Ovary

Protocol applies to all malignant surface epithelial tumors, germ cell tumors, and sex cord-stromal tumors.

· Cytology

· Incisional Biopsy

· Unilateral Oophorectomy

· Salpingo-oophorectomy

· Subtotal Resection or Removal of Tumor in Fragments

· Hysterectomy with Salpingo-oophorectomy

· Second-look Staging

This protocol is intended to assist pathologists in providing clinically useful and relevant information as a result of the examination of surgical specimens. Use of this protocol is intended to be entirely voluntary. If equally valid protocols or similar documents are applicable, the pathologist is, of course, free to follow those authorities. Indeed, the ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of the individual circumstances presented by a specific patient or specimen.

It should be understood that adherence to this protocol will not guarantee a successful result. Nevertheless, pathologists are urged to familiarize themselves with the document. Where a physician chooses to deviate from the protocol based on the circumstances of a particular patient or specimen, the physician is advised to make a contemporaneous written notation of the reason for the procedure followed.

The College recognizes that this document may be used by hospitals, attorneys, managed care organizations, insurance carriers, and other payers. However, the document was developed solely as a tool to assist pathologists in the diagnostic process by providing information that reflects the state of relevant medical knowledge at the time the protocol was first published. It was not developed for credentialing, litigation, or reimbursement purposes. The College cautions that any uses of the protocol for these purposes involve considerations that are beyond the scope of this document.

I. Cytologic Material back Top Main Page

A. CLINICAL INFORMATION

1. Patient identification

a. Name

b. Identification number

c. Age (birth date)

2. Responsible physician(s)

3. Date of procedure

4. Other clinical information

a. Relevant history

(1) currently pregnant

(2) abnormal uterine bleeding pattern

(3) previous therapy (hormonal, radiation, chemotherapy)

(4) previous tumors or operations of possible relevance

(5) family history of ovarian or breast cancer

b. Relevant findings (e.g. radiologic studies, aspiration of cyst,laboratory data)

c. Clinical diagnosis

d. Procedure (e.g. brushing, washing, other)

e. Operative findings (e.g. rupture-preoperative, intraoperative, or postoperative)

f. Type(s) or site(s) of specimen(s):

(1) ascitic fluid

(2) peritoneal washings (specify site)

(3) brushings (specify site)

(4) cyst fluid (specify site)

(5) fine needle aspirate (specify site)

(6) cytology preparation of tissue (touch preparation) (specify site)

(7) pleural fluid

(8) other

B. MACROSCOPIC EXAMINATION

1. Specimen

a. Unfixed/fixed (specify fixative)

b. Number of slides received, if appropriate

c. Quantity and appearance of fluid specimen, if appropriate

d. Other (e.g. tissue received for cytologic preparation)

e. Results of intraprocedural consultation

2. Material submitted for microscopic evaluation (e.g. smear; cytocentrifuge, touch or filter preparation, cell block)

3. Special studies (specify) (e.g. immunocytochemistry)

C. MICROSCOPIC EVALUATION

1. Adequacy of specimen (if unsatisfactory for evaluation, specify reason)

2. Tumor, if present

a. Histologic type, if possible (Note A)

b. Other characteristics, as pertinent

3. Additional cytologic findings, if present

4. Results/status of special studies (specify)

5. Comments

a. Correlation with intraprocedural consultation, as appropriate

b. Correlation with other specimens, as appropriate

c. Correlation with clinical information, as appropriate

II. Incisional biopsy back Top Main Page

A. CLINICAL INFORMATION

1. Patient identification

a. Name

b. Identification number

c. Age (birth date)

2. Responsible physician(s)

3. Date of procedure

4. Other clinical information

a. Relevant history

(1) currently pregnant

(2) abnormal uterine bleeding pattern

(3) previous therapy (hormonal, radiation, chemotherapy)

(4) previous tumors or operations of possible relevance

(5) family history of ovarian or breast cancer

b. Relevant findings (e.g. radiologic studies, aspiration of cyst, laboratory data)

c. Clinical diagnosis

d. Procedure

e. Operative findings (e.g. rupture-preoperative, intraoperative, or postoperative)

f. Type(s) or site(s) of specimen(s)

B. MACROSCOPIC EXAMINATION

1. Specimen

a. Fixed/unfixed (specify fixative)

b. Number of pieces, size or size range

c. Descriptive features

d. Orientation if designated

e. Results of intraoperative consultation

2. Tissues submitted for microscopic evaluation

a. Submit entire specimen

b. Frozen section tissue fragment(s) (unless saved for special studies)

3. Special studies, specify (e.g. immunohistochemistry, flow cytometry)

C. MICROSCOPIC EVALUATION

1. Tumor, if present

a. Histologic type (Note A)

b. Histologic grade (Note B)

c. Invasion

d. Other features of possible prognostic or therapeutic significance

2. Additional pathologic findings, if present (specify) and relation to tumor, if pertinent

3. Results/status of special studies (Note C)

4. Comments

a. Correlation with intraoperative consultation, as appropriate

b. Correlation with other specimens, as appropriate

c. Correlation with clinical information, as appropriate

III. Unilateral oophorectomy or salpingo-oophorectomy back Top Main Page

A. CLINICAL INFORMATION

1. Patient identification

a. Name

b. Identification number

c. Age (birth date)

2. Responsible physician(s)

3. Date of procedure

4. Other clinical information

a. Relevant history

(1) currently pregnant

(2) abnormal uterine bleeding pattern

(3) previous therapy (hormonal, radiation, chemotherapy)

(4) previous tumors or operations of possible relevance

(5) family history of ovarian or breast cancer

b. Relevant findings (e.g. radiologic studies, laboratory data)

c. Clinical diagnosis

d. Procedure

e. Operative findings (e.g. rupture-postoperative/intraoperative)

f. Type(s) or site(s) of specimen(s)

g. Identification of areas for special study

(1) rupture site(s)

(2) adhesions suspicious for tumor

(3) resection margin(s), if pertinent

B. MACROSCOPIC EXAMINATION

1. Specimen

a. Organs/tissues received (specify)

b. Unfixed/fixed (specify fixative)

c. Number of pieces

d. Dimensions (measure attached tissues individually)

e. Orientation of specimen

f. Results of intraoperative consultation

2. Ovary or ovary-tube if fused into single mass [Note. If fused ovary and tube are identifiable separately on sectioning, describe tumor in each, including relation to one another.]

a. Size, weight, or volume, as appropriate

b. Outer surface (describe)

(1) adhesions, roughening, granularity (extent in two dimensions or proportion of total area involved)

(2) rupture (Note E)

c. Sectioned surface of specimen or opened cyst(s)

d. Tumor (Note D)

(1) location (Note F)

i. cortex

ii. medulla

iii. hilus

iv. combination

v. replaces specimen

(2) dimensions (and proportion of entire specimen, if appropriate)

(3) solid and cystic components

i. proportion of each

ii. number of cysts is easily countable

iii. size range of each component

iv. location(s) if pertinent

v. contents of cyst(s)

vi. lining of cyst(s)

vii. papillary or polypoid excrescences

viii. roughening, etc. (extent in two dimensions or proportion of total area involved)

e. Identification of areas for special study (e.g. rupture site(s), adhesions suspicious for tumor)

f. Resection margin(s), if pertinent

g. Additional pathologic findings, if present

3. Fallopian tube if not fused with ovary into single mass

a. Tumor, if present

(1) size

(2) location and relation to ovarian tumor

(3) descriptive features

b. Additional pathologic findings, if present

4. Tissues submitted for microscopic evaluation (Note G)

5. Special studies (specify) (e.g. immunohistochemistry, flow cytometry)

C. MICROSCOPIC EVALUATION

1. Ovary or ovary-tube if fused into single mass

a. Tumor

(1) site(s) of origin (Note H)

(2) location (Note F)

(3) surface (if possible distinguish origin on surface from invasion onto surface by subjacent tumor)

(4) extent of invasion in ovary

i. cortex

ii. medulla

iii. hilus

iv. combination

v. replaces specimen

(5) extent and distribution of invasion of tube, if involved

(6) low-power pattern (single mass, discrete nodules, etc) (Note I)

(7) histologic type (Note mixtures) (Note J)

(8) histologic grade (Note B)

(9) blood/lymphatic vessel invasion (Note K)

(10) other features of possible prognostic or therapeutic significance

b. Status of any specially designated resection margins

c. Additional pathologic findings, if present (specify) and relation to tumor, if pertinent (Note L)

2. Fallopian tube if not fused with ovary into single mass

a. Tumor

(1) site(s) of origin (Note H)

(2) location

(3) extent

(4) histologic type or grade if different from that of ovarian tumor

(5) blood/lymphatic vessel invasion (Note K)

(6) other features of possible prognostic or therapeutic significance

b. Status of any specially designated resection margins

c. Appearance of epithelium adjacent to tumor (Note H)

d. Additional pathologic findings, if present (specify) and relation to tumor, if pertinent

3. Results/status of special studies (Note C)

4. Comments

a. Correlation with intraoperative consultation, as appropriate

b. Correlation with other specimens, as appropriate

c. Correlation with clinical information, as appropriate

IV. Subtotal resection or removal of tumor in fragments back Top Main Page

A. CLINICAL INFORMATION

1. Patient identification

a. Name

b. Identification number

c. Age (birth date)

2. Responsible physician(s)

3. Date of procedure

4. Other clinical information

a. Relevant history

(1) currently pregnant

(2) abnormal uterine bleeding pattern

(3) previous therapy (hormonal, radiation, chemotherapy)

(4) previous tumors or operations of possible relevance

(5) family history of ovarian or breast cancer

b. Additional pathologic findings, if present

5. Tissues submitted for microscopic evaluation (Note G)

6. Special studies (specify) (e.g. immunohistochemistry, flow cytometry)

B. MACROSCOPIC EXAMINATION

1. Specimen

a. Organs/tissues received

b. Unfixed/fixed (specify fixative)

c. Number of pieces

d. Dimensions (measure organs, tissues individually)

e. Orientation of specimen

f. Results of intraoperative consultation

g. Outer surface (describe)

(1) adhesions, roughening, granularity (extent in two dimensions or proportion of total area involved)

(2) rupture (Note E)

h. Sectioned surface of specimen or opened cyst(s) [Note. If fused ovary and tube are identifiable separately on sectioning, describe tumor in each, including relation to one another.]

i. Tumor (Note D)

(1) location (Note F)

i. cortex

ii. medulla

iii. hilus

iv. combination

v. replaces specimen

j. Dimensions (and proportion of entire specimen, if appropriate) of solid and cystic components

(1) proportion of each

(2) number of cysts if easily countable

(3) size range of each component

(4) location(s) if pertinent

(5) contents of cyst(s)

(6) lining of cyst(s)

(7) papillary or polypoid excrescences

(8) roughening, etc. (extent in two dimensions or proportion of total area involved)

k. Outer surface (describe)

l. Identification of areas for special study

(1) rupture site(s)

(2) adhesions suspicious for tumor

(3) resection margin(s) if pertinent

2. Additional pathologic findings, if present

3. Tissues submitted for microscopic evaluation (Note G)

4. Special studies (specify) (e.g. immunohistochemistry, flow cytometry)

C. MICROSCOPIC EVALUATION

1. Tumor

a. Site(s) of origin (Note H)

b. Location (Note F)

c. Surface (if possible distinguish origin on surface from invasion onto surface by subjacent tumor)

d. Extent of invasion

(1) cortex

(2) medulla

(3) hilus

(4) combination

(5) replaces specimen

e. Extent and distribution in tube, if involved

f. Low-power pattern (single mass, discrete nodules, etc) (Note I)

g. Histologic type (Note mixtures) (Note J)

h. Histologic grade (Note B)

i. Blood/lymphatic vessel invasion (Note K)

j. Other features of possible prognostic or therapeutic significance

2. Status of any specially designated resection margins

3. Additional pathologic findings, if present and relation to tumor, if pertinent (Note L)

a. Endometriosis

b. Abnormalities of surface epithelium or surface epithelial inclusion glands or cysts

c. Others

4. Results/status of special studies (Note C)

5. Comments

a. Correlation with intraoperative consultation, as appropriate

b. Correlation with other specimens, as appropriate

c. Correlation with clinical, information, as appropriate

V. Hysterectomy with salpingo-oophorectomy and removal of attached and/or unattached organs or tissues

back Top Main Page

A. CLINICAL INFORMATION

1. Patient identification

a. Name

b. Identification number

c. Age (birth date)

2. Responsible physician(s)

3. Date of procedure

4. Other clinical information

a. Relevant history

(1) currently pregnant

(2) abnormal uterine bleeding pattern

(3) previous therapy (hormonal, radiation, chemotherapy)

(4) previous tumors or operations of possible relevance

(5) family history of ovarian or breast cancer

b. Relevant findings (e.g. radiologic studies, laboratory data)

c. Clinical diagnosis

d. Procedure

e. Operative findings (e.g. rupture-postoperative, intraoperative, or postoperative)

f. Type(s) or site(s) of specimen(s)

g. Identification of areas for special study

(1) rupture site(s)

(2) adhesions suspicious for tumor

(3) resection margins, if pertinent

B. MACROSCOPIC EXAMINATION

1. Specimen

a. Organs/tissues included

b. Unfixed/fixed (specify fixative)

c. Number of pieces

d. Dimensions (measure attached tissues individually)

e. Orientation of specimen

f. Results of intraoperative consultation

2. Ovary or ovary-tube if fused into single mass [Note. If fused ovary and tube are identifiable separately on sectioning, describe tumor in each, including relation to one another.]

a. Size, weight, or volume, as appropriate

b. Outer surface (describe)

(1) adhesions, roughening, granularity (extent in two dimensions or proportion of total area involved)

(2) rupture (Note E)

3. Sectioned surface of specimen or opened cyst(s)

a. Tumor (Note D)

(1) location (Note F)

i. cortex

ii. medulla

iii. hilus

iv. combination

v. replaces specimen

(2) dimensions (and proportion of entire specimen, if appropriate) of solid and cystic components

i. proportion of each

ii. number of cysts if easily countable

iii. size range of each component

iv. location(s) if pertinent

v. contents of cyst(s)

vi. lining of cyst(s)

vii. papillary or polypoid excrescences

viii. roughening, etc. (extent in two dimensions or proportion of total area involved)

b. Identification of areas for special study (e.g. rupture site(s), adhesions suspicious for tumor, resection margin(s), if pertinent)

c. Additional pathologic findings, if present

4. Fallopian tube if not fused with ovary into single mass

a. Tumor, if present

(1) size

(2) location and relation to ovarian tumor

(3) descriptive features

b. Additional pathologic findings, if present

5. Contralateral ovary (Note M)

a. Size, weight, or volume, if appropriate

b. Outer surface (describe)

c. Sectioned surface

d. Tumor, if present (handle as for predominant ovarian mass)

e. Other lesions (specify)

6. Uterus

a. Descriptive features of endometrium, myometrium, and serosa

b. Tumor, if present

(1) descriptive features

(2) location (depth of myometrial invasion if appropriate)

(3) relation to ovarian tumor (separate or adherent)

c. Other lesions, if present (specify)

7. Omentum (Note G)

8. Regional lymph nodes

a. Number and size range at each designated location

b. Tumor, if identifiable

c. Other lesions, if present (specify)

9. Other staging biopsy specimens (specify)

a. Tumor, if present

(1) descriptive features

(2) location

b. Other lesions, if present (specify)

10. Other organ(s) or tissue(s) removed

a. Type, dimensions, and other descriptive features

b. Tumor

(1) location and relation to ovarian tumor (separate or adherent)

(2) size and distribution within organ or tissue

c. Resection margins if applicable

d. Other lesions, if present (specify)

11. Tissues submitted for microscopic evaluation (Note G)

12. Special studies (specify) (e.g. immunohistochemistry, flow cytometry)

C. MICROSCOPIC EVALUATION

1. Ovary or ovary-tube if fused into single mass

a. Tumor

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