Endometrial Carcinoma, Grossing and Processing Issues: Recommendations of the International Society of Gynecologic Pathologists

Abstract

Endometrial cancer is the most common gynecologic neoplasm in developed countries; however, updated universal guidelines are currently not available to handle specimens obtained during the surgical treatment of patients affected by this disease. This article presents recommendations on how to gross and submit sections for microscopic examination of hysterectomy specimens and other tissues removed during the surgical management of endometrial cancer such as salpingo-oophorectomy, omentectomy, and lymph node dissection—including sentinel lymph nodes. In addition, the intraoperative assessment of some of these specimens is addressed. These recommendations are based on a review of the literature, grossing manuals from various institutions, and a collaborative effort by a subgroup of the Endometrial Cancer Task Force of the International Society of Gynecological Pathologists. The aim of these recommendations is to standardize the processing of endometrial cancer specimens which is vital for adequate pathological reporting and will ultimately improve our understanding of this disease.

Frozen section accurately allows pathological characterization of endometrial cancer in patients with a preoperative ambiguous or inconclusive diagnoses: our experience

“…In conclusion, in the setting of current standards of care, we are aware that actually most centers are performing sentinel lymph node mapping and thus the role of frozen section evaluation appears to be diminishing. Anyway as recently defined by some Authors [27] we have demonstrated that the intraoperative FS could still be considered a useful diagnostic tool, which in few minutes (about 20 min), when performed by a dedicated gynaecological pathologists team, provides accurate information about the risk stratification of EC patients. In particular, IOE is useful in those cases in which the classical histopathological prognostic information are preoperatively ambiguous or inconclusive by imaging and endometrial biopsies (often too small or not well representative of the entire lesions, or rich in necrosis or bloody samples).…”

Endocervical Adenocarcinoma, Gross Examination, and Processing, Including Intraoperative Evaluation: Recommendations From the International Society of Gynecological Pathologists

“…Although there is no clinically relevant role for recording the hysterectomy specimen weight, it is routinely recorded in pathology practices in the United States since there are different billing codes for specimens that weigh up 250 g versus those above it 42 . Furthermore, the certification requirements of the American Board of Obstetrics and Gynecology mandate candidates to document specimen weights during their training experience in performing hysterectomies.…”

“…The disadvantage is that this requires laboratory staffing to be available to perform this processing immediately upon receipt of the fresh specimen. The second option is to use the conventional bivalve approach for opening a uterus along the lateral wall resulting in an anterior half and a posterior half 42 , and can also be used if the hysterectomy is received in formalin. The disadvantage is that the cervix will have to be dissected using a radial slice strategy, similar to that for a formalin-fixed intact cone, which produces slices of uneven thickness that have to be trimmed down to fit in the cassette properly.…”

“…The uterine corpus should be serially thinly sliced (3–5 mm) parallel to the axial plane, from the endometrial surface through the wall to the serosa, as is conventionally done for other hysterectomy indications 42 . Careful evaluation for secondary involvement of the corpus is merited given its association with ovarian and/or lymph node metastasis.…”

Leitlinienbasierte Aufarbeitung und Befundung von Lymphonodektomiepräparaten und Sentinel-Lymphknoten gynäkologischer Malignome

“…1 Organbezogene Aufarbeitung von Lymphonodektomiepräparaten gynäkologischer Malignome. (Nach AWMF [3][4][5][6], Malpica et al [30], McCluggage et al [32] und Hirschowitz et al [46] AWMF-Leitlinien empfohlen, die extrakapsuläre Ausbreitung standardmäßig im Befundbericht zu erwähnen [3][4][5][6]. Parametrane (mesometrane) Lymphknoten gehören beim Endometrium-, Zervix-und proximalen Vaginalkarzinom zu den regionären Lymphknoten [51] und sollen unter den pelvinen Lymphknoten subsumiert werden.…”