1 Purpose目的

Maintenance proper examination and accurate description of Endometrial Biopsy，Uterine Content and HYSTERECTOMY SPECIMEN specimens，accurate diagnosisendometrial carcinoma
    确保正确检查和准确描述宫内膜、宫内容物、子宫切除标本，正确诊断子宫内膜癌。

2 Scopes适用范围

Handling and processing endometrial biopsy ，uterine content，or hysterectomy specimen

宫内膜活检、宫内容物及子宫切除标本大体检查

3 Specimen required标本要求
Endometrial biopsy,uterine content or hysterectomy specimen in fixative, along with a filled-out Tissue Examination Form.
    宫内膜活检、宫内容物及子宫切除标本，填写好的申请单。
4 Reagents,Instrumentation试剂、设备
Plastic cassettes. Pencil. Clean dissection instruments.LIS computor system 
    塑料盒、铅笔、取材器具, LIS系统

5 Step-by-step description具体步骤

5.1 

endometrial biopsy or uterine content宫内膜活检、宫内容物

5.1 Measure (3 dimensions, in aggregate). Large specimens should be weighed. Describe the fragments (color,friability, shape – irregular vs. cylindrical cores vs.globular).Distinguish blood clot from endometrial tissue and state the proportion of clots relative to the entire specimen. If the specimen is tissue spontaneously passed, mention whether the tissue appears to be a decidual cast.

测量大小（三径）。标本量大时可称重。描述组织（颜色、脆性、形状-不规则、柱状、圆形）。区分血块和1内膜组织，评估血块与内膜组织的相对比例。如果组织是自发排出的，注明组织是否向蜕膜管型。

5.1.2 In cases of suspected abortion, search for chorionic villi. Examine for presence of gestational sac and embryonic tissue. Submit three representative sections of tissue with the appearance of placenta, fetal parts, gestational sac, and decidua unless the entire specimen is small enough to fit into three cassettes. Avoid submitting blood clot. 

怀疑流产的标本，应寻找绒毛、胎囊和胚胎组织。 取三块有代表性的组织（胎囊、胎盘、胚胎、蜕膜等）或将组织取光（组织较少时），避免取血块。

5.1.3 In cases of molar pregnancy, the villi may be cystically dilated. Submit ten blocks or the entire specimen (whichever is less).

葡萄胎患者，绒毛会囊性扩张。取10块或取尽所有的组织。

5.1.4 Dictation Template描写模板:

1）Endometrial Biopsy 子宫内膜活检

Received without fixative/in formalin, labeled _____ and ____ are five friable, red-brown, cylindrical soft tissue cores measuring __ x __ x __ cm in aggregate. Entirely submitted in cassette #__ .

福尔马林固定标本。红褐色柱状软组织5块，质脆，总体__ x __ x __ cm，取完。

__ blocks, __ H&E

2）Products of Conception 妊娠物

Received without fixative/in formalin in a suction container, labeled _____ and ____， are numerous irregular, red-brown to gray-tan, friable fragments of soft tissue and blood clot measuring in aggregate __ x __ x __ cm. Clots comprise approximately __% of the specimen. A few fragments of soft tissue appear globular. There is also a ruptured/unruptured translucent gray gestational sac measuring __ cm in diameter. Representatively submitted as follows:

#__ = embryo

#__ = gestational sac

#__ = soft tissue fragments

__blocks, __ H&E

福尔马林固定标本。标记有病人姓名、样本名称。无数块不规则、棕红色至灰褐色，质脆软组织和凝血块一堆，总体__ x __ x __ cm，凝血块约占样本的__%。其中几块呈球形。可见一破裂/未破裂的半透明胎囊，直径__cm。取3块。

#__ = 胚胎

#__ = 胎囊

#__ = 软组织

5.2 hysterectomy子宫切除

5.2.1 Orient the uterus. The round ligaments are most anterior, and the ovaries, if present, are most posterior. The shiny peritoneum extends further inferiorly along the posterior aspect of the uterus than along the anterior aspect of the uterus. This is because the anterior aspect of the uterus juxtaposes the posterior aspect of the urinary bladder.
确定子宫的方位：圆韧带总在最前，如果有卵巢，卵巢在最后。脏层腹膜在子宫背面的延伸比在子宫腹面的延伸更深。这是因为子宫前面与膀胱的背面是相邻的。

5.2.2 Measure the uterine corpus and the uterine cervix. 测量子宫及子宫颈。

5.2.3 Ink the paracervical stroma and parametrial soft tissue, that lies along the non-shiny, non-peritoneal anterior surface of the uterus.
将子宫表面未被腹膜覆盖的子宫及子宫颈旁组织进行标记。

5.2.4 Place a probe in the endocervical canal. Bivalve the uterus into an anterior half and a posterior half. Describe the endometrial lining, and any distortions or masses present.

放一个探针到宫颈管及宫腔，沿着探针将子宫分成前后两半，描述子宫内膜、任何异常情况及肿块。
5.2.5 Serially section the cervix, extending the excision up to the lower uterine segment, in longitudinal sections, 3 mm thick. Describe the size and depth of gross tumor, if seen.

将子宫颈做纵形连续切开，并延伸到子宫体下段，每个组织片约3毫米厚。如果看到肿瘤，要描述其大小及深度。
5.2.6 Serially breadloaf the uterine corpus with 5 mm slices.

每隔约5毫米将子宫体连续切成薄片。 
5.2.7. Describe the size, appearance, and location of tumor and any other gross abnormalities.

描述子宫的大小、外观和肿瘤的位置及任何其他的异常。
5.2.8 Submit sections of tumor to demonstrate maximum tumor thickness, anterior and posterior lower uterine segment, uninvolved endometrium, and representative sections of anterior and posterior cervix. If the hysterectomy is for cervical cancer, then submit the entire cervix in four quadrants, similar to a cone biopsy.

选取代表肿瘤最大面的切面，子宫下段前后壁各取一块，正常子宫内膜一块，宫颈的前后面各一块。如果是因宫颈癌的子宫切除，那么要在宫颈的四个象限各取一块，就像宫颈锥切活检取材一样。
5.2.9 If adnexa are present, then submit sections of ovary and Fallopian tube.

如果有附件，那么卵巢和输卵管也要切开检查并取材。

5.2.10 SAMPLE GROSS DESCRIPTION OF HYSTERECTOMY SPECIMEN. 标本的大体描述

1) PATIENT IDENTIFICATION AGREES WITH REQUISITION AND ONE CONTAINER.

患者的病理申请单和容器               

2) SPECIMEN #1 IS RECEIVED IN FORMALIN, LABELED WITH THE PATIENT'S NAME AND "UTERUS, CERVIX, RIGHT AND LEFT TUBES AND OVARIES (P)", AND CONSISTS OF A DISTORTED UTERUS WITH AMPUTATED CERVIX AND UNATTACHED LEFT AND RIGHT FALLOPIAN TUBES WITH EACH CORESPONDING OVARIES.  THE UTERUS LATERAL (CORNU) TO LATERAL (CORNU), ... CM ANTERIOR TO POSTERIOR AND ... CM FROM THE AMPUTATED CERVIX TO THE FUNDUS.  THE ECTOCERVIX IS NOT INCLUDED IN THE SPECIMEN. THE CERVICAL OS MEASURES ... CM IN DIAMETER. THE EXTERNAL SURFACE OF THE UTERUS IS MARKEDLY DISTORTED BY PROTRUDING MYOMETIAL NODULES AND SOME APPEAR LOCATED IN THE SUBSEROSA.  A PROBE IS PLACED THROUGH THE CERVICAL OS INTO THE ENDOMETRIAL CAVITY. THE UTERUS IS THEN BISECTED FROM INFERIOR TO SUPERIOR ALONG THE PROBE, REVEALING MULTIPLE SUENDOMETRIAL, INTRAMURAL, AND SUBSEROSAL NODULES, RANGING FROM ... CM IN DIAMETER TO ... CM.  THE NODULES ARE FIRM, WELL-CIRCUMSCRIBED AND THE CUT SURFACE IS TAN AND WHORLED.  AN AREA OF BROWN COLORATION IS NOTED IN ONE OF THE INTRAMURAL NODULES. THE ENDOMETRIAL CAVITY IS OBLITERATED BY INTRAMURAL NODULES AND IN PARTICULAR, BY A PROTRUDING, POLYPOID SUBENDOMETRIAL NODULE MEASURING ... CM. THIS NODULE IS COVERED BY SOFT, FRIABLE, POSSIBLY ENDOMETRIAL TISSUE. THE UNDISTORTED MYOMETRIUM AVERAGES ... CM IN THICKNESS AND THE ENDOMETRIUM MEASURES LESS THAN ... CM.  NO OTHER LESIONS ARE IDENTIFIED.  LEFT FALLOPIAN TUBE MEASURES ... CM IN LENGTH X ... CM IN DIAMETER.  LEFT OVARY MEASURES ... CM. RIGHT TUBE MEASURES ... CM IN LENGTH ... CM IN DIAMETER AND THE RIGHT OVARY IS... CM。THE LEFT AND THE RIGHT FALLOPIAN TUBES AND OVARIES ARE SECTIONED AND REVEALED NO GROSSLY DISCERNABLE ABNORMALITIES.

REPRESENTATIVE SECTIONS ARE SUBMITTED.

福尔马林固定子宫、宫颈及双侧输卵管和卵巢标本，子宫左右径（宫角-宫角）... CM，子宫前后径... CM，宫颈-宫底... CM，宫颈外口直径... CM，子宫因表面有肌瘤结节脱出而明显扭曲变形，部分肌瘤位于浆膜下。自宫颈口插入1探针至宫腔。自下而上沿探针将子宫切成2半，见粘膜下、肌壁间及浆膜下多个结节，直径…至…CM。结节质硬、界清，切面褐色，编织状。肌壁间一结节部分区域为棕色。宫腔被肌壁间结节特别是粘膜下息肉样突出的结节填塞，粘膜下结节... CM。该结节表面被覆质软组织，可能为内膜。未扭曲的肌壁平均厚... CM，内膜厚... CM。未见其它病理改变。左输卵管长... CM，直径... CM，左卵巢... CM。右输卵管长... CM，直径... CM，右卵巢... CM。切开左、右输卵管和卵巢，未见肉眼可见的病理改变。

3) SUMMARY OF SECTIONS取材部位及块数:

a. ENDOCERVIX, 6 AND 12 O'CLOCK, 2 PIECES. 颈管6点及12点各1块

b. SUBENDOMETRIAL POLYPOID NODULE WITH ENDOMETRIUM,1 PIECE.粘膜下结节带内膜,1块

c. MYOMETRIAL AND SUBSEROSAL NODULES, ONE PIECE EACH.肌壁间及浆膜下结节各1块

d. ENDOMETRIUM, RANDOM, 1 PIECE.  内膜1块  

e. LEFT TUBE AND OVARY, 2 PIECES.  左输卵管及卵巢，2块

f. RIGHT TUBE AND OVARY, 2 PIECES. 右输卵管及卵巢，2块

6 References参考文献

6.1  Zhejiang Protocols for management of medical institutions and clinics technical specifications Series  Pathological Diagnosis  and Technique Division,2003.浙江省医疗机构管理与诊疗技术规范丛书《病理诊断与技术规范》（2003）

6.2 EF3035-G Chinese Medieal Association Clinical Technical Operating specification - Pathologic fascicle，2004.中华医学会《临床技术操作规范 病理学分册》（2004）

6.3 EF3036-G WHO pathology and genetics Tumours of the Breast and Female Genital Organs,2006.WHO 《乳腺及女性生殖器官肿瘤病理学和遗传学》（2006）

6.4 EF3070-G Surgical Pathology,nine edition,2005.《外科病理学》第九版（2005）

6.5 EF3089-G Surgical Pathology Dissection An Illustrated Guide, Second Edition,2009.《外科病理学取材图解指南》（2009）

7 Records相关记录(无)

（仅供参考，不妥之处，敬请指正）