Auto text: “Insert Uterus Cervical Cancer”
- These specimens should be radical hysterectomies, which have parametrial tissue and vaginal cuff.
- Weigh specimen and measure:
- 3 dimensions of uterus (Cornu-Cornu, Fundus-LUS, Anterior-Posterior)
- 3 dimensions of cervix (face and length)
- shape, diameter of os
- width of vaginal cuff
- ovaries (3D) and fallopian tubes (2D), if present
- 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, paracervical/parametrial tissues, and vaginal cuff margin: anterior-blue, posterior-black, vaginal cuff-red.
- Amputate parametrial tissue, pin on wax, and fix in formalin, noting right and left.
- Amputate cervix at lower uterine segment and ink the lower uterine segment end a different color (note, this is not a margin).
- Open cervix at 12:00, unless the carcinoma is clearly present at 12:00.
- Accurately measure lesion and note location. Measure endocervical canal.
- Pin cervix on wax and fix in formalin, making sure to note 12:00, 3:00, 6:00, 9:00.
- Coronally bisect uterus through 3:00 and 9:00 positions.
- Measure endometrial cavity in 2 dimensions, and thickness of endometrium and myometrium.
- Fix uterus in formalin.
- Serially section parametrial tissue in parasagittal plane and submit entirely from medial to lateral, noting right and left.
- Measure distance of tumor to the vaginal cuff and submit as follows:
- If no tumor is grossly present, submit the entire vaginal cuff margin in continuity with the ecto/endocervix in quadrants, making sure all sections include red ink (vaginal cuff).
- If tumor is grossly present and close to the vaginal cuff margin, submit sections perpendicular to margin, making sure your sections include red ink. The remainder of the cuff margin can be trimmed and submitted en face in quadrants.
- If tumor is grossly present and far from the vaginal cuff margin (i.e. tumor and margin won’t fit in one block), the margin can be trimmed and submitted en face in quadrants.
- Serially slice the tumor using full-thickness radial sections around the cervix.
- Measure depth of invasion of tumor and distance from nearest inked margin.
- Submit full-thickness representative sections of tumor. If the cervical wall is too thick to submit in a single cassette, then divide and ink the bisected sections.
- Submit several sections of the cervix that do not appear involved by tumor.
- IF THERE IS NO VISIBLE LESION, submit the entire squamo-columnar junction radially around cervix.
- Serially section the uterus, examine for lesions, and submit representative anterior and posterior endomyometrium – refer to Benign Uterus section for more detail.
- Submit representative sections of ovaries, if present. Submit entirely per SEE-FIM protocol if patient has a history of breast cancer.
- Submit representative sections of fallopian tubes, if present. Submit entirely per SEE-FIM protocol if patient has a history of breast cancer.
Updated 5-2-2022 SRR