grossing procedure for ovary
TRANSCRIPT
Gross of ovary
Procedure
Measure the dimensions of organ. Weigh it if it is obviously abnormal.
During the reproductive period, Average size is 4 × 2 × 1 cm. Average weight is 5–8 g.
After menopause, they shrink to one half or less of this size.
Procedure If the specimen received is:
a Normal-sized or nearly normal-sized organ: bivalve the ovary with a cut through its longest dimension and fix for several hours.
b Enlarged organ: make several cuts at distance of 1 cm apart and fix for several hours.
External surface smooth or irregular? Capsule: thickened? adhesions?
haemorrhage? rupture?
ProcedureCystectomies are usually performed for
benign lesions or in women with ovarian masses who wish to preserve their fertility.
If ovarian cystectomy specimen is received, after weighing and measuring the specimen , examine the external surface for evidence of rupture.
In absence of rupture, place the cyst in a container, and carefully make a small incision in the wall to allow its contents to be drained.
Procedure
Note the colour and consistency of the cyst fluid.
Clear fluid – Serous tumour.Fluid to viscous material of mucoid
nature – Mucinous tumour.Thick sebaceous material along with
hairs, teeth etc - Dermoid cyst. Continue the incision with a pair of
scissors to expose the entire inner surface.
On cut section
In cystectomy specimen:-
Examine the surfaces of the cysts for evidence of granularity, nodules, or papillary projections.
The thickness of the cyst walls should also be recorded.
On cut sectionTumor : Size External surface Smooth or papillary? Solid or cystic? Document area of each
separately, if both are present in a specimen.
Content of cystic mass Hemorrhage, necrosis, or
calcification?
Papillary projection within the cyst
Solid area
Cystic area
Sections for histology
1 For incidental oophorectomies: one sagittal section of each entire ovary, labeled as to side.
2 For cysts: up to three sections of cyst wall (particularly from areas with papillary appearance).
3 For tumors: three sections or one section for each centimeter of tumor, whichever is greater; also, one section of non-neoplastic ovary, if identifiable
If the ovary and fallopian tube were removed as a prophylactic procedure in a woman with a family history of ovarian or breast carcinoma, the entire ovary and fallopian tube should be submitted.
Follicular cysts
Cyst diameter exceeding 2.5 cm
Stein–Leventhal syndrome
Numerous follicular cysts
The luminal content is typically hemorrhagic
corpus luteum cyst. Endometrosis
Uni-/ multiloculated cystsfilled with clear fluid
Serous cystadenoma
Increased papillary projections within cyst
Borderline serous cystadenoma
- irregular tumour mass - ↑ solid/ papillary - necrosis/ haemorrhage
Serous cystadenocarcinoma
Mucinous cystadenoma
Uni-/ multiloculated cysts (filled with mucinous material)
Borderline mucinous cystadenoma
-multiloculated cysts -papillae
Mucinous cystadenocarcinoma
Necrosis/ Haemorrhage
- Solid /cystic / combination -Cyst content- haemorrhagic usually
Endometrioid carcinoma Clear cell adenocarcinoma
- Spongy, often cystic -Unilocular cysts with solid nodules
- Mostly solid - well circumscribed - On cut- firm, white/yellowish white
Brenner tumour
On cut- predominantly solid with areas of haemorrhage, necrosis (+) cartilage/bone
Immature Teratoma
Mature teratoma
cheesy sebaceous material
HairTeeth
Struma ovarii
-Thyroid tissue predominantly - solid, gelatinous or cystic - Locules - brown/ greenish brown fluid
Carcinoid tumour
Typically firm, tan to yellow, solid or cystic
DysgerminomaEncapsulated,smooth, lobulated surface
On cut- solid, fleshy with foci of haemorrage & necrosis
-Smooth, glistening external surface.
-On cut-variegated
Yolk sac tumour Embryonal carcinomaExternal surface- smooth & glisteningCut surface- solid, variegated with extensive haemorrhage & necrosis
Adult Granulosa cell tumour
-encapsulated -uniformly solid/cystic/ combination - on cut:solid, yellow areas, haemorrhage
Juvenile Granulosa cell tumourSolid,lobulated On cut:solid with cysticHaemorrhage /Necrosis
Thecoma
-Encapsulated, Firm - on cut: solid, yellow with white foci
Fibroma
Solid, lobulated -On cut- firm, uniformly white -cyst formation/ calcification/ haemorrhage/ necrosis
Krukenberg tumourSolid, multinodular
Metastasis of large bowel adenocarcinoma
solid, nodular
Thank you
Presented by- Dr. Monika Nema