The specimen may consist of fallopian tube only or, more commonly, both fallopian tubes are present as part of a TAH and BSO.
Initial procedure and description
• the length (cm) of each fallopian tube is recorded.
• the presence or absence of a fimbriated end is noted.
• if a sterilization clip is present this is documented.
• note the presence of any gross external abnormality, such as cyst, nodule or tumour.
• if the fallopian tube is dilated, the diameter is measured.
• if necessary any gross lesion may be photographed.
• if tumour is present, note the presence or absence of serosal involvement or breach.
• if grossly normal, the fallopian tube is serially sectioned at 3-5 mm intervals.
• the presence of any gross abnormality seen on sectioning, e.g., luminal occlusion, pus, placental tissue or haemorrhage is noted.
• if an ectopic pregnancy is suspected, note the presence or absence of tubal rupture.
• if a tumour is present, the size in three dimensions (cm), the colour and consistency are noted as is the presence or absence of haemorrhage and necrosis.
• if a cyst is present, it is measured and documented as unilocular or multilocular. The relationship to the fallopian tube should be stated. The character of the internal and external surfaces is noted as is the consistency of the fluid.
• fallopian tubes removed prophylactically in those with a predisposition to developing ovarian cancer are serially sectioned transversely at 2-3 mm intervals. The entire fallopian tubes should be examined histologically since small neoplasms which are not visible grossly may be present.
• as stated, fallopian tubes removed prophylactically in those with a hereditary predisposition to develop ovarian cancer should be examined in their entirety.
• a single transverse section is examined in cases of tubal ligation.
• if the fallopian tube is grossly normal, one or two transverse sections are examined in a single cassette.
• any gross lesion, e.g., cyst or nodule, is blocked to show its relationship to the tube.
• in cases of suspected ectopic pregnancy, several sections should be taken (Figure 22.2). Blood clot and placental tissue identified grossly are sampled as is any site of tubal rupture. A section should also be taken from an area of grossly normal proximal tube. If trophoblastic tissue is not identified in initial sections, then extra blocks are taken.
• for malignant fallopian tube neoplasms, at least one block per cm of tumour is submitted for histology. These are taken preferentially from any gross areas of serosal involvement to show the most extensive tumour infiltration. Blocks are also taken to demonstrate origin of the tumour from the fallopian tube. Blocks of uninvolved fallopian tube should also be submitted.
• in neoplasms with a variegated appearance, grossly different areas are blocked.
• side of tumour - right/left or bilateral.
• dimensions of tumour - measure in three dimensions (cm).
1. Proximal limit
2. Multiple transverse sections of the dilated tube, its contents and any areas of deficiency
Figure 22.2. Blocking the fallopian tube in an ectopic pregnancy.
• gross appearance - solid/cystic, colour and consistency, presence of haemorrhage or necrosis.
• tumour type - most primary fallopian tube malignancies comprise serous adenocarcinomas.
• tumour differentiation - well, moderate or poorly differentiated.
• extent of local tumour spread - involvement of mucosa, submucosa, muscularis, serosa, surrounding structures.
• lymphovascular invasion - present/not present.
• lymph nodes - sites and presence or absence of tumour involvement.
• involvement of other organs, e.g., ovary, omentum.
• peritoneal washings/cystic fluid - involved/not involved by tumour.
FIGO/TNM Staging pT1 tumour limited to the fallopian tube(s). pT2 tumour involving tube(s) with pelvic extension.
pT3 tumour involving tube(s) with metastases to abdominal peritoneum, and/or regional nodes. pT4 tumour involving tube(s) with distant metastases, e.g., liver parenchyma or positive pleural fluid cytology.
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