Resection Specimens

Radical or Werdheim's hysterectomy involves removal of the uterus and cervix together with the upper vagina. This operation, which generally also involves pelvic lymphadenectomy, is usually performed for stage I disease located in the upper part of the vagina. Otherwise, many vaginal cancers are primarily treated by radiotherapy. Occasional vaginectomy (colpectomy) specimens are encountered.

Procedure and description for radical hysterectomy (Figure 25.1)

• the specimen is weighed (g) and the length of the uterus, cervix and vagina measured (cm). The serosal surface of the uterus and the external surface of the cervix and vagina are inked. Care should be taken so that the ink does not contaminate other surfaces.

• the distal vaginal limit is transversely sectioned in its entirety and processed for histological examination. Scissors are useful for obtaining these blocks.

• on opening the vagina the site of the tumour and its relationship to the cervix is assessed and described.

• the distance of tumour to the distal vaginal limit of excision is measured (cm).

• the tumour is carefully transversely sectioned and the minimum distance from tumour to the circumferential limit measured (mm). The nearest circumferential limit should be stated.

• the deep soft tissue paravaginal margin is sampled for histological examination.

• the presence or absence of cervical involvement is noted grossly.

• sections are taken from the cervix to show its relationship with the vaginal tumour if possible.

• the uterus is sampled as per a benign protocol.

• the ovaries and tubes, if present, are sampled as per a benign protocol. It is often convenient to do this prior to handling of the main specimen.

1. Transverse section vaginal limit

2. Paint external aspect of paracervical and paravaginal tissues

3. Amputate the cervix

4. Transverse section the vaginal tumour

5. Block tumour longitudinally in relation to the cervix

6. Sample paracervical/parametrial tissues, endometrium and myometrium

Figure 25.1. Blocking a radical hysterectomy specimen for vaginal carcinoma.

• photography may be undertaken at any stage.

• colpectomy specimens: weigh, measure, paint externally, open longitudinally, describe the tumour (its dimensions and distance to the specimen limits), transverse section into multiple serial slices.

Blocks for histology (Figure 25.1)

• multiple representative blocks of tumour are submitted for histopathological examination. These may be taken either transversely or longitudinally but should show the relationship with both the cervix and the nearest circumferential margin.

• the vaginal distal limit is blocked in its entirety for histological examination.

• any lymph nodes submitted are sampled for histology and their site of origin noted.

• as already stated the uterus, ovaries and tubes are examined as per a benign protocol.

Histopathology report

• the site of the tumour (upper, mid or lower; anterior or posterior; left side or right side) within the vagina is stated.

• the tumour measurement is given in three dimensions (cm) if possible.

• tumour type - most tumours arising primary within the vagina are squamous carcinomas. Adenocarcinomas are rarer although they do occur. With an adenocarcinoma, secondary spread from elsewhere should always be excluded, e.g., bladder, uterus, rectum.

• tumour differentiation - squamous carcinomas and adenocarcinomas are classified as well, moderately or poorly differentiated.

• the presence or absence of the following are noted:

- adjacent VAIN or signs of HPV infection.

- lymphovascular permeation.

- lymph node involvement (site, intraparenchymal or extracapsular spread).

- VAIN or tumour at the distal vaginal limit, or if clear, the minimum distance (mm) from it.

- paravaginal soft tissue extension.

- tumour at the circumferential limit (state which one), or if clear, the minimum distance (mm) from it.

- response to preoperative chemoradiation.

- coexistent pathology in other organs, e.g., CIN.

FIGO/TNM Staging pT1 tumour confined to the vagina.

pT2 tumour invades paravaginal tissues but does not extend to pelvic wall. pT3 tumour extends to pelvic wall.

pT4 tumour invades mucosa of bladder or rectum, and/or extends beyond the true pelvis.

Regional nodes: upper two-thirds - pelvic nodes; lower third - inguinal nodes.

pN0 no regional lymph node metastasis. pN1 metastasis in regional lymph node(s).

0 0

Post a comment