Difference between revisions of "Hysterectomy"

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Steps:<ref name=stora/>
 
Steps:<ref name=stora/>
*{{Moderate-begin}}Remove the '''adnexa'''.<ref name=stora/> '''Weighing'' the uterus without the adnexa.{{Moderate-end}}
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*{{Moderate-begin}}Remove the '''adnexa'''.<ref name=stora/> '''Weigh''' the uterus without the adnexa.{{Moderate-end}}
 
*Perform a general '''inspection'''
 
*Perform a general '''inspection'''
 
*'''Measure''' length, width, thickness
 
*'''Measure''' length, width, thickness

Revision as of 13:01, 18 September 2020

Author: Mikael Häggström [note 1]

Fixation

Generally 10% neutral buffered formalin.

  See also: General notes on fixation


Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

Gross processing

Benign indications

Applicable in bleeding disorders, pain, leiomyoma and endometrial hyperplasia.[1]

Gross examination

For orientation:

  • The round ligament lies anterior to the tubes and ovaries.[1]
  • The peritoneum extends further down along the cervix posteriorly than anteriorly.[2] Its ends bluntly posteriorly and sharply anteriorly.[2]

Steps:[1]

  • (Remove the adnexa.[1] Weigh the uterus without the adnexa.)
  • Perform a general inspection
  • Measure length, width, thickness
  • Open the uterus by transmural radial cuts on both sides of the uterine cavity.[notes 1] The cavity is sometimes be squeezed or rolled around a leiomyoma, and you'll you have to improvise and perhaps go around the leiomyoma to open the cavity properly.
  • Inspect the mucosa. If any polyps: Further information: Endometrial polyp
  • Measure the thickness of the mucosa and myometrium
Smooth muscle tumor (in this case leiomyoma).

Gross report

Components:[1]

  • Shape of uterus and adnex
  • Measurements
  • Mucosa, such as smooth or irregular.
  • Any polyps. Further information: Endometrial polyp
  • Mucosal and endometrial thickness
  • Any smooth muscle tumor. Further information: Smooth muscle tumor

Slices for microscopy

Submit:[1]

  • Four cross-sectiosn from any accompanying ectocervix. In subtotal extirpation, a cross-section is taken from the lower resection border.
  • A transverse slice through the endocervix, possibly divided into two.
  • One slice from the front and one from the back wall of the corpus, and one piece from each corner, including myometrium.
  • Any mucosal parts with macroscopically abnormal appearance, including polyps.
  • In case of endometrial hyperplasia, most of the mucosa of the corpus and fundus.
  • Samples form all smooth muscle tumors >5 cm in diameter. Further information: Smooth muscle tumor

Microscopic evaluation

Look for signs of malignancy:

Cervix

edit
Look for cervical dysplasia. It is mainly seen as nuclei with hyperchromasia, coarse chromatin and irregular contours.[3]

Further information: Cervical dysplasia


Uterine body

Main findings:

Microscopy report

Example in a normal case:

Microscopy of hysterectomy shows ecto and endocervix without atypia. The glands have columnar epithelium without atypia.

In the uterine cavity, there is endometrial mucosa with ordinary thickness and regularly arranged endometrial glands. (Optionally: Description of likely menstrual phase.) Sharp delimitation between endometrium and myometrium. The myometrium contains no focal changes. No evidence of malignancy.

Notes

    • In the US, the cut goes from side to side, through the cervix and uterine cavity, keeping the anterior and posterior halves attached by a relatively thin connection left at the fundus. It is done by cutting with scissors with the blunt end in the cervix and then uterine cavity, or by a blade guided on each side by the shanks of a pair of forceps inserted through the cervix.
    • In Sweden, the uterus is usually opened at the front in the midline, optionally with an incision towards each corner.
  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.
  2. 2.0 2.1 . General Specimen Orientation Tips. The University of Michigan (2020-01-29).
  3. Khaled J. Alkhateeb, M.B.B.S., Ziyan T. Salih, M.D.. HSIL / CIN II / CIN III. PathologyOutlines. Topic Completed: 29 March 2021. Minor changes: 9 February 2022
  4. Source image by Ed Uthman from Houston, TX, USA. Creative Commons Attribution 2.0 Generic (CC BY 2.0) license

Image sources