Grossing hysterectomy specimens

Uterus
Miscellaneous tumors
Grossing hysterectomy specimens

Author: Nat Pernick, M.D. (see Authors page)

Revised: 7 February 2017, last major update September 2011

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed search: histologic sampling hysterectomy

Table of Contents

Procedure (tumor) | Sections to obtain | Gross images / diagrams

Cite this page: Grossing hysterectomy specimens. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/uterusgrossing.html. Accessed July 16th, 2017.

Procedure (tumor)

Measure, weigh, describe, photograph
Open along lateral sides
Ink serosa adjacent to tumor, vaginal margin of resection
Section from endocervical canal to superior aspect
If cervical tumor present / suspected, amputate cervix and process as cone biopsy

Sections to obtain

No significant gross pathology:

Anterior and posterior cervix (important for identifying carcinoma in situ, J Clin Pathol 2002;55:629)
Anterior and posterior endomyometrium
Lower uterine segment
Each ovary (cortex, hilar region) and fallopian tube
Any gross lesions, including leiomyomas

Suspected tumor:

Above, plus:
With tumor, full thickness endomyometrium and serosa to assess depth of invasion
1 section per 1 cm of tumor, minimum 3 sections
All grossly different appearing regions of tumor
High endocervical canal or lower isthmus
Ink and obtain margins of resection, including vaginal mucosa
Notes: in laparoscopic hysterectomies, pathologists may create artifactual vascular invasion by mechanically transporting tumor into vascular spaces during the grossing process (Am J Surg Pathol 2009;33:298)
May be difficult to identify specific cervical anatomic regions in morcellated specimens (Indian J Pathol Microbiol 2010;53:634)

Gross images / diagrams

Images hosted on other servers:

IARC: various images for grossing protocol

Morcellated specimen:
endometrium identified
as a slit-like space