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Module: Non-Neoplastic Uterus
The purpose of this module is to ensure all uterus specimens are described and dissected properly so that a diagnosis can be issued. Please refer to local standard operating procedures (SOP) for complete details.
(NOTE: You can view 3D models in larger format by clicking on the "fullscreen" icon at the bottom right.)
Specimen Handling Objectives
Specimen Handling Objectives
The learner is expected to apply some elements of the content learned in part 1 in the grossing of the simulation specimens.
Note: If the learner is unsure of the next steps during the simulation workshop, they should ask questions and/or seek help.
After reviewing the relevant readings, images, and SOPs and finishing the Introduction to Grossing Workshop, the learner will:
Confirm patient identification, specimen type, and alpha designation for the specimen
Read the provided clinical history
Orientate a uterus, identifying the anterior and posterior aspects, cervix, fallopian tubes and ovaries (if included)
Select and wear the appropriate PPE for the grossing of the simulation specimens.
Set up an organized grossing bench for the grossing of simulation specimens.
Follow and apply patient, specimen and tissue cassette identification procedures.
Describe the steps for grossing a non-neoplastic uterus AP04-7.08 Non-Neoplastic Uterus (labqms.com)
Gross a simulated uterus using the non-neoplastic uterus SOP
Select the correct processing time for the uterus
Demonstrate the safe setup, cleaning and discard of sharps (scalpel and feather blades)
Clean the grossing bench between specimens and apply steps to limit cross-contamination between specimens.
Determine when they are unsure of the next steps and ask questions/seek help.
Hysterectomy - Example Gross Description
Hysterectomy - Example Gross Description
The specimen is received fresh and is labeled PATIENT LAST NAME, FIRST NAME, designated Uterus: Uterus, Cervix, Bilateral Fallopian Tubes and Ovaries. The specimen consists of an intact, simple hysterectomy (57.7 g; 7.5 cm SI x 4.7 cm RL x 2.6 cm AP) with attached bilateral fallopian tubes (left: 4.8 x 0.4 x 0.4 cm; right: 5.7 x 0.3 x 0.3 cm) and attached bilateral ovaries (left: 2.3 x 1.2 x 0.8 cm; right: 2.5 x 1.1 x 0.8 cm).
The uterine serosa is smooth and tan to hemorrhagic. The paracervical surfaces are unremarkable, with the anterior half inked blue and the posterior half inked black. The exocervical mucosa (2.9 x 2.2 cm) is smooth, tan to congested and complete. The exocervical os (1.2 x 0.4 cm) is oval. The endocervical canal (2.5 cm in length) is unremarkable. The endometrial cavity (4.9 cm in length, 1.9 cm across cornua) is symmetrical. The endometrium (0.1 cm in maximum thickness) is tan and unremarkable. The myometrium (1.9 cm in thickness of the body) appears tan and unremarkable.
Both the left and right fallopian tubes are tan to congested, with open fimbriated ends and unremarkable cut surfaces.
The external and cut surfaces of both ovaries are unremarkable.
Representative sections are submitted as follows:
A1-A3. Anterior midline strip submitted from cervix to fundus
A4-A6. Posterior midline strip submitted from cervix to fundus
A7-A8. Fimbriated end bisected in toto and two transverse sections of left fallopian tube (modified SEE-FIM)
A9. One-half of the bisected left ovary
A10-A11. Fimbriated end bisected in toto and two transverse sections of the right fallopian tube (modified SEE-FIM)
A12. One-half of the bisected right ovary
Learning Material
Learning Material
AP04-7.08 Non-Neoplastic Uterus (labqms.com)
AP05-1.02 Peloris (see Tissue Size Chart)
AP04-1.01 Dissection Guidelines AP04-1.01 Dissection Guidelines (labqms.com)
Anatomy
Anatomy
Please note: this is only a brief description of relevant anatomy that is most likely encountered at the time of dissection/grossing. For more complete details, please refer to complete and detailed anatomy references.
(see collapsable images on the right)
The uterus, cervix, Fallopian (uterine) tubes, and ovaries constitute some of the parts of the female reproductive system.
The uterus is a thick-walled muscular organ located within the pelvis, in the midline, between the bladder and rectum. It consists of a body and a cervix which inferiorly joins the vagina. The body of the uterus is flattened anteroposteriorly with a rounded superior aspect (fundus of the uterus) above the attachment of the lateral attachment of the uterine tubes. The uterine cavity resembles the shape of an inverted triangle (viewed anteriorly) and a narrow slit-like shape (viewed laterally). Each of the superior corners joins in continuity with the lumen of the uterine tubes; the inferior corner joins with the endocervical canal.
Fallopian (uterine) tubes extend laterally from the superior end of the uterine body and are enclosed within the upper margins of the mesosalpinx portions of the broad ligament. Both tubes pass superiorly over and terminate laterally to the ovaries, which are suspended from the posterior aspect of the broad ligament. The terminal aspect of each tube has an expanded funnel-like shape (infundibulum), which is rimmed by small finger-like projections (fimbriae). Tracking back towards the uterus, medial to the infundibulum, is the ampulla, which then narrows to form the isthmus before joining the uterine corpus.
The cervix forms the inferior part of the uterus and has a short, broad, cylindrical shape. The narrow central channel (endocervical canal) joins the uterine cavity and inferior exocervix, which projects into the upper anterior aspect of the vagina.
Ovaries are bilateral female gonadal organs that lie lateral to the uterus, close to the lateral pelvic wall. Ovaries are suspended in the pelvic cavity by the mesovarium, which is attached to the upper limit of the posterior aspect of the broad uterine ligament. They are typically almond-shaped (3 cm on average) and consist of dense fibrous tissue. The ligamentous support of the ovary includes suspensory (infundibulopelvic) and ovarian ligaments. The ovarian ligament attaches to the lateral angle of the uterus.
Indications for Surgery
Indications for Surgery
Hysterectomy can be removed due to a variety of diseases, including benign and malignant conditions. The type of surgery and organs included determine the method of specimen processing. Specimens may fall into the following categories:
Total hysterectomy for benign conditions (such as prolapse or fibroids)
Total hysterectomy for malignant conditions (such as endometrial malignancies)
Radial hysterectomy for malignant conditions that include vaginal cuff, parametrium, and regional lymph nodes
This is an introductory module to uterus specimen and pathological findings are not further discussed.
3D Model, Closed Uterus (Textured)
3D Model, Closed Uterus (Textured)
3D model provides an anatomic representation of a typical total hysterectomy with bilateral salpingo-oophorectomy (fallopian tubes and ovaries)
Orientation of hysterectomy specimens can be aided based on the location of adjacent structures
From anterior to posterior, these structures include:
Round ligament
Fallopian tube
Ovary
Ovarian ligament
The peritoneal reflection is lower on the posterior surface and often comes to a point. In comparison, the anterior aspect is higher and blunter where the bladder has been dissected away.
If orientation cannot be provided, designate two sides as "A" and "B" when submitting sections.
3D Model, Open Uterus (Textured)
3D Model, Open Uterus (Textured)
3D model provides an anatomic representation of a a uterus opened in a typical fascion into anterior and posterior halfs.
Regions of interest include (from superior to inferior):
Lateral cornu (left and right) connecting to fallopian tubes
Endometrial cavity
Myometrium
Lower uterine segment
Endocervical canal
Exocervix
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