Uterus
General
Grossing & features to report
Author: Nat Pernick, M.D.
Last author update: 1 September 2011
Last staff update: 21 October 2022
Copyright: 2002-2025, PathologyOutlines.com, Inc.
PubMed search: Histologic sampling hysterectomy
Table of Contents
Procedure (tumor) | Sections to obtain | Gross images | Diagrams / tables | Features to reportCite this page: Pernick N. Grossing & features to report. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/uterusgrossing.html. Accessed January 2nd, 2025.
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:
Suspected tumor:
- 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
Images hosted on other servers:
IARC: various images for grossing protocol
Morcellated specimen:
endometrium
identified as a
slit-like space
Diagrams / tables
Images hosted on other servers:
IARC: various images for grossing protocol
Features to report: recommended sectioning
Features to report
- Features to report by organization:
- Features to report for endometrial carcinoma (J Clin Pathol 2008;61:241):
- Specimen type, procedure, morcellation or intact
- Tumor size and location
- Histologic type
- Histologic grade
- Depth of invasion (maximum depth of myoinvasion, measured from endomyometrial junction)
- Note: must differentiate myoinvasion from extension into adenomyosis (Arch Pathol Lab Med 2007;131:372)
- Angiolymphatic invasion
- Cervical involvement
- Involvement of other organs / tissues
- Features of uninvolved uterus (hyperplasia, metaplasia, etc.)
- Margin involvement
- Nodal involvement (site of nodes, # positive nodes, # total lymph nodes)
- TNM stage
