Surgical Pathology Cancer Case Summary (Checklist) |
Specimen (select all that apply) |
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___Liver |
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___Gallbladder |
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___Other (specify):____________________ |
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___Not specified |
Procedure (select all that apply) |
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___Wedge resection |
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___Partial hepatectomy |
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*___Major hepatectomy (3 segments or more) |
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*___Minor hepatectomy (< 3 segments) |
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___Other (specify):____________________ |
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___Not specified |
Tumor Size |
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Greatest dimension: _____ cm |
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*Additional dimensions: _____ x _____ cm |
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___Cannot be determined |
Tumor Focality |
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___Solitary (specify location):____________________ |
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___Multiple (specify location:____________________ |
Histologic Type |
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___Hepatocellular carcinoma |
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___Fibrolamellar hepatocellular carcinoma |
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___Undifferentiated carcinoma |
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___Other (specify):____________________ |
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___Carcinoma, type cannot be determined |
Histologic Grade |
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___Not applicable |
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___GX: Cannot be assessed |
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___GI: Well differentiated |
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___GII: Moderately differentiated |
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___GIII: Poorly differentiated |
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___GIV: Undifferentiated/anaplastic |
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___Other (specify):____________________ |
Tumor Extension (select all that apply) |
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___Tumor confined to liver |
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___Tumor involves a major branch of portal vein |
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___Tumor involves 1 or more hepatic vein(s) |
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___Tumor involves visceral peritoneum |
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___Tumor directly invades gallbladder |
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___Tumor directly invades other adjacent organs (specify):____________________ |
Margins (select all that apply) |
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Parenchymal margin |
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___Cannot be assessed |
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___Uninvolved by invasive carcinoma |
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Distance of invasive carcinoma from closest margin: _____ mm |
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Specify margin:______________ |
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___Involved by invasive carcinoma |
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Other margin |
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Specify margin:____________________ |
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___Cannot be assessed |
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___Uninvolved by invasive carcinoma |
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Distance of invasive carcinoma from closest margin: _____ mm |
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Specify margin:______________ |
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___Involved by invasive carcinoma |
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Other margin |
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Specify margin:____________________ |
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___Cannot be assessed |
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___Uninvolved by invasive carcinoma |
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___Involved by invasive carcinoma |
Lymph-Vascular Invasion |
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Macroscopic venous (large vessel) invasion (V) |
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___Not identified |
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___Present |
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___Indeterminate |
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Microscopic (small vessel) invasion (L) |
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___Not identified |
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___ Present |
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___ Indeterminate |
*Perineural Invasion |
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*___ Not identified |
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*___ Present |
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*___ Indeterminate |
Pathologic Staging (pTNM) |
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TNM descriptors (required only if applicable) (select all that apply) |
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___ m (multiple primary tumors) |
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___ r (recurrent) |
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___ y (post-treatment) |
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Primary tumor (pT) |
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___ pTX: Cannot be assessed |
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___ pT0: No evidence of primary tumor |
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___ pT1: Solitary tumor without vascular invasion |
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___ pT2: Solitary tumor with vascular invasion or multiple tumors, none > 5 cm |
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___ pT3a: Multiple tumors > 5 cm |
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___ pT3b: Single tumor or multiple tumors of any size involving a major branch of portal vein or hepatic veins |
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___ pT4: Tumor(s) with direct invasion of adjacent organs other than gallbladder or with perforation of visceral peritoneum |
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Regional lymph nodes (pN) |
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___ pNX: Cannot be assessed |
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___ pN0: No regional lymph node metastasis |
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___ pN1: Regional lymph node metastasis |
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Specify: Number examined: __________ |
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Number involved: __________ |
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Distant metastasis (pM) |
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___ Not applicable |
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___ pM1: Distant metastasis |
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*Specify site(s), if known: ______________________________ |
*Additional Pathologic Findings (select all that apply) |
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*Fibrosis score: |
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*___ Cirrhosis/severe fibrosis (Ishak score 5-6) (F1) |
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*___ None to moderate fibrosis (Ishak score 0-4) (F2) |
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*___ Hepatocellular dysplasia |
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*___ Low-grade dysplastic nodule |
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*___ High-grade dysplastic nodule |
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*___ Steatosis |
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*___ Iron overload |
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*___ Chronic hepatitis (specify etiology): ______________________________ |
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*___ Other (specify): ______________________________ |
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*___ None identified |
*Ancillary Studies |
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*Specify: ______________________________ |
*Clinical History (select all that apply) |
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*___ Cirrhosis |
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*___ Hepatitis C infection |
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*___ Hepatitis B infection |
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*___ Alcoholic liver disease |
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*___ Obesity |
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*___ Hereditary hemochromatosis |
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*___ Other (specify): ______________________________ |
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*___ 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. |
