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    Gynaecological small biopsies

    Background

    A range of small biopsies from lesions of the cervix, vagina, vulva and peritoneum are received.1-4 Separate protocols are provided for endometrial curettings and biopsies, and products of conception.


    Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

    • No
      • Non-routine fixation (not formalin), describe.
    • Yes
      • Special studies required, describe.
      • Ensure samples are taken prior to fixation.

    Follow best practice procedures to minimise cross over contamination of small fragments to other specimens.5

    Orientate and identify the mucosal surface if possible. Some specimens will be received mounted on card or filter paper with mucosal surface uppermost.

    Handle fragments with care to preserve the delicate epithelial tissue.

    See general information for more detail on specimen handling procedures.

    Inspect the specimen and dictate a macroscopic description.

    See also the Structured Pathology Reporting Protocol for Cervical pre-neoplasia.


    External Inspection

    Describe the following features of the specimen:

    Procedure1

    Describe as stated by the clinician.

    • Cervical punch biopsy
    • Vaginal biopsy
    • Vulval biopsy
    • Perineal biopsy
    • Peritoneal biopsy
    • Other, specify

    Specimen measurement

    • Number of fragments
      • If <3 pieces, record the maximum dimension (mm) of the smallest and largest piece of tissue.
      • If >3 pieces, measure the aggregate size of the tissue.

    Larger pieces of tissue (>5mm in maximum dimension) including polyps may be measured in three dimensions. For cysts, record the maxium dimension and wall thickness.

    Specimen description

    Describe e.g.

    • Colour1
    • Mucoid
    • Granular
    • Friable
    • Polyp
      • If >5mm, three dimensions (mm)
    • Cyst
      • Maximum dimension (mm)
      • Thickness of wall
      • Contents

    Dissection

    Not required in most circumstances. Larger pieces of tissue, polyps and cysts may be bisected transversely, perpendicular to the mucosal surface.


    Internal Inspection

    Not required.


    Processing

    Submit all tissue directly into cassettes for processing. Biopsy pads, lens paper or similar are required to prevent loss of tissue during processing.1,3

    Be aware that blood clot and mucus may not survive processing.

    Record details of each cassette.

    An illustrated block key similar to the one below may be useful.

    Block allocation key

    Cassette id
    Site
    No. of pieces
    A
    Cervical biopsy
     
     

    Acknowledgements

    Drs Kerryn Ireland-Jenkin and Marsali Newman for their contribution in reviewing and editing this protocol.


    References

    1. Brown L, Andrew A, Hirschowitz L and Millan D. Tissue pathways for gynaecological pathology, The Royal College of Pathologists, London, 2008.
    2. Pradhan S and Tobon H. Vaginal cysts: a clinicopathological study of 41 cases. Int J Gynecol Pathol 1986;5(1):35-46.
    3. Lester SC. Small Biopsies. In: Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010;243-245.
    4. Nielsen GP and Young RH. Mesenchymal tumors and tumor-like lesions of the female genital tract: a selective review with emphasis on recently described entities. Int J Gynecol Pathol 2001;20(2):105-127.
    5. Lester SC. Extraneous Tissue. In: Manual of Surgical Pathology, Saunders Elsevier, Philadelphia, 2010;33-34.

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      Gyn small bx 1

      Gynaecological small biopsy

      Gyn small bx 2

      Gynaecological small biopsy, close up

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      25-Mar-2019
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