Grossing procedure for ovary

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