Grossing procedure for ovary

grossing procedure for ovary

1. Gross of ovary

2. 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.   

3. 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.

4. External surface smooth or irregular? Capsule: thickened? adhesions? haemorrhage? rupture?

5. Procedure Cystectomies 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.

6. 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.

7. 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.

8. On cut section Tumor : 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

9. 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

10. 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.

11. Follicular cysts Cyst diameter exceeding 2.5 cm Stein– Leventhal syndrome Numerous follicular cysts

12. The luminal content is typically hemorrhagic corpus luteum cyst. Endometrosis

13. Uni -/ multiloculated cysts filled with clear fluid Serous cystadenoma Increased papillary projections within cyst Borderline serous cystadenoma - irregular tumour mass - ↑ solid/ papillary - necrosis/ haemorrhage Serous cystadenocarcinoma

14. Mucinous cystadenoma Uni -/ multiloculated cysts (filled with mucinous material ) Borderline mucinous cystadenoma - multiloculated cysts -papillae Mucinous cystadenocarcinoma Necrosis/ Haemorrhage

15. - Solid /cystic / combination -Cyst content- haemorrhagic usually Endometrioid carcinoma Clear cell adenocarcinoma - Spongy, often cystic - Unilocular cysts with solid nodules

16. - Mostly solid - well circumscribed - On cut- firm, white/yellowish white Brenner tumour

17. On cut- predominantly solid with areas of haemorrhage , necrosis (+) cartilage/bone Immature Teratoma Mature teratoma cheesy sebaceous material Hair Teeth

18. Struma ovarii -Thyroid tissue predominantly - solid, gelatinous or cystic - Locules - brown/ greenish brown fluid Carcinoid tumour Typically firm, tan to yellow, solid or cystic

19. Dysgerminoma Encapsulated,smooth , lobulated surface On cut- solid, fleshy with foci of haemorrage & necrosis

20. -Smooth, glistening external surface. -On cut-variegated Yolk sac tumour Embryonal carcinoma External surface- smooth & glistening Cut surface- solid, variegated with extensive haemorrhage & necrosis

21. Adult Granulosa cell tumour -encapsulated -uniformly solid/cystic/ combination - on cut:solid , yellow areas, haemorrhage Juvenile Granulosa cell tumour Solid,lobulated On cut:solid with cystic Haemorrhage /Necrosis

22. Thecoma -Encapsulated, Firm - on cut: solid, yellow with white foci Fibroma Solid, lobulated -On cut- firm, uniformly white -cyst formation/ calcification/ haemorrhage / necrosis

23. Krukenberg tumour Solid, multinodular Metastasis of large bowel adenocarcinoma solid, nodular

24. Thank you Presented by- Dr. Monika Nema