Biopsy/Resection

^*History of Previous Tumor/Familial Syndrome

^*____ None known

^*____ Known (specify, if known: ______________________________)

^*____ Not specified

Specimen Type/Procedure

____ Open biopsy

____ Resection

____ Stereotactic biopsy

____ Other (specify): ______________________________

____ Not specified

Specimen Handling (check all that apply)

____ Squash/smear/touch preparation

____ Frozen section

____ Tissue for electron microscopy

____ Frozen tissue

____ Unfrozen for routine permanent paraffin sections

____ Other (specify): ______________________________

____ Not specified

^*Specimen Size

^*____ Greatest dimension: __________ cm

^*____ Additional dimensions: __________ x __________ cm (for fragmented tissue, aggregate size may be given)

^*____ Cannot be determined

Laterality

____ Right

____ Left

____ Bilateral

____ Not specified

____ Not applicable

Tumor Site (check all that apply)

____ Skull

^*Specify further (e.g., frontal, parietal, temporal, occipital), if known: ______________________________

____ Dura

^*Specify further (e.g., cerebral [convexity/lobe, falx, tentorium, sphenoid wing, skull base, other], spinal, or other), if known: ______________________________

____ Leptomeninges

^*Specify further (e.g., cerebral [convexity/lobe], spinal, or other), if known: ______________________________

____ Brain/cerebrum

^*Specify lobe(s) (e.g., frontal, temporal, parietal, occipital), if known: ______________________________

____ Brain, other

____ Basal ganglia

____ Thalamus

____ Hypothalamus

____ Pineal

____ Cerebellum

____ Cerebellopontine angle

____ Suprasellar

____ Sella

____ Other (specify, if known: ______________________________)

____ Cranial nerve

^*Specify I-XII, if known: __________

____ Ventricle

^*Specify lateral, 3rd, 4th, cerebral aqueduct, if known: ______________________________

____ Brainstem

^*Specify midbrain, pons, or medulla, if known: ______________________________

____ Spine (vertebral column)

^*Specify bony level (e.g., C5, T2, L3), if known: ______________________________

____ Spinal cord

^*Specify bony level (e.g., C5, T2, L3), if known: ______________________________

^*Specify spinal location (e.g., extradural, intradural-extramedullary, intramedullary, conus medullaris filum terminale), if known: ______________________________

____ Spinal nerve root(s)

^*Specify bony level (e.g., C5, T2, L3), if known: ______________________________

^*Specify location (e.g., intradural, foramen), if known: ______________________________

____ Cranial or peripheral nerve

^*Specify site, if known: ______________________________

____ Ganglion

^*Specify site, if known: ______________________________

____ Other (specify): ______________________________

____ Not specified

Histologic Type and Grade (Applicable World Health Organization [WHO] Classification and Grade) (check all that apply)

Astrocytic tumors

____ Pilocytic astrocytoma (WHO grade I)

____ Pilomyxoid astrocytoma (WHO grade II)

____ Subependymal giant cell astrocytoma (WHO grade II)

____ Pleomorphic xanthoastrocytoma (WHO grade II)

____ Pleomorphic xanthoastrocytoma with anaplastic features (WHO grade not assigned)

____ Diffuse astrocytoma (WHO grade II)

____ Fibrillary astrocytoma (WHO grade II)

____ Protoplasmic astrocytoma (WHO grade II)

____ Gemistocytic astrocytoma (WHO grade II)

____ Anaplastic astrocytoma (WHO grade III)

____ Glioblastoma (WHO grade IV)

____ Giant cell glioblastoma (WHO grade IV)

____ Gliosarcoma (WHO grade IV)

____ Gliomatosis cerebri (usually WHO grade III; diagnosis requires clinical-pathological correlation)

____ Astrocytoma, not otherwise characterized (WHO grades I-IV)

Oligodendroglial tumors

____ Oligodendroglioma (WHO grade II)

____ Anaplastic oligodendroglioma (WHO grade III)

Oligoastrocytic tumors (mixed glioma)

____ Oligoastrocytoma (WHO grade II)

____ Anaplastic oligoastrocytoma (WHO grade III)

Ependymal tumors

____ Subependymoma (WHO grade I)

____ Myxopapillary ependymoma (WHO grade I)

____ Ependymoma (WHO grade II)

____ Cellular ependymoma (WHO grade II)

____ Papillary ependymoma (WHO grade II)

____ Clear cell ependymoma (WHO grade II)

____ Tanycytic ependymoma (WHO grade II)

____ Anaplastic ependymoma (WHO grade III)

Choroid plexus tumors

____ Choroid plexus papilloma (WHO grade I)

____ Atypical choroid plexus papilloma (WHO grade II)

____ Choroid plexus carcinoma (WHO grade III)

Other neuroepithelial tumors

____ Astroblastoma (WHO grade not assigned)

____ Chordoid glioma of 3rd ventricle (WHO grade II)

____ Angiocentric glioma (WHO grade I)

Neuronal and mixed neuronal-glial tumors

____ Dysplastic gangliocytoma of cerebellum (Lhermitte-Duclos) (WHO grade I)

____ Desmoplastic infantile astrocytoma/ganglioglioma (WHO grade I)

____ Dysembryoplastic neuroepithelial tumor (WHO grade I)

____ Gangliocytoma (WHO grade I)

____ Ganglioglioma (WHO grade I)

____ Anaplastic ganglioglioma (WHO grade III)

____ Central neurocytoma (WHO grade II)

____ Extraventricular neurocytoma (WHO grade II)

____ Cerebellar liponeurocytoma (WHO grade II)

____ Papillary glioneuronal tumor (PGNT) (WHO grade I)

____ Rosette-forming glioneuronal tumor of 4th ventricle (RGNT) (WHO grade I)

____ Paraganglioma of spinal cord (WHO grade I)

Tumors of pineal region

Pineal parenchymal tumors

____ Pineocytoma (WHO grade I)

____ Pineal parenchymal tumor of intermediate differentiation (WHO II-III)

____ Pineoblastoma (WHO grade IV)

____ Papillary tumor of pineal region (WHO grade II-III)

Embryonal tumors

____ Medulloblastoma, not otherwise characterized (WHO grade IV)

____ Desmoplastic/nodular medulloblastoma (WHO grade IV)

____ Medulloblastoma with extensive nodularity (WHO grade IV)

____ Anaplastic medulloblastoma (WHO grade IV)

____ Large cell medulloblastoma (WHO grade IV)

____ Central nervous system (CNS) primitive neuroectodermal tumor (PNET) (WHO grade IV)

____ Medulloepithelioma (WHO grade IV)

____ Neuroblastoma (WHO grade IV)

____ Ganglioneuroblastoma (WHO grade IV)

____ Ependymoblastoma (WHO grade IV)

____ Atypical teratoid/rhabdoid tumor (WHO grade IV)

Tumors of cranial and paraspinal nerves

____ Schwannoma (WHO grade I)

____ Cellular (WHO grade I

____ Plexiform (WHO grade I)

____ Melanotic (WHO grade I)

____ Neurofibroma (WHO grade I)

____ Plexiform (WHO grade I)

____ Perineurioma (WHO grade I)

____ Intraneural perineurioma (WHO grade I)

____ Soft tissue perineurioma (WHO grade I)

____ Ganglioneuroma (WHO grade I)

____ Malignant peripheral nerve sheath tumor (MPNST) (WHO grade II-IV)

____ Epithelioid (WHO grade II-IV)

____ MPNST with divergent mesenchymal &/or epithelial differentiation (WHO grade II-IV)

Tumors of meninges/meningothelial cells

____ Meningioma (WHO grade I)

____ Meningothelial (WHO grade I)

____ Fibrous (fibroblastic) (WHO grade I)

____ Transitional (mixed) (WHO grade I)

____ Psammomatous (WHO grade I)

____ Angiomatous (WHO grade I)

____ Microcystic (WHO grade I)

____ Secretory (WHO grade I)

____ Lymphoplasmacyte-rich (lymphoplasmacytic) (WHO grade I)

____ Metaplastic (WHO grade I)

____ Atypical meningioma (WHO grade II)

____ Clear cell meningioma (WHO grade II)

____ Chordoid meningioma (WHO grade II)

____ Anaplastic meningioma (WHO grade III)

____ Papillary meningioma (WHO grade III)

____ Rhabdoid meningioma (WHO grade III)

____ Other (specify): _____________________________

Mesenchymal (nonmeningothelial) tumors

____ Lipoma

____ Angiolipoma

____ Hibernoma

____ Liposarcoma (intracranial)

____ Solitary fibrous tumor

____ Fibrosarcoma

____ Malignant fibrous histiocytoma

____ Leiomyoma

____ Leiomyosarcoma

____ Rhabdomyoma

____ Rhabdomyosarcoma

____ Chondroma

____ Chondrosarcoma

____ Osteosarcoma

____ Osteochondroma

____ Hemangioma

____ Epithelioid hemangioendothelioma

____ Hemangiopericytoma

____ Angiosarcoma

____ Kaposi sarcoma

____ Chordoma

____ Mesenchymal, nonmeningothelial tumor, other (specify type): _____________________________

____ Sarcoma, primary CNS (specify type, if possible): ____________________________

Primary melanotic tumors

____ Diffuse melanocytosis

____ Melanocytoma

____ Malignant melanoma

____ Meningeal melanomatosis

Tumors of uncertain histogenesis

____ Hemangioblastoma (WHO grade I)

Lymphoma and hematopoietic tumors

____ Malignant lymphoma (specify type, if possible): _____________________________

____ Plasmacytoma

____ Granulocytic sarcoma

____ Hematopoietic neoplasm, other (specify type, if possible): _____________________________

Germ cell tumors

____ Germinoma

____ Embryonal carcinoma

____ Yolk sac tumor

____ Choriocarcinoma

____ Teratoma, mature

____ Teratoma, immature

____ Teratoma with malignant transformation

____ Malignant mixed germ cell tumor

Specify components, e.g., germinoma, embryonal, yolk sac, choriocarcinoma, teratoma: _____________________________

Tumors of sellar region

____ Craniopharyngioma, adamantinomatous (WHO grade I)

____ Craniopharyngioma, papillary (WHO grade I)

____ Granular cell tumor (WHO grade I)

____ Pituicytoma (WHO grade I)

____ Spindle cell oncocytoma (WHO grade I)

____ Pituitary adenoma

Specify nonfunctional or hormone expression (if known): _____________________________

____ Pituitary carcinoma

____ Pituitary hyperplasia

____ Other (specify): _____________________________

Other/nonclassifiable

____ Other(s) (specify): _____________________________

____ Malignant neoplasm, type cannot be determined

Histologic Grade (WHO histologic grade)

____ Not applicable

____ Cannot be determined

____ WHO grade I

____ WHO grade II

____ WHO grade III

____ WHO grade IV

____ WHO grade not assigned

____ Other (specify): _____________________________

Margins (for resections of malignant peripheral nerve sheath tumors only)

____ Cannot be assessed

____ Margins not involved by tumor

____ Margins involved by tumor

^*Specify, if possible: _____________________________

^*Ancillary Studies (check all that apply)

^*____ None performed

^*____ Immunohistochemistry (specify): _____________________________

^*____ Electron microscopy

^*____ Molecular genetic studies (specify): ____________________________

^*____ 1p deletion identified

^*____ 1p deletion not identified

^*____ 19q deletion identified

^*____ 19q deletion not identified

^*____ Other (specify): ____________________________

^*____ Other (specify): _____________________________

^*Additional Pathologic Findings

^*Specify: _____________________________

^* Data elements with asterisks are not required for accreditation purposes for the Commission on Cancer. These elements may be clinically important but are not yet validated or regularly used in patient management. Alternatively, the necessary data may not be available to the pathologist at the time of pathologic assessment of this specimen. Adapted with permission from College of American Pathologists, “Protocol for the Examination of Specimens from Patients with Tumors of the Brain/Spinal Cord.” Web posting date June 2008; protocol effective date: February 2009, www.cap.org.