
  • 2 sections of posterior uterine corpusfull thickness (showing depth of invasion)
  • 1 section of uterine fundus with and without lesion
  • Tumor with relationship to unremarkable endometrium
  • Anterior lower uterine segment full thickness, perpendicular
  • Posterior lower uterine segment full thickness, perpendicular
  • Right and left fallopian tube
  • 2 cross sections and fimbriated end
  • Entirely submit both ovaries if grossly unremarkable
  • If ovaries are large and cyst-filled, submit representative sections
  • Submit all lymph nodes (if present)

-Malignant conditions (cervical carcinoma): 20-25 cassettes