ILEUM AND CECUM

The patient presented with epigastric pain and vomiting. Clinical impression is Complete Bowel
Obstruction secondary to Ileocecal Mass, to consider Malignancy.

Received in formalin is a previously incised specimen labeled “ileum and cecum”. The ileum measures 10
cm in length, 3.0 cm in diameter and 0.2 to 0.3 cm in wall thickness. There is a constricted segment
located 9.0 cm from the proximal margin measuring 1.5 cm in length with walls measuring 0.5 cm in
thickness and an adjacent area of mucosal erosions. The rest of the ileal mucosa is dark-red with intact
mucosal folds. The cecum measures 17 cm in length, 2.0 cm in diameter and 0.2 to 0.4 cm in wall
thickness. There is a constricted segment located 11 cm from the distal margin measuring 1.5 cm in
length with firm walls and densely adherent pericolic fat. The mucosa is tan-brown with minimal areas
of flattening. On cut sections, the walls are cream-white with fibrosis extending to the pericolic fat. No
hemorrhage or necrosis identified. An area of erythematous mucosa is seen 5.0 cm from the distal
margin with intact mucosal folds. No definite tumor identified. Several lymph nodes are isolated
measuring from 0.2 x 0.2 x 0.2 cm to 2.0 x 0.6 x 0.5 cm. The appendix is not grossly identified.

Sections are taken and labeled as follows:

A1-A3. Cecal constriction. Block 4 (3).
A4. Erythematous ileal mucosa. Block 3 (1).
A5. Ileal mucosal erosions. Block 3 (1).
A6. Ileal constricted segment. Block 1 (1).
A7. Distal margin. Block 1 (1).
A8. Proximal margin. Block 1 (1).
A9-A12. Lymph nodes. Block several (4).

Ileum and cecum, exploratory laparotomy, ileocecal resection:

GALLBLADDER
Clinical impression is Chronic Calculous Cholecystitis.

Received in formalin is a previously incised specimen labeled “gallbladder” measuring 6.5 cm in length,
1.0 cm in diameter and 0.3 cm in wall thickness with a cream-white and dull serosa. The mucosa is green
and velvety with two (2) yellow, friable stones both measuring 0.5 cm in diameter. Block 3 (1).

Gallbladder, laparoscopic cholecystectomy:

A) UTERUS, CERVIX, LEFT FALLOPIAN TUBE, LEFT OVARY; B) RIGHT FALLOPIAN TUBE
Clinical impression is Endometriotic Cyst, left; Adenomyosis.

Received in formalin are two (2) specimens:

A. Labeled “uterus, cervix, left fallopian tube, ovary” weighing 311 grams. The uterus and cervix are
anteriorly incised. The cervix measures 4.0 cm in length, 2.0 cm in diameter and 1.0 cm in wall thickness
with a 1.0 cm cream-white cyst posteriorly. The uterus measures 9.0 x 7.0 x 6.5 cm with a fairly-defined
round mass measuring 7.0 x 6.5 x 6.0 cm involved the serosa and bulging into the lumen. The overlying
endometrium is soft measuring 0.1 to 0.2 cm in thickness with areas of erythema. Cut sections show
several blood-filled cystic spaces measuring 0.2 to 0.5 cm in diameter. A submucous myoma is present
measuring 0.9 cm in diameter. The left fallopian tube measures 5.0 cm in length. 0.5 cm in diameter and
0.1 cm in wall thickness with no gross lesions. The left ovary is converted to a cystic mass measuring 6.0
cm in diameter with walls measuring from 0.2 to 0.8 cm in thickness. The outer surface is cream-tan to
red and smooth. The inner surface is tan-brown to dark-yellow and smooth. Sections are taken and
labeled as follows:
A1. Uterine mass. Block 2 (1).
A2. Endometrium with mass and myoma. Block 2 (1).
A3-A4. Left ovary. Block 7 (2).
A5. Left fallopian tube. Block 3 (1).
A6. Anterior cervix. Block 1 (1).
A7. Posterior cervix. Block 1 (1).

B. Labeled “right fallopian tube” measuring 4.8 cm in length, 0.9 cm in diameter and 0.1 to 0.2 cm in wall
thickness. There is a 0.4 cm paratubal cyst. Block 3 (1).

A. Uterus, cervix, left fallopian tube, ovary”, total abdominal hysterectomy with bilateral salpingectomy
and left oophorectomy:

B. Right fallopian tube, total abdominal hysterectomy with bilateral salpingectomy:

A) UTERUS; B) RIGHT FALLOPIAN TUBE; C) LEFT FALLOPIAN TUBE

Clinical impression is Abnormal Uterine Bleeding secondary to Submucous Myoma.

Received in formalin are three (3) specimens:

A. Labeled “uterus” which is anteriorly incised and weighs 96.6 grams. The cervix measures 3.0 cm in
length, 2.5 cm in diameter and 1.0 to 1.5 cm in wall thickness. The mucosa is cream-white to red and
smooth with no lesions. The corpus measures 5.5 x 4.5 x 3.0 with several myomas measuring from 1.8 x
1.0 x 0.9 cm to 2.5 x 2.0 x 1.0 cm located at the serosal, intramural and submucosal levels. The
endometrium is tan-brown to red and soft measuring 0.1 cm in thickness. Sections are taken and labeled
as follows:
A1-A2. Myoma. Block 6 (2).
A3. Endometrium/myometrium. Block 1 (1).
A4. Anterior and posterior cervix. Block 2 (1).

B. Labeled “right fallopian tube” measuring 4.0 cm in length, 0.5 cm in diameter and 0.1 cm in wall
thickness with a tan-red and smooth serosa. No lesions identified. Block 3 (1).

C. Labeled “left fallopian tube” measuring 6.0 cm in length, 0.5 cm in diameter and 0.1 cm in wall
thickness with a tan-red and smooth serosa. No lesions identified. Block 3 (1).

A/B/C. Uterus, right and left fallopian tubes, total abdominal hysterectomy with bilateral salpingectomy:

PLACENTA
Clinical impression is G3P2(2002) Pregnancy Uterine 28 4/7 AOG Breech in Threatened Preterm Labor
PPROM x 9 hours. Intraoperative findings show difficulty in extracting the placenta.
Received in formalin is a specimen consisting of a 220-gram singleton placenta with a marginally
inserted extraplacental membrane. The placental disc is fragments measuring 11 cm in widest diameter.
The fetal surface is tan-brown, smooth and glistening with prominent blood vessels near the umbilical
cord insertion. Cut sections show tan-brown to red-brown, meaty parenchyma with no pale areas noted.
The cream-white, three-vessel umbilical cord measures 13 cm in length and 1.0 cm in diameter with the
usual coiling. The thin, glistening translucent extraplacental membrane can be easily stripped off.
Representative sections are taken and labeled as follows:
 
A1. Placental disc. Block four (1).
A2. Umbilical cord and extraplacental membrane. Block four (1).

Placenta, low-transverse cesarean section:

A) ILEAL MUCOSA; B) SIGMOID COLON POLYP

Clinical impression is Colonic Polyps.

Received in formalin are two (2) specimens:

A. Labeled “ileal mucosa” which consists of one (1) cream-tan, soft and irregular tissue fragment
measuring 0.2 x 0.2 x 0.1 cm. Block all (1).

B. Labeled “sigmoid colon polyps” which consists of three (3) cream-tan, firm and irregular tissue
fragments measuring from 0.2 x 0.2 x 0.2 cm to 0.3 x 0.2 x 0.1 cm. Block all (1).

A. Ileal mucosa, colonoscopy with biopsy:

B. Sigmoid colon polyps, colonoscopy with biopsy:

GASTRIC ULCER EDGE

Clinical impression is Gastric Ulcer.

Received in formalin is a specimen labeled “gastric ulcer edge” which consists of one (1) cream-tan, firm
and irregular tissue fragment measuring 0.2 x 0.1 x 0.1 cm. Block all (1).

Gastric ulcer edge, gastroscopy with biopsy: