• Determine from the requisition form, the electronic medical record, or the submitting physician that the hysterectomy was performed for endometrial hyperplasia or carcinoma.  If you receive a uterus without any clinical information, especially if there is a vaginal cuff and parametrial soft tissue, contact the submitting physician.

• Follow the guidelines in Hysterectomy for Benign Condition, Salpingectomy and Oophorectomy with the following differences:

• Ink the entire uterine serosa, using different colors for anterior and posterior.
• If the endometrium is very soft and friable, it may be helpful to pin the uterus to a board after opening and allow it to “fix” for a few hours before sectioning the wall.
• Determine whether the tumor is diffuse or localized and whether it involves the endocervix or other attached structures.  Examine the cut surface of the myometrium to assess for invasion, and measure from the “normal” endometrial surface to the deepest point of invasion.  Describe the tumor, both superficial and invasive aspects (color, shaggy, solid, soft, ulcerated).
• If no tumor is grossly macroscopically apparent, serially section the uterine wall at 3 mm intervals.
• Measure and ink attached parametria and vaginal cuff, if present.

• Tumor:  minimum of five sections (three transmural {= endometrium to serosa} sections from points of deepest invasion).  Large sections can be divided in half and placed in two cassettes, dictated accordingly.
• Non-neoplastic endometrium:  three sections.
• Junction of endocervix and lower uterine segment:  one to two longitudinal sections from the anterior and posterior walls.
• If no apparent tumor:  submit one transmural section each from anterior and posterior walls.  Submit entire endometrium with attached superficial myometrium from remainder of uterus (do not submit deep myometrium), dictated as to anterior and posterior.
• Left and right parametrial margins:  submit entirely, en face.
• Vaginal cuff margin:  submit entirely, en face divided into four cassettes by quadrants.
• Cervix:  two sections (one anterior and one posterior), with squamocolumnar junction and lesions included.

• Fallopian tubes and ovaries:  see Salpingectomy and Oophorectomy.

Received without fixative/in formalin, labeled _____ and “_____”, is an intact/previously opened uterus with attached fallopian tubes and ovaries. The uterus weighs __ gm after removal of the bilateral adnexae and is __ cm from cervix to fundus, __ cm from cornu to cornu, and __ cm in maximum anteroposterior diameter.  The serosa is smooth/has ragged adhesions over the anterior aspect.  The anterior surface is inked blue and the posterior black.  The uterus has a ___ (shape) __ x __ cm endometrial cavity ____ (covered by a ___ cm-thick endometrium/filled by shaggy, white-gray tumor). The tumor involves ____ (extent and location) and is __ x __ cm in greatest surface dimensions and __ cm above the endometrial surface.  It invades __ cm into the __ cm thick myometrium, at ____ (location).  The remaining anterior endometrium is ____ (appearance) and __ cm thick.  The remaining myometrium measures __ cm in greatest thickness and contains a single ___ cm diameter, rubbery, white nodule in (location).  The __ x __ cm ectocervical surface is ____ (appearance) with a __ cm slit-like os. [See Salpingectomy and Oophorectomy for dictation templates of fallopian tubes and ovaries.]  Margins are inked as follows:  anterior = black, posterior = blue.  Representative sections, including ______ (approximately __% of the tumor/entire endometrium), are submitted as follows:  

#__ & #__ = anterior cervix, 1 piece

#__ = posterior cervix, 1 piece

#__ = left parametrium, 2 pieces

#__ = right parametrium, 2 pieces

#__ = anterior upper endocervical canal /lower uterine segment, 1 piece

#__ = posterior upper endocervical canal/lower uterine segment, 1 piece

#__ & #__ = tumor invading myometrium, full-thickness  section, 1 piece in each*

#__ = tumor with anterior adjacent lower endometrium

#__ = tumor with posterior adjacent lower endometrium,

#__ & #__ = myometrial nodule,

#__ = right fallopian tube and ovary

#__ = left fallopian tube and ovary

__ blocks, __ H&E

* For hyperplasia without identifiable carcinoma, the endometrium should submitted as follows:

#__ = full-thickness anterior wall,

#__ = full-thickness posterior wall,

#__ - #__ = endometrium with superficial myometrium, upper anterior, __ pieces each

#__ - #__ = endometrium with superficial myometrium, upper posterior, __ pieces each

#__ - #__ = endometrium with superficial myometrium, lower anterior portion, 4 pieces each

#__ - #__ = endometrium with superficial myometrium, lower posterior portion, 4 pieces each

__ blocks, __ H&E