Uterus cervical invasive tumours
Background
Total abdominal hysterectomy (TAH) is undertaken for the treatment of invasive lesions of the cervix.1-5
Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.
- No
- Non-routine fixation (not formalin), describe.
- Yes
- Special studies required, describe.
- Ensure samples are taken prior to fixation.
- Not performed
- Performed, describe type and result
- Frozen section
- Imprints
- Other, describe
See general information for more detail on specimen handling procedures.
Inspect the specimen and dictate a macroscopic description.
External Inspection
Orientate and identify the anatomical features of the specimen.
Record additional orientation or designation provided by operating clinician:
- Absent
- Present
- Method of designation (e.g. suture, incision)
- Featured denoted
Photograph the intact specimen if required.
Describe the following features of the specimen:
Procedure
Record as stated by the clinician.
- Simple hysterectomy
- Subtotal hysterectomy
- Radical trachelectomy*
- Total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BS)
- Other, describe
*Radical trachelectomy is an uncommon procedure. Refer to SRP cervix protocol for more information.
Specimen integrity
Anatomical components included (more than one may apply) and specimen size (mm)
Describe and measure the anatomical components present.
Specimen weight (g)
Uterus
- Measure in three dimensions
- Mid-line fundal-serosa to ectocervix
- Maximum intercornual
- Maximum anterior to posterior
Cervix
- Measure in two dimensions anterior-posterior (12 to 6 o’clock) x transverse (3 to 6 o’clock)
Vaginal cuff
- Absent
- Present
- Measure in two dimensions, length x diameter3
Parametrium
- Right
- Absent
- Present
- Measure in three dimensions (mm)
- Left
- Absent
- Present
- Measure in three dimensions (mm)
Dissection
Paint the surgical resection margins (parametrial, paracervical and vaginal) with ink and record the colours used.3
Various methods are used for dissection of hysterectomy specimens.1-3
If the specimen is received fresh or even partially fixed, it is preferable to open and pin out the entire specimen as anterior and posterior halves, leaving the cervix attached and carefully pinned with mucosal surface up. Parametrial attachments are also pinned out if received.
In this method the cervix is amputated by a transverse slice to separate the uterine corpus from the cervix so it can be dissected in a similar manner to cone biopsy specimens.2
This method preserves the delicate cervical epithelium which can be denuded easily if sectioned before adequate fixation occurs. In this method then the vaginal cuff and parametrium should be left intact, and pinned out without further slicing.
Once fixed, sagitally section the amputated cervix at 3mm serial intervals perpendicularly to the transverse axis of endocervical os, sequentially from left to right (3 to 9 o’clock).3,4 The vaginal cuff should be included while remaining attached to the cervix.
Cervical epithelium can be fragile, particularly where a lesion is present, so care must be taken when sectioning.
The remaining uterine corpus is sliced into anterior and posterior halves which are pinned to corkboard, with the endomucosal surfaces facing upwards to fix.
Thorough sectioning of the lower uterine segment (isthmic region) is important to assess the upper extent of tumour.2
Photograph the dissected specimen if required. An annotated photograph is a valuable record of block taking.
Parametrial tissues are usually present in radical specimens and should be processed in their entirety for histological examination.
If minimal parametrial tissue is present (for example in simple hysterectomy), then a shave of the lateral myometrial margins should be submitted, to ensure that the vascular margin is sampled.
Internal Inspection
Describe the cut surface appearance of the uterus including the following items:
Site of previous cone biopsy2
Tumour (macroscopically visible)
- Absent
- Present, describe
- Number; if more than one tumour, designate and describe each tumour separately
Tumour size (mm)
- In two dimensions, length x width in mucosal surface area
- Tumour thickness and thickness of cervical wall at this point1 (i.e. __mm out of __mm)
Tumour site (more than one may apply)
- Ectocervix1-4
- Endocervix1-4
- Other, specify
- Radial location, using clock-face notation4
Tumour appearance4
- Exophytic
- Endophytic
- Nodule
- Other, specify
Multiple tumours4
Measure (mm):
- Distance between tumours
- Outermost span of tumours
Distance to margins (mm)4
- Distance of tumour to nearest resection margin
- Specify margin (e.g. anterior or posterior radial stromal margin or vaginal margin)
Macroscopic invasion, if present4
- Vaginal cuff
- Uterine body
- Parametrium
- Other organ or tissue, specify
Endometrium
- Thickness (mm)
- Abnormalities
- Absent
- Present, describe
- Polyp(s)
- Atrophy
Myometrium
- Describe any abnormalities. See protocol for benign uterus for more detail.
Retrieved from resection specimen
- Describe site(s)
- Number retrieved
Separately submitted
- For each specimen container, record specimen number and designation
- Collective size of tissue in three dimensions (mm)
- Number of grossly identified lymph nodes submitted
- Maximum diameter of each (mm)
Note any photographs taken, diagrams recorded and markings used for identification.
Processing
Dissect the specimen further and submit sections for processing according to the diagram provided.
Submit all sections of cervix for processing, keeping sequential order and record designation in the block key.
Place each section with new cut surface consecutively face down in its own cassette to ensure examination of the specimen at equal intervals. One method recommends marking the top to surface (opposite to the surface to be sectioned) with a dot of ink so it can be identified at embedding.2
Submit representative sections of:
- Surgical margins
- Closest radial margins (specify which)
- Paracervical/parametrial margin
- Vaginal margins
- Tumour < 20mm, submit entire tumour for processing
- Tumour > 20mm
- At least one full-face section of tumour and sections demonstrating deepest point of invasion, interface with adjacent cervix and longitudinal extent of tumour (i.e. into lower segment/endocervical mucosa/endometrium)
- Sections of possible invasion into adjacent tissues
- Cervix, sections from each quadrant
- Sections of the vaginal cuff should be taken perpendicularly in continuity with the tumour if possible.3
Submit representative sections of the body of the uterus. See protocol for benign uterus for more detail.
Submit all lymph nodes and identify the site of each.
Record details of each cassette.
An illustrated block key similar to those provided below may be useful.
Block allocation key
| Cassette id |
Site |
No. of pieces |
| |
Cervix and vaginal cuff, all sequential sections. If cervix is small and surgical margins differentiated with ink, both anterior and posterior slices may fit in one cassette. Alternatively: |
|
| A-B |
Parametrial wings, right and left |
|
| C-D |
Lower uterine segment margin |
|
| E-H |
Cervix, right radial margin (9 o’clock) |
|
| I-AH |
Composite sections of cervix (slices 2-6 in diagram) |
|
| AI-AL |
Cervix, left radial margin (3 o'clock), longitudinal section |
|
| AM-AR |
Normal uterus, ovaries and fallopian tubes, representative sections |
|
|
Normal uterus, ovaries and fallopian tubes, representative sections
| Cassette id |
Site |
No. of pieces |
| A-B |
Parametrial wings, right and left |
|
| C-D |
Lower uterine segment margin |
|
| E-P |
Composite sections of anterior and posterior lip of cervix (slice 6 in diagram) including tumour at deepest point of invasion and vaginal cuff |
|
| Q-V |
Composite sections of tumour, anterior lip of cervix |
|
| W |
Further sections of tumour |
|
| X-Y |
Right radial margin (9 o’clock), longitudinal section |
|
| Z |
Left lateral tumour |
|
| AA-AB |
Left lateral cervix, no macroscopic tumour |
|
| AC |
Left lateral margin (3 o'clock), longitudinal section |
|
| AD-AI |
|
|
Acknowledgements
Drs Kerryn Ireland-Jenkin and Marsali Newman for their contribution in reviewing and editing this protocol.
References
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