Resection Specimens

Initial Procedures and Description

• abrading the cortical surface should be avoided in order to preserve the mesothelial lining.

• each ovary is weighed (g) and measured in three dimensions (cm) and if necessary photographed. The presence of fallopian tubes is confirmed and they are measured.

• the cortical surfaces of the ovaries may be inked but in general this is not necessary.

• the cortical surface of each ovary is closely inspected around the whole circumference. The presence of obvious tumour deposits on the capsular surface or of papillary areas or capsular breach is noted. This is important since if a malignant tumour breaches the capsular surface it is at least stage IC. In many instances this is the cut-off for adjuvant chemotherapy.

• abnormal ovaries are serially sectioned at approximately 1 cm intervals. Note that large cystic lesions may contain abundant fluid which can exude under pressure. The characteristics of the fluid should be noted, e.g., serous, mucinous or bloody. Scissors can also be of use in opening and blocking cystic lesions.

• if the ovary is predominantly solid, the colour and consistency of the lesion is noted as is the presence or absence of areas of haemorrhage or necrosis.

• if the lesion is both solid and cystic, record the proportion of each.

• if the lesion is cystic, note whether the cyst is unilocular, multilocular or whether a main cyst is present together with multiple smaller daughter cysts. The presence of residual ovary is documented.

• with a cystic lesion, describe whether the internal surface of the cysts are smooth or whether they contain papillary projections.

• the presence of other elements within the lesion is recorded, e.g., hair and teeth in dermoid cysts.

• ovaries removed prophylactically in those with a hereditary predisposition to develop ovarian cancer are serially sectioned parallel to the short axis at 2-3 mm intervals. The presence of any gross abnormality is noted. The entire ovaries (and fallopian tubes) should be submitted for histological examination since very small neoplasms, which are not recognisable grossly, may be present.

• grossly normal ovaries removed during a hysterectomy for benign disease or for uterine or cervical neoplasms are bisected longitudinally and inspected.

• any paraovarian cystic or solid lesions should be treated in a similar way.

• omentum is weighed, measured in three dimensions (cm) and sectioned thinly. The presence of obvious tumour deposits, grittiness or areas of thickening or induration is noted.

Blocks for Histology (Figure 21.2)

• as stated previously, ovaries removed prophylactically in those with a hereditary predisposition to develop ovarian cancer are examined in their entirety.

• a single section through the long axis of the ovary suffices for grossly normal ovaries removed as part of a hysterectomy specimen for benign disease or uterine or cervical cancer.

• for suspected benign cystic lesions (thin-walled unilocular or multiloculated cysts) without thickenings or papillary excresences on the external or internal surfaces, representative sampling suffices. With mucinous lesions, at least one block per cm is required as malignant areas may be focal and coexist with benign and borderline areas.

• for those lesions with papillary excresences on the internal or external surface, multiple blocks are taken, especially from the papillary areas. This is important since these areas often represent borderline foci.

• for grossly malignant neoplasms, representative sections are taken, usually one section per cm of tumour.

• special attention should be given to the sampling of areas of capsular breach or infiltration by tumour.

• in neoplasms with a variegated appearance, grossly different areas are blocked.

• paraovarian lesions should be blocked similarly.

• representative sections of omentum are examined. If the omentum is grossly normal, three or four blocks suffice. Any tumour deposits or areas of thickening, grittiness or induration are preferentially sampled. If histological examination reveals implants or borderline lesions, then multiple additional sections may have to be examined.

Histopathology Report

• side of tumour - right/left or bilateral.

• dimensions of tumour - measure in three dimensions (cm).

• gross appearance - solid/cystic, colour and consistency, presence of haemorrhage or necrosis.

• tumour type - it is stressed that a wide range of benign and malignant tumours may arise within the ovary. The ovary is also a relatively common site for metastatic carcinomas.

• tumour differentiation - there is no universally agreed grading system for ovarian adenocarcinomas. Most systems use a combination of cytological and architectural features and

Bisect and submit a longitudinal slice

Bisect and submit a longitudinal slice

Residual ovary

Fallopian tube

Ovarian cyst

Residual ovary

Ovarian cyst

Submit

- tube and residual ovary

- cyst wall

- internal/external projections

Internal and external papillary projections

Internal and external papillary projections

Submit

- tube and residual ovary

- cyst wall

- internal/external projections

Solid tumour b

Solid tumour

Capsular deficiency

Figure 21.2. Blocking of ovarian tissues: (a) normal, (b) cystic, (c) mixed solid/cystic.

Submit

- tube and residual ovary

- cyst wall

- internal/external projections

- capsular deficiency

- solid tumour

Capsular deficiency a b c

Figure 21.2. Blocking of ovarian tissues: (a) normal, (b) cystic, (c) mixed solid/cystic.

grade neoplasms as well, moderately or poorly differentiated. Clear cell carcinomas should be graded solely on the nuclear features.

• capsule - it should be stated whether the capsule is intact, deficient or breached by tumour.

• lymphovascular invasion - present/not present.

• lymph nodes - mention sites and presence or absence of tumour involvement.

• omentum - involved/not involved by tumour and size of tumour deposits (cm).

• other organs (fallopian tube, uterus, cervix) - involved/not involved by tumour.

• peritoneal washings/ascitic fluid - involved/not involved by tumour.

• other pathology - the presence of coexistent pathology should be mentioned. Endometrioid and clear cell carcinomas may arise in endometriosis.

FIGO/TNM Staging pT1 growth limited to the ovaries:

a. one ovary, capsule intact, no serosal disease or malignant cells in ascites or peritoneal washings.

b. two ovaries, capsule intact, no serosal disease or malignant cells in ascites or peritoneal washings.

c. one or both ovaries with any of: capsule rupture, serosal disease or malignant cells in ascites or peritoneal washings.

pT2 growth involving one or both ovaries with pelvic extension:

a. uterus, tubes.

b. other pelvic tissues.

c. 2a or 2b plus malignant cells in ascites or peritoneal washings.

pT3 growth involving one or both ovaries with metastases to abdominal peritoneum, and/or regional nodes:

a. microscopic peritoneal metastasis beyond pelvis.

b. macroscopic peritoneal metastasis < 2 cm in greatest dimension beyond pelvis.

c. peritoneal metastasis > 2 cm in greatest dimension and/or regional lymph node metastasis (N1).

pT4/M1 growth involving one or both ovaries with distant metastases, e.g., liver parenchyma or positive pleural fluid cytology.

Regional nodes: obturator, common iliac, external iliac, lateral sacral, para-aortic, inguinal pN0 no regional lymph node metastasis. pN1 metastasis in regional lymph node(s).

0 0

Post a comment