Ovary, fallopian tube and primary peritoneum
Data element
Macroscopic reporting dictation template
Response
If yes, describe any additional tests/ frozen sections/biobanking performed
No
Yes
Text
As stated by the clinician
Laterality
Left/right/bilateral/ unspecified
Ovary, right/left Fallopian tube, right/left
Omentum
Peritoneal biopsies
Lymph nodes
Uterus
Cervix
If uterus/cervix is present, see relevant dictation template
Specimen weight –of ovary/adnexal mass
__ g
Macroscopic tumour site(s) if applicable
L/R ovary
L/R fallopian tube, fimbrial/non-fimbrial
Peritoneal
Indeterminate
Other, specify _____
For each ovary and fallopian tube describe the following:
Fallopian tube, if applicable
Fimbriae
Not identified
Present
Serosal integrity
Intact
Disrupted
Tumour present
Specimen dimensions
If normal __x__mm
If abnormal __x__x__mm
Specimen description
No macroscopic abnormalities
Text
if applicable description of any abnormalities
Ovary, if applicable
Capsule
Intact
Ruptured
Fragmented/morcellated
Specimen dimensions
__x__x__mm
If applicable, record the following.
No macroscopic abnormalities
Tumour on surface
Absent
Present
Number __
Dimensions __x__mm
Tumour dimensions
__x__x__mm
Solid component
Not identified
Present
Tumour description
Text (texture, colour, consistency, necrosis)
Cystic component
Not identified
Present
Type of cyst
Unilocular
Multilocular
Cyst contents, describe
Blood-filled/stained
Clear/watery/serous
Mucoid/gelatinous
Hair/sebum/teeth (teratoma)
Internal surface abnormalities
Absent
Present, describe
Appearance e.g. papillary excrescences
Number __
Range of sizes __ to __mm
Tumour involvement of other organs
Text, describe e.g. involvement of fallopian tube(s), uterus etc.
Omentum dimensions, if applicable
__x__x__mm
Omental involvement
Not involved
Involved
Number __ and/or area inv.__%
Max. dimension of largest deposit __mm
Lymph nodes, if applicable
Not submitted
Submitted
Record number per cassette
Other relevant macroscopic information
Text
E.g. any additional orientation, distance to margins
Fresh tissue received
Operative procedure and laterality
Specimen type
Block identification key
Ovary, fallopian tube, peritoneum dictation template
Text
Describe nature and site of blocks
Date: 10 February 2016
Version: 1.2