Abstract
Endometrial cancer is the most common gynecologic neoplasm in developed countries; however, updated universal guidelines are currently not available to handle specimens obtained during the surgical treatment of patients affected by this disease. This article presents recommendations on how to gross and submit sections for microscopic examination of hysterectomy specimens and other tissues removed during the surgical management of endometrial cancer such as salpingo-oophorectomy, omentectomy, and lymph node dissection—including sentinel lymph nodes. In addition, the intraoperative assessment of some of these specimens is addressed. These recommendations are based on a review of the literature, grossing manuals from various institutions, and a collaborative effort by a subgroup of the Endometrial Cancer Task Force of the International Society of Gynecological Pathologists. The aim of these recommendations is to standardize the processing of endometrial cancer specimens which is vital for adequate pathological reporting and will ultimately improve our understanding of this disease.
Highlights
HYSTERECTOMY SPECIMEN HANDLINGGeneral Rule of Gross/Macroscopic Examination Orient the specimen, that is identify the anterior and posterior walls of the uterus using anatomic landmarks
Patients with endometrioid adenocarcinoma, FIGO grades 1 or 2, measuring ≤ 2 cm and with ≤ 50% myometrial invasion are spared of pelvic lymph node dissection as the risk of lymph node metastases is 2 cm and ≤ 50% myometrial invasion undergo a dissection of pelvic lymph nodes as the risk of pelvic lymph node metastases increases to 10% [21]
Recommendation The cervix should be left attached to the corpus during the gross examination of a hysterectomy specimen obtained for endometrial carcinoma
Summary
General Rule of Gross/Macroscopic Examination Orient the specimen, that is identify the anterior and posterior walls of the uterus using anatomic landmarks. Document all organs/structures received and record their measurements and gross appearance
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