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 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 distance to the vaginal margin. 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 sides.
- Vaginal Cuff
- If no tumor is grossly present or measures <2 cm, 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 measures >2 cm and close to the vaginal cuff margin, submit sections perpendicular to margin, making sure your sections include ink. The remainder of the cuff margin can be trimmed and submitted en face in quadrants.
- If tumor is grossly present and measures >2 cm 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 section the tumor/specimen using full-thickness radial sections around the cervix.
- Measure depth of invasion, tumor thickness and distance from nearest inked deep margin.
- IF THERE IS NO VISIBLE LESION or tumor measures <2 cm, submit the entire specimen, radially around cervix.
- If tumor measures > 2 cm, submit representative sections of the lesion.
- 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 6-8-2022 SRR