Longitudinal blocks of tumour and transformation zone ensuring at least quadrant representation

1. Process adnexae and paint paracervical/parametrial tissues

2. Transverse section the vaginal limit

3. Amputate cervix and block

4. Probe and hemisect the corpus laterally

5. Transverse section corpus

Figure 24.3. Blocking a radical hysterectomy for cervical carcinoma.

Procedure for dealing with trachelectomy specimens

• the specimen is orientated, weighed and measured in three dimensions (cm).

• the parametrial surface is inked.

• the tissue is serially sliced longitudinally at 3-4 mm intervals and examined in its entirety.

Procedure for hysterectomy with CIN and CGIN

• the cervix is amputated and longitudinally sectioned to give good junctional zone representation. The number of blocks obtained depends on the local cervical anatomy and distortion/stenosis as a result of previous procedures, e.g., LLETZ. Block numbers may therefore range from three to four (quadrants) right up to twelve. They are labelled as to their site of origin. It is better to take fewer blocks with good junctional zone representation rather than many blocks with poor representation.

Histopathology report

• the number of blocks of tumour examined and the site of the tumour are stated.

• the tumour is measured in three dimensions (cm). If this is not possible grossly then it is done histologically. The maximum depth and length of invasion are measured on the slide. It should be remembered that there is a third dimension and this is calculated by taking into account the presence of tumour in adjacent tissue blocks. If a block is taken as measuring 3 mm in thickness then the total third dimension can be calculated on this basis.

• tumour type - most tumours within the cervix are either of squamous or glandular type.

• tumour differentiation - both squamous carcinomas and adenocarcinomas are classified as being well, moderately or poorly differentiated. For squamous carcinomas, the prognostic significance of grading is controversial. Squamous carcinomas can also be classified as large cell keratinising, large cell non-keratinising and small cell non-keratinising.

• the presence or absence of the following are noted:

- adjacent CIN, CGIN or signs of HPV infection.

- vaginal, paracervical or parametrial soft tissue tumour involvement.

- tumour at the circumferential limit (state anterior, posterior, right or left lateral), or if clear, the minimum distance (mm) from it (Figure 24.4).

- vaginal limit involvement.

- lymphovascular permeation.

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

- response to preoperative chemoradiation.

- uterine involvement, although this does not affect the staging of cervical cancer.

- coexisting pathology in other organs, e.g., vaginal HPV or VAIN.

• for tumours confined to the cervix note the minimum distance (mm) from the tumour to the external cervical surface (Figure 24.4) and state which aspect of the cervix.

• when local excision is performed for a small invasive cancer, record the tumour distance (mm) to the ectocervical, endocervical and deep limits.

FIGO/TNM Staging pTis carcinoma in situ (= CIN III or adenocarcinoma in situ/high-grade CGIN). pT1 carcinoma confined to the uterus.

1A lesions detected only microscopically; maximum size 5 mm deep and 7 mm across; venous or lymphatic permeation does not alter the staging. 1A1 < 3 mm deep, < 7 mm horizontal axis. 1A2 3 mm < tumour depth < 5 mm, < 7 mm horizontal axis. 1B clinically apparent lesions confined to the cervix or preclinical lesions larger than stage 1A (occult carcinoma).

1B1 clinical lesions no greater than 4 cm in size. 1B2 clinical lesions greater than 4 cm in size. pT2 invasive carcinoma extending beyond the uterus but has not reached either lateral pelvic wall. Involvement of upper two-thirds of vagina, but not lower third.

a. without parametrial invasion.

b. with parametrial invasion.

pT3 a. invasive carcinoma extending to either lower third of vagina and/or b. lateral pelvic wall and/or causes hydronephrosis/non-functioning kidney. pT4 invasive carcinoma involving urinary bladder mucosa and/or rectum or extends beyond the true pelvis.

Distance to deep aspect of cervical stroma

Width (mm) = sum of involved serial blocks of standard thickness Tumour volume (mm3) can be estimated by length x depth x width

D = tumour distance (mm) to the Circumferential Radial Margin (CRM) of excision of the parametrium

Figure 24.4. Cervical carcinoma - tumour dimensions and margins. Reproduced from Allen DC. Histopathology Reporting: Guidelines for Surgical Cancer. Springer-Verlag: London, 2000.

Regional nodes: paracervical, parametrial, hypogastric (internal iliac, obturator), common and external iliac, presacral, lateral sacral.

pN0 no regional lymph nodes involved. pN1 metastasis in regional lymph nodes(s).

0 0

Post a comment