Determine from the requisition form, the electronic medical record, or the submitting physician that the hysterectomy was performed for in situ or invasive cervical carcinoma. If you receive a uterus without any clinical information, especially if there is a vaginal cuff and parametrial soft tissue, contact the submitting physician.
Measure the ectocervix, vaginal cuff, and parametrial soft tissue. Describe the mucosa, the os, and any lesions (defect corresponding to prior conization, ulcer, tumor). Include tumor measurements, depth of invasion, and extent of invasion.
Ink the resection margins of the vaginal cuff and parametrium, using different colors for anterior and posterior.
If the vaginal cuff and/or parametria are too large to submit the margins together with the cervix, cut off the margins, retaining their orientation. Separate the cervix from the corpus via a transverse incision made two to three centimeters above the external os. Section the cervix in a radial fashion, similar to what is described inCervical Conization/LEEP, being sure to include the squamocolumnar junction in each section.
Cervix: submit entirely, proceeding clockwise from the 12 o’clock position. Since the sections will be larger than those in a cervical cone, it may be necessary to trim away some of the stroma; however, it is critical to submit all of the mucosa. If there is a very large, obviously invasive tumor, submit the most deeply invasive areas and reserve the remainder of the specimen, maintaining orientation. Include areas demonstrating parametrial invasion.
Vaginal cuff margin: submit entirely, either with the cervix (if small cuff) or en face divided into four cassettes by quadrants (if large cuff).
Left and right parametrial margins: submit entirely, either with the cervix (if small parametria) or en face divided into two or more cassettes (if large parametria).
Junction of endocervix and lower uterine segment: one to two longitudinal sections from the anterior and posterior walls.
See Hysterectomy for Benign Condition, Salpingectomy, and Oophorectomy for remainder of specimen.
Received without fixative/in formalin, labeled _____ and “_____”, is an intact/previously opened _____ distorted/symmetrically enlarged, pyriform) uterus with attached cervix, a vaginal cuff, and bilateral left/right/bilateral adnexa with a total weight of __ g. The uterus measures __ cm anterior to posterior, __ cm cornu to cornu, and __ cm fundus to cervix. The serosa is ___ (smooth, nodular, covered by adhesions). The parametria (left = __ x __ x __ cm, right = __ x __ x __ cm) are free of/involved by tumor measuring __ cm. The ectocervix is __ x __ cm, with a slit-like/patulous/stenotic __ cm os, and is rimmed by the vaginal cuff ranging from __ to __ cm. There is a _____ (color, shape, plaque, ulcer, mass) (__ x __ cm surface area, __ cm elevation) at the __-__ o’clock position of the ectocervix, extending ___ cm upwards into the anterior/posterior endocervical canal/lower uterine segment, __ cm from the endometrial cavity proper. It is ___ cm from/extends to the ___ o’clock (nearest) vaginal cuff margin. The maximal depth of invasion is approximately ___ cm at the __ o’clock position, __ cm from the left and __ cm from the right parametrial margins. The endocervical canal is lined by _____ (color) mucosal folds and has a length of __ cm. The __ x __ cm endometrial cavity has a _____ (color, texture) lining with an average thickness of __ cm. The myometrium is _____ (color, consistency) with a maximal thickness of __ cm. No/__ (#, multiple) _____ (color, hemorrhagic foci, tan-white whorled nodules) ranging from __ to __ cm in maximal dimension are identified in the submucosal/intramural/subserosal regions. [See Salpingectomy and Oophorectomy for dictation templates of Fallopian tubes and ovaries.] Margins are inked as follows: anterior = black, posterior = blue. Representatively submitted as follows: