Uterus, Endometrial Cancer

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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.
    • Bilateral ovaries (3D) and fallopian tubes (2D), if present.
  2. Identify anterior and posterior sides and note quality of serosa. (The peritoneal reflection extends further inferiorly on the posterior side; the tube is anterior to the ovary).
  3. Ink outer surface: anterior blue and posterior black.
  4. Bisect uterus through 3:00 and 9:00 positions.
  5. Measure endocervical canal and endometrial cavity in 2 dimensions, and thickness of endometrium and myometrium.
  6. Measure lesion and note location. * Specifically, note if lesion involves endocervical canal.*
  7. Slice endomyometrium transversely at 1 cm intervals.
  8. Fix in formalin.

Gross

  1. Take 2 longitudinal sections through ecto/endocervix (1 anterior and 1 posterior).
  2. Take 2 longitudinal sections through upper endocervix/lower uterine segment (1 anterior and 1 posterior), immediately adjacent to sections taken from cervix:
  3. Measure deepest area of tumor invasion and thickness of wall.
    • If tumor < 3 cm, submit entirely.
    • If tumor > 3 cm, submit 1 per cm.
    • Include 2 full-thickness sections (1 anterior and 1 posterior).
      • Remaining sections can be superficial to include tumor and inner myometrium (submit sections from LUS to fundus to maintain orientation).
  4. If possible, include 1 section with interface between tumor and normal.
  5. Submit any additional pathology (leiomyomas, polyps in their entirety, etc).
  6. Submit 1 section of uninvolved endometrium.
  7. Inspect serosa for implants and submit sections if you see any.
  8.  For serous carcinomas, submit the entire ovary and fallopian tube:
    • Ovary serially sectioned perpendicular to long axis.
    • SEE-FIM protocol for fallopian tube:
      • Amputate the distal 2 cm (fimbriae) and section parallel to the long axis.
      • Section the remainder of tube transversely in 2-3 mm intervals.
  9. For all other types, submit adnexa as follows:
    • 2 representative sections of each ovary.
    • Entire fimbriae (longitudinally sectioned) and 2 representative cross-sections on each side.

Lymph Nodes (Sentinel and Non-Sentinel)

  1. For lymph nodes < 2 mm, submit intact.
  2. For lymph nodes > 2 mm, serially section perpendicular to the long axis in 2 mm intervals.
    • If no gross tumor, submit entirely.
    • If grossly positive, submit 1-2 representative sections showing the greatest tumor dimension and extranodal fat.

Updated 6-22-2020 SRR

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