Uterus, Benign

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Triage

  1. Weigh specimen and measure:
    • 3 dimensions of uterus (C-C, Fundus-LUS, A-P)
    • 3 dimensions of cervix (face and length)
    • Shape, diameter of os
    • Ovaries (3D) and fallopian tubes (2D), if present
  2. Identify anterior and posterior sides and note quality of serosa:
    1. The peritoneal reflection extends further inferiorly on the posterior side and is pointed.
    2. The peritoneal reflection on the anterior side is rounded.
    3. The tube is anterior to the ovary.
    4. The round ligament stump is anterior to the tubal isthmus.
  3. Bisect uterus through 3:00 and 9:00 positions.
  4. Measure endocervical canal and endometrial cavity in 2 dimensions, and thickness of endometrium and myometrium.
  5. Measure any lesions (whorled nodules, polyps, etc).
  6. Most of these cases should be grossed on same day of receipt.

Gross

  1. Obtain longitudinal sections through cervix, anterior and posterior sides.
    • If there was a history of HSIL on prior biopsy specimen, submit the entire squamo-columnar junction radially. Specify cassettes by quadrant (12-3, 3-6, 6-9, 9-12 o’clock).
  2. Transversely section the endomyometrium and take 2 full-thickness sections (1 anterior and 1 posterior).
  3. 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):
      • If largest is < 10 cm, submit up to 5 representative sections (can be included in the full-thickness sections of the endomyometrium).
      • If largest is > 10 cm, submit 3 sections of the largest nodule and 3 representative sections of smaller nodules.
    • For atypical-appearing whorled nodules (hemorrhage, necrosis, softening, discoloration, infiltration) submit 1 section per cm of the atypical nodule, up to 10 sections.  We can always go back if more sections are needed.
  4. Endometrial polyps should be submitted entirely, including interface with underlying endometrium.
  5. Submit representative sections of ovaries, if present.
  6. For fallopian tubes, if present: Submit entire fimbriae (longitudinally sectioned) and 2 representative tubal cross-sections.

Updated 1-8-19 NAC.

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