Resection Specimens

In cases of cervical cancer (usually greater than stage Ia) the operation of choice is radical hysterectomy together with pelvic lymph node sampling. Radical (Werdheim's) hysterectomy involves removal of the uterus and cervix together with a cuff of vagina and the surrounding parametrium. Both ovaries and fallopian tubes are also usually removed although in young women they may be left behind in order that ova may be available for those who wish to have children.

A trachelectomy is performed in young women with cervical cancer who wish to preserve their fertility. This operation is usually undertaken for early stage Ib carcinomas, the carcinoma measuring less than 2 cm in maximum diameter. During the process of trachelectomy local excision of the cervix is undertaken together with the surrounding parametrium, and pelvic lymph nodes are sampled.

Sometimes, simple hysterectomy is carried out for extensive or recurrent CINIII, or in patients with CIN who are symptomatic for other reasons, e.g., dysfunctional uterine bleeding. No uterus should be dissected or reported without full knowledge of any prior endometrial sampling or cervical cytology results.

Procedure, description and blocks for histology in a radical hysterectomy (Figure 24.3)

• the specimen is weighed and the combined length of the uterus and cervix measured.

• the external surface of the uterus and cervix are carefully evaluated to ascertain whether there is any tumour infiltration.

• at this stage the serosal surface of the uterus and the external surface of the cervix together with the vaginal resection margin can be inked. Different colours of ink may be used to designate right and left lateral, anterior and posterior. Care should be taken so that the ink does not contaminate other surfaces, especially on sectioning.

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

• the cervix is detached from the uterus by a complete transverse cut. A parallel slice from the proximal limit of the amputated cervix provides blocks of right and left parametrium, which should be inspected for the presence or absence of tumour and lymph nodes.

• the cervix is opened longitudinally and the presence of any gross tumour noted.

• if a tumour is apparent it is measured in three dimensions (cm) and its site stated (anterior, posterior, left lateral, right lateral, etc.).

• if a gross tumour is identified, representative longitudinal sections are examined, a minimum of one from each quadrant depending on the tumour location and distortion of the cervical anatomy. These are taken to show the deepest point of infiltration into the underlying cervical stroma and the relationship of the tumour to the closest margins. Blocks are labelled as to their site of origin.

• if no tumour is seen grossly then the entire cervix should be sectioned and examined histologically. Sections are labelled as to what part of the cervix they are taken from; e.g., 1 to 12 o'clock, with 12 being from the anterior lip of the cervix.

• two sections are taken from the lower uterine segment to assess the presence or absence of spread of tumour into the lower uterus.

• the uterus is carefully examined and if unremarkable sampled as per a benign protocol.

• the ovaries and tubes are carefully sectioned and if unremarkable sampled as per a benign protocol. It is usually convenient to dissect and block the adnexae prior to the handling of the main specimen.

• photography can be undertaken at any stage in the cutting process.

• lymph nodes are carefully sectioned and labelled as to their site of origin. These are usually dissected and submitted to the laboratory by the surgeon in separately labelled pots.

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Parametrial/paracervical tissues

Tumour and isthmus block

Parametrial/paracervical tissues

Tumour and isthmus block

i Transverse section vaginal limit

Endometrium Myometrium

Endometrium Myometrium

Transverse section of endocervix, tumour and parametrial/paracervical tissues

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