Surgical Pathology Cancer Case Summary (Checklist)

Specimen

____ Head of pancreas

____ Body of pancreas

____ Tail of pancreas

____ Stomach

____ Common bile duct

____ Gallbladder

____ Spleen

____ Adjacent large vessels

____ Portal vein

____ Superior mesenteric vein

____ Other larger vessel (specify): ______________________________

____ Other (specify): ______________________________

____ Not specified

____ Cannot be determined

Procedure

____ Excisional biopsy (enucleation)

____ Pancreaticoduodenectomy (Whipple resection), partial pancreatectomy

____ Pancreaticoduodenectomy (Whipple resection), total pancreatectomy

____ Partial pancreatectomy, pancreatic tail

____ Other (specify): ______________________________

____ Not specified

Tumor Site (select all that apply)

____ Pancreatic head

____ Uncinate process

____ Pancreatic tail

____ Other (specify): ______________________________

____ Cannot be determined

____ Not specified

Tumor Size

Greatest dimension: __________ cm (specify size of largest tumor if multiple tumors are present)

^*Additional dimensions: _________ × __________ cm

____ Cannot be determined

Tumor Focality

____ Unifocal

____ Multifocal (specify number of tumors): ______________________________

____ Cannot be determined

____ Not specified

Histologic Type

____ Well-differentiated endocrine neoplasm

____ Poorly differentiated endocrine carcinoma

^*____ Small cell carcinoma

^*____ Large cell endocrine carcinoma

____ Other (specify): ______________________________

____ Carcinoma, type cannot be determined

^*World Health Organization Classification

^*____ Well-differentiated endocrine tumor, benign behavior

^*____ Well-differentiated endocrine tumor, uncertain behavior

^*____ Poorly differentiated endocrine carcinoma

^*Functional Type (select all that apply)

^*____ Cannot be assessed

^*____ Pancreatic endocrine tumor, functional

(Correlation with clinical syndrome and elevated serum levels of hormone product)

^*____ Insulin-producing (insulinoma)

^*____ Glucagon-producing (glucagonoma)

^*____ Somatostatin-producing (somatostatinoma)

^*____ Gastrin-producing (gastrinoma)

^*____ Vasoactive intestinal polypeptide (VIP)-producing (VIP-oma)

^*____ Other (specify): ______________________________

^*____ Pancreatic endocrine tumor, nonfunctional

^*____ Pancreatic endocrine tumor, functional status unknown

Mitotic Activity (select all that apply)

____ Not applicable

___ < 2 mitoses/10 high-power fields (HPF)

Specify mitoses per 10 HPF: __________

____ 2-10 mitoses/10 HPF

Specify mitoses per 10 HPF: _________

____ > 10 mitoses per 10 HPF

____ Cannot be determined

^*Ki-67 labeling index

^*____ ≤ 2% Ki-67-positive cells

^*____ 3-20% Ki-67-positive cells

^*____ > 20% Ki-67-positive cells

^*Tumor Necrosis

^*____ Not identified

^*____ Present

^*____ Not applicable

^*____ Cannot be determined

Microscopic Tumor Extension (select all that apply)

____ Cannot be determined

____ No evidence of primary tumor

____ Tumor is confined to pancreas

____ Tumor invades ampulla of Vater

____ Tumor invades common bile duct

____ Tumor invades duodenal wall

____ Tumor invades peripancreatic soft tissues

____ Tumor invades other adjacent organs or structures (specify): ______________________________

Margins (select all that apply)

____ Cannot be assessed

____ Margins uninvolved by tumor

Distance of tumor from closest margin: __________ mm

^*Specify margin (if possible): ______________________________

____ Margin(s) involved by tumor

____ Uncinate process (retroperitoneal) margin (nonperitonealized surface of the uncinate process)

____ Distal pancreatic margin

____ Common bile duct margin

____ Proximal pancreatic margin

____ Other (specify): ______________________________

^*____ Tumor involves posterior retroperitoneal surface of pancreas

Lymph-Vascular Invasion

____ Not identified

____ Present

____ Indeterminate

Pathologic Staging (pTNM)

TNM descriptors (required only if applicable) (Select all that apply)

____ m (multiple descriptors)

____ r (recurrent)

____ y (post-treatment)

Primary tumor (pT)

____ pTX: Cannot be assessed

____ pT0: No evidence of primary tumor

____ pT1: Tumor limited to pancreas, ≤ 2 cm in greatest dimension

____ pT2: Tumor limited to pancreas, > 2 cm in greatest dimension

____ pT3: Tumor extends beyond pancreas but without involvement of celiac axis or superior mesenteric artery

____ pT4: Tumor involves celiac axis or superior mesenteric artery

Regional lymph nodes (pN)

____ pNX: Cannot be assessed

____ pN0: No regional lymph node metastasis

____ pN1: Regional lymph node metastasis

Specify: Number examined: __________

Number involved: __________

Distant metastasis (pM)

____ Not applicable

____ pM1: Distant metastasis

^*Specify site(s), if known: ______________________________

^*Additional Pathologic Findings (select all that apply)

^*____ None identified

^*____ Chronic pancreatitis

^*____ Acute pancreatitis

^*____ Adenomatosis (multiple endocrine tumors, each < 5 mm in greatest dimension)

^*____ Other (specify): ______________________________

^*Clinical History (select all that apply)

^*____ von Hippel-Lindau disease

^*____ Multiple endocrine neoplasia type 1

^*____ Familial pancreatic cancer syndrome

^*____ Hypoglycemic syndrome

^*____ Necrolytic migratory erythema

^*____ Watery diarrhea

^*____ Hypergastrinemia

^*____ Zollinger-Ellison syndrome

^*____ Other (specify): ______________________________

^*____ Not specified

^* Data elements with asterisks are not required. However, these elements may be clinically important but are not yet validated or regularly used in patient management. Adapted with permission from College of American Pathologists, “Protocol for the Examination of Specimens from Patients with Carcinoma of the Endocrine Pancreas.” Web posting date October 2009, www.cap.org.