GROSSING FORMAT -

OVARIAN CARCINOMA
-Nayonikha Deokar
ANATOMY OF OVARY
MANUAL OF SURGICAL PATHOLOGY-
Susan . C. Lester
 Ovaries are removed for evaluation of a mass, as part of a larger resection, or
prophylactically in a patient with a personal or family history of breast cancer
or a BRCA mutation.
Neoplasms generally have one of the three following appearances:
1. Simple cyst, thin-walled, without solid areas. Almost always benign.
Most are follicular cysts (cystic follicles), corpus luteum cysts, or cystadenomas
(epithelial-lined cysts). This is the most common type of cyst.
2. Complex cyst with or without a solid component. May be
nonneoplastic (e.g., an endometriotic or “chocolate” cyst), a benign neoplasm
(dermoid), a borderline tumor, or a malignant tumor.
3. Solid tumors. May be benign fibromas, Brenner tumors, granulosa cell
tumors, or malignant carcinomas. Most have cystic areas.
Ovary with Simple Cyst:

1. Record the overall dimensions of the ovary and describe the outer surface
including color (white), surface (smooth or convoluted, adhesions, papillary
projections), simple (thin-walled without a solid component) cysts.
Papillations or a “nubby” appearance on the surface of the ovary could
indicate either invasion of a tumor through the capsule or a serosal implant.
Avoid rubbing or abrading the outer surface in order to preserve the surface
epithelial lining.
2.Ink the outer surface including all areas of irregularity.
Ovarian cysts are opened with great care as the cyst fluid may be under
pressure. Wear goggles and appropriate clothing protection. Open in a pan or
on sufficient numbers of surgical drapes to absorb all the fluid. Very large cysts
may need to be opened in a sink. Make a small initial incision inferiorly (away
from the face of the prosector) to allow the fluid to drain slowly.
Try to identify remaining ovarian tissue. It can sometimes be seen as a
thickened portion of the wall readily visible on transillumination. Do not
abrade the lining by excessive handling.
Describe the cyst including size, inner surface (smooth or with
papillary areas or solid areas, velvety texture as in endometriotic cysts), wall
thickness, contents (blood, serous fluid, mucinous fluid, keratinaceous
and sebaceous material and hair as in mature teratoma), solid areas (color,
texture, extension to serosal surface). If the fallopian tube is included,
describe its relationship to the cyst. Describe the remaining ovary
including color, corpus luteum, corpora albicantia.
3. Large thin-walled cysts can be rolled into a “jelly roll” and fixed in formalin
overnight. Submit transverse sections of the roll.
Submit a section of the residual ovary.
If there is any suspicion of malignancy (e.g., mucinous cyst, complex cyst,
papillary projections, solid areas) additional sections must be taken to
document these areas and any extension into adjacent tissues.
At least one cassette per cm greatest dimension of cyst must be taken if the
cyst is mucinous (malignant features can be focal in this type of neoplasm).
Submit a section with fallopian tube, if present.
SAMPLE DICTATION
Received fresh, labelled with the patient’s name and unit number
and “left ovary,” is an intact 10 × 8 × 8 cm thin walled (0.3 cm)
white/tan unilocular cyst with smooth inner and outer surfaces. A 1 ×
1 × 0.8 cm area of white fibrotic tissue is present, possibly
representing residual ovarian tissue. No corpora albicantia are seen.
The cyst is filled with clear nonviscous fluid.
Cassette #1: Transverse sections of cyst wall, 2 frags, RSS.
Cassette #2: Possible residual ovarian tissue, 1 frag, RSS.
Ovary with Complex Cyst :

1.Record the overall dimensions of the ovary and describe the outer surface
including color (white), surface (smooth or convoluted, adhesions, papillary
projections), simple (thin-walled without a solid component) cysts. Carefully
examine the surface for invasion or adhesion to adjacent structures.
Avoid rubbing or abrading the outer surface in order to preserve the surface
epithelial lining.
2. Ink the outer surface in all irregular areas.
Open ALL cysts and examine carefully for papillary or solid
components.
3. Fix the specimen in formalin overnight.
One cassette per cm largest cyst diameter should be submitted if there is any
suspicion of malignancy.
Include solid or papillary areas within wall and areas of gross invasion.
Submit a section of the residual ovary.
At a minimum, submit the entire fimbriae and a representative cross section
of the tube, but consider submitting the ENTIRE fallopian tubes
according to the SEE FIM (“Section and Extensively Examine
the FIMbriated end of the fallopian tube”) protocol.
SAMPLE DICTATION

Received fresh, labelled with the patient’s name and unit number and “left
ovary,” is an intact 18 × 15 × 10 cm multilocular tan/white cyst. Most of the
cyst wall is thin (0.2 cm) but focal areas of thickening are present measuring
up to 0.8 cm. The outer surface is smooth. Within the inner surface of the
cysts there are multiple minute papillary areas (all less than 0.4 cm in height).
A representative frozen section was taken of one of these areas. A 1 × 0.8 cm
area of residual ovarian tissue is present with a single corpus albicans. The
cysts are filled with thick yellow viscous fluid.
Cassette #1: Frozen section remnant, papillary area, 1 frag, ESS.Cassettes #2-
19: Representative sections of cyst including papillary areas and areas of
thickened wall, 18 frags, RSS.Cassette #20: Residual ovarian tissue, 1 frag, RSS.
Ovary with Solid Tumor
1. Record the overall dimensions of the ovary and describe the outer surface
including:
• Colour: usually white• Surface: smooth or convoluted, adhesions, papillary
projections• Presence of simple cysts: thin-walled cysts without a solid
component
Carefully examine the surface for invasion or adhesion to adjacent structures.
Avoid rubbing or abrading the outer surface in order to preserve the surface
epithelial lining.
2.Ink the outer surface. Serially section through the tumor. Describe size, surface,
color, relationship to surface and adjacent ovary (i.e., margins), the presence of a
cystic component and texture upon cutting.

3. Fix the specimen in formalin overnight. One cassette per cm largest tumor diameter
should be submitted if there is any suspicion of malignancy.
Include atleast one section to demonstrate relationship of tumor to adjacent ovary and
peritoneal surface.
Include all areas of gross invasion.
Submit a section of the residual ovary.
At a minimum, submit the entire fimbriae and a representative cross section of the tube,
but consider submitting the ENTIRE fallopian tubes according to the SEE FIM (“Section
and Extensively Examine the FIMbriated end of the fallopian tube”).
SAMPLE DICTATION
Received fresh, labeled with the patient’s name and unit number and “left ovary,”
is a 12 × 10 × 7 cm lobulated mass attached to the fallopian tube (5 cm in length ×
0.8 cm in diameter with a fimbriated end). The mass has multiple small cysts of
variable size (0.3 to 2 cm) filled with hemorrhagic viscous fluid occupying
approximately half the area. The remaining portion of the mass is firm and solid
with a mottled appearance ranging from dark red/brown to yellow. The outer
surface is irregular with multiple shaggy adhesions. Definite residual ovarian
tissue is not identified. The mass does not grossly involve the fallopian tube.
During an intraoperative consultation a representative frozen section of a solid
area was taken as frozen section A.
Cassette #1: Frozen section remnant, solid area, 1 frag, ESS.Cassettes #2-7:
Representative sections of cystic areas of mass, 6 frags, RSS.Cassettes #8-10:
Representative sections of solid areas of mass, 3 frags, RSS.Cassettes #11-12:
Mass and relationship to surface, 2 frags, RSS.Cassette #13: Mass and fallopian
tube and additional section of fallopian tube, 2 frags, RSS. Cassette #14: Possible
residual ovarian tissue, 1 frag, RSS.
Omental Biopsies for Staging Ovarian
Malignancies
• Carcinomas: If there is a grossly evident metastatic focus, one
section is sufficient to document.
If the omentum is grossly negative, take 5 to 10 sections (or entire
specimen if possible) to evaluate for subgross metastases.
• Borderline tumors or immature teratomas: Multiple
sections of grossly evident metastases are taken to evaluate invasive
versus noninvasive implants (borderline tumors) and maturity of
implants (teratomas).
If the omentum is grossly negative, take 5 to 10 sections (or entire
specimen if possible) to evaluate for subgross metastases.
ATLAS OF SURGICAL GROSSING-
SPRINGER
For ovarian specimens with mass lesions, the outer surface of the ovary
should be inked before sectioning.
2. TATA GROSSING MANUAL
TYPES OF SPECIMEN
1. Total Oophorectomy.
2. Subtotal/Partial Oophorectomy.
3. Salpingo-Oophorectomy.
4. Hysterectomy with Salpingo-Oophorectomy.
5. Post- neoadjuvant chemotherapy (NACT) specimen.
Steps in Grossing :
1. Weigh and then measure the ovarian mass in three dimensions.
Identify the laterality and 'match' it with the requisition form.

2. Examine and note the external surface (smooth or nodular), border

(circumscribed or irregular) and the attached fallopian tube, including
its length. It is noteworthy that patients undergoing prophylactic
oophore­ctomy because of a family history of breast and / or ovarian
cancer might have a small focus of carcinoma on the ovarian surface.
Therefore' examination of external surface is vital.
3. Carefully examine the external capsular surface and document whether it is
intact; thickened or "breached".

4. Note, if any surface growth is identified.

5. It is optional to ink the capsular surface. For those who prefer this, it is meant
for easy identification of capsular blocks and capsular integrity.

6. After examination of external surface' including capsule, cut open the

specimen along its largest dimension. Document the cyst contents, if
identified. It is useful to photograph the specimen at this time and keep it for
records.
7. Identify the normal ovarian parenchyma, including cortex and medulla, if
present.

8. In case of cystic masses, measure thickness of the cyst wall during serial
cutting and note whether it is uni- or multicystic with septae.

9. Identify and document solid areas, including papillary excrescences, necrotic,

haemmorrhagic areas or calcification.
10. The sections to be submitted are:
A- Ideally submit a single section per 1 cm of the ovarian mass in the largest
dimension. This is subject to variation in cases of very large tumours or tumours
with homogenous appearance.
B- Sections from the normal ovary, if identified

C- Sample tumour adhesions, sites of rupture, and resection margins,i

D- Sections from the attached fallopian tube, including the fimbrial end as per
Sectioning and Extensively Examining the Fimbriated End (SEE-FIM) protocol.

E- Sections from hilum of the ovary or mesovarium, if identifiable

F- In case omentum is submitted, submit representative sections. In case lymph

nodes are submitted, process these entirely if these are grossly unremarkable
Noteworthy, in cases of post neoadjuvant chemotherapy (NACT) ovarian
specimens, when the size of the ovary is small, as well as in cases of a suspected
primary peritoneal serous carcinoma, submit the ovary in its entirety.

Additional sampling of a tumor that poses problems in differential diagnosis is

more informative than special studies. This is especially significant in
borderline ovarian serous papillary tumours with micropapillary pattern or
micro invasion, wherein extensive sampling is necessary to rule out a low-
grade serous carcinoma.
GROSS DESCRIPTION
Specimen type: ____________________________
The right ovary measures _ X _ X _ cm. The external surface is smooth / unremarkable /
The capsule is intact / breached ____________________
Stretched fallopian tube is seen / not seen.
On cut section, the ovarian mass is cystic (unilocular / multilocular / multicystic) / solid and
cytic-predominantly cystic / predominantly solid / solid. The tumour is _______
Areas of haemorrhage and necrosis are seen / not seen.
The right fallopian tube is __ cm in length and is ______________
The left ovary measures __ X ___ X ___ cm. The external surface is smooth /
unremarkable / ____________________________
The capsule is intact / breached ______________________
Stretched fallopian tube is seen / not seen.
On cut section, the ovarian mass is cystic (unilocular / multilocular / multicystic) / solid and
cytic - predominantly cystic / predominantly solid / solid. The tumour is _______
Areas of haemorrhage and necrosis are seen / not seen.
The left fallopian tube is ___ cm in length and is ______________
The uterus with cervix measures __ X __ X __ cm. On opening, ________
The endometrium is ___ cm in thickness and is _______________
The myometrium is ___ cm in thickness and is _______________
The cervix is _____________________________
The omentum measures __ X __ X _. __ cm and is unremarkable / shows multiple tumour deposits, the largest measuring __ cm.
Sections:
A- Tumor with solid and cystic areas.
B- Adjacent Normal ovary
C- Fallopian tube with Fimbrial end.
D- Mesoovarium ( if identified)
E- Other Adnexa
F- Omentum
G- Lymph nodes.