Surgical Pathology Cancer Case Summary (Checklist)

Specimen (select all that apply)

___Liver

___Gallbladder

___Other (specify):____________________

___Not specified

Procedure (select all that apply)

___Wedge resection

___Partial hepatectomy

^*___Major hepatectomy (3 segments or more)

^*___Minor hepatectomy (< 3 segments)

___Other (specify):____________________

___Not specified

Tumor Size

Greatest dimension: _____ cm

^*Additional dimensions: _____ x _____ cm

___Cannot be determined

Tumor Focality

___Solitary (specify location):____________________

___Multiple (specify location:____________________

Histologic Type

___Hepatocellular carcinoma

___Fibrolamellar hepatocellular carcinoma

___Undifferentiated carcinoma

___Other (specify):____________________

___Carcinoma, type cannot be determined

Histologic Grade

___Not applicable

___GX: Cannot be assessed

___GI: Well differentiated

___GII: Moderately differentiated

___GIII: Poorly differentiated

___GIV: Undifferentiated/anaplastic

___Other (specify):____________________

Tumor Extension (select all that apply)

___Tumor confined to liver

___Tumor involves a major branch of portal vein

___Tumor involves 1 or more hepatic vein(s)

___Tumor involves visceral peritoneum

___Tumor directly invades gallbladder

___Tumor directly invades other adjacent organs (specify):____________________

Margins (select all that apply)

Parenchymal margin

___Cannot be assessed

___Uninvolved by invasive carcinoma

Distance of invasive carcinoma from closest margin: _____ mm

Specify margin:______________

___Involved by invasive carcinoma

Other margin

Specify margin:____________________

___Cannot be assessed

___Uninvolved by invasive carcinoma

Distance of invasive carcinoma from closest margin: _____ mm

Specify margin:______________

___Involved by invasive carcinoma

Other margin

Specify margin:____________________

___Cannot be assessed

___Uninvolved by invasive carcinoma

___Involved by invasive carcinoma

Lymph-Vascular Invasion

Macroscopic venous (large vessel) invasion (V)

___Not identified

___Present

___Indeterminate

Microscopic (small vessel) invasion (L)

___Not identified

___ Present

___ Indeterminate

^*Perineural Invasion

^*___ Not identified

^*___ Present

^*___ Indeterminate

Pathologic Staging (pTNM)

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

___ m (multiple primary tumors)

___ r (recurrent)

___ y (post-treatment)

Primary tumor (pT)

___ pTX: Cannot be assessed

___ pT0: No evidence of primary tumor

___ pT1: Solitary tumor without vascular invasion

___ pT2: Solitary tumor with vascular invasion or multiple tumors, none > 5 cm

___ pT3a: Multiple tumors > 5 cm

___ pT3b: Single tumor or multiple tumors of any size involving a major branch of portal vein or hepatic veins

___ pT4: Tumor(s) with direct invasion of adjacent organs other than gallbladder or with perforation of visceral peritoneum

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)

^*Fibrosis score:

^*___ Cirrhosis/severe fibrosis (Ishak score 5-6) (F1)

^*___ None to moderate fibrosis (Ishak score 0-4) (F2)

^*___ Hepatocellular dysplasia

^*___ Low-grade dysplastic nodule

^*___ High-grade dysplastic nodule

^*___ Steatosis

^*___ Iron overload

^*___ Chronic hepatitis (specify etiology): ______________________________

^*___ Other (specify): ______________________________

^*___ None identified

^*Ancillary Studies

^*Specify: ______________________________

^*Clinical History (select all that apply)

^*___ Cirrhosis

^*___ Hepatitis C infection

^*___ Hepatitis B infection

^*___ Alcoholic liver disease

^*___ Obesity

^*___ Hereditary hemochromatosis

^*___ Other (specify): ______________________________

^*___ Not known

^* Data elements with asterisks are not required. However, these elements may be clinically important but they 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 Hepatocellular Carcinoma.” Web posting date October 2009, www.cap.org.