Hysterectomy

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Author: Mikael Häggström [notes 1]

Gross processing

Benign conditions

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]

Optionally, remove the adnexa.[1]

Steps:[1]

  • Perform a general inspection
  • Measure length, width, thickness
  • The uterus is usually opened at the front in the midline, optionally with an incision towards each corner.[notes 2] Open the cavity completely, along the existing incision. 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. Cut through the front wall into both corners.
  • Inspect the mucosa. If any polyps, see Endometrial polyp
  • Measure the thickness of the mucosa and myometrium
  • Inspect the myometrium. If any tumor, see Smooth muscle tumor

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

Notes

  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.
  2. The uterus can also be opened laterally, through the parameters.

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).