Lung: Resection

Surgical Pathology Cancer Case Summary (Checklist)

Specimen

____ Lung

____ Lobe(s) of lung (specify): ______________________________

____ Bronchus (specify): ______________________________

____ Other (specify): ______________________________

____ Not specified

Procedure

____ Major airway resection

____ Wedge resection

____ Segmentectomy

____ Lobectomy

____ Bilobectomy

____ Pneumonectomy

____ Other (specify): ______________________________

____ Not specified

Specimen Integrity

____ Intact

____ Disrupted

____ Indeterminate

Specimen Laterality

____ Right

____ Left

____ Not specified

Tumor Site (select all that apply)

____ Upper lobe

____ Middle lobe

____ Lower lobe

____ Other(s) (specify): ______________________________

____ Not specified

Tumor Size

Greatest dimension: __________ cm

^*Additional dimensions: __________ x __________ cm

____ Cannot be determined

Histologic Type

____ Carcinoma, type cannot be determined

____ Non-small cell carcinoma, subtype cannot be determined

____Small cell carcinoma

____Combined small cell carcinoma (small cell carcinoma and non-small cell component)

Specify type of non-small cell carcinoma component: ______________________________

____ Squamous cell carcinoma

____ Squamous cell carcinoma, papillary variant

____ Squamous cell carcinoma, clear cell variant

____ Squamous cell carcinoma, small cell variant

____ Squamous cell carcinoma, basaloid variant

____ Adenocarcinoma

____ Adenocarcinoma, mixed subtype

____ Acinar adenocarcinoma

____ Papillary adenocarcinoma

____ Bronchioalveolar carcinoma

____ Bronchioalveolar carcinoma, nonmucinous

____ Bronchioalveolar carcinoma, mucinous

____ Bronchioalveolar carcinoma, mixed nonmucinous and mucinous

____ Solid adenocarcinoma

____ Fetal adenocarcinoma

____ Mucinous (colloid) adenocarcinoma

____ Mucinous cystadenocarcinoma

____ Signet ring adenocarcinoma

____ Clear cell adenocarcinoma

____ Large cell carcinoma

____ Large cell neuroendocrine carcinoma

____ Combined large cell neuroendocrine carcinoma

Specify type of other non-small cell carcinoma component: ______________________________

____ Basaloid carcinoma

____ Lymphoepithelioma-like carcinoma

____ Clear cell carcinoma

____ Large cell carcinoma with rhabdoid phenotype

____ Adenosquamous carcinoma

____ Sarcomatoid carcinoma

____ Pleomorphic adenoma

____ Spindle cell carcinoma

____ Giant cell carcinoma

____ Carcinosarcoma

____ Pulmonary blastoma

____ Typical carcinoid tumor

____ Atypical carcinoid tumor

____ Mucoepidermoid carcinoma

____ Adenoid cystic carcinoma

____ Epithelial-myoepithelial carcinoma

____ Other (specify): ______________________________

Histologic Grade

____ Not applicable

____ GX: Cannot be assessed

____ G1: Well differentiated

____ G2: Moderately differentiated

____ G3: Poorly differentiated

____ G4: Undifferentiated

____ Other (specify): ______________________________

Visceral Pleura Invasion

____ Not identified

____ Present

____ Indeterminate

Tumor Extension (select all that apply)

____ Not applicable

____ Not identified

____ Superficial spreading tumor with invasive component limited to bronchial wall

____ Tumor involves main bronchus 2 cm or more distal to the carina

____ Parietal pleura

____ Chest wall

^*Specify involved structure(s): ______________________________

____ Diaphragm

____ Mediastinal pleura

____ Phrenic nerve

____ Parietal pericardium

____ Tumor in main bronchus < 2 cm distal to carina but does not involve carina

____ Mediastinum

^*Specify involved structures: ______________________________

____ Heart

____ Great vessels

____ Trachea

____ Esophagus

____ Vertebral body

____ Carina

____ Other (specify): ______________________________

Margins (select all that apply)

Bronchial margin

____ Not applicable

____ Cannot be assessed

____ Uninvolved by invasive carcinoma

____ Involved by invasive carcinoma

____ Squamous cell carcinoma in situ (CIS) present at bronchial margin

____ Squamous cell carcinoma in situ (CIS) not identified at bronchial margin

Vascular margin

____ Not applicable

____ Cannot be assessed

____ Uninvolved by invasive carcinoma

____ Involved by invasive carcinoma

Parenchymal margin

____ Not applicable

____ Cannot be assessed

____ Uninvolved by invasive carcinoma

____ Involved by invasive carcinoma

Parietal pleural margin

____ Not applicable

____ Cannot be assessed

____ Uninvolved by invasive carcinoma

____ Involved by invasive carcinoma

Chest wall margin

____ Not applicable

____ Cannot be assessed

____ Uninvolved by invasive carcinoma

____ Involved by invasive carcinoma

Other attached tissue margin (specify): ______________________________

____ Not applicable

____ Cannot be assessed

____ Uninvolved by invasive carcinoma

____ Involved by invasive carcinoma

If all margins uninvolved by invasive carcinoma: Distance of invasive carcinoma from closest margin: __________ mm

Specify margin: ______________________________

Treatment Effect

____ Not applicable

____ Cannot be determined

____ > 10% residual viable tumor

____ < 10% residual viable tumor

^*Tumor-associated Atelectasis or Obstructive Pneumonitis

^*____ Extends to hilar region but does not involve entire lung

^*____ Involves entire lung

Lymph-Vascular Invasion

____ Not identified

____ Present

____ Indeterminate

^*Lymph Nodes

^*Extranodal extension

^*____ Not identified

^*____ Present

Pathologic Staging (pTNM)

TNM descriptors (required only if applicable)

____ m (multiple primary tumors)

____ r (recurrent)

____ y (post-treatment)

Primary tumor (pT)

____ PTX: Cannot be assessed, or tumor proven by presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy

____ pT0: No evidence of primary tumor

____ pTis: Carcinoma in situ

____ pT1a: Tumor ≤ 2 cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e., not in the main bronchus); or superficial spreading tumor of any size with its invasive component limited to the bronchial wall, which may extend proximally to the main bronchus

____ pT1b: Tumor > 2 cm but ≤ 3 cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e., not in the main bronchus)

____ PT2a: Tumor > 3 cm but ≤ 5 cm in greatest dimension surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e., not in the main bronchus); or tumor ≤ 5 cm in greatest dimension with any of the following features of extent: Involves main bronchus ≥ distal to the carina; invades the visceral pleura; associated with atelectasis or obstructive pneumonitis that extends to the hilar region but does not involve the entire lung

____ pT2b: Tumor > 5 cm but ≤ 7 cm in greatest dimension

____ pT3: Tumor > 7 cm in greatest dimension; or tumor of any size that directly invades any of the following: Parietal pleural chest wall (including superior sulcus tumors), diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium; or tumor of any size in the main bronchus < 2 cm distal to the carina but without involvement of the carina; or tumor of any size associated with atelectasis or obstructive pneumonitis of the entire lung; or tumors of any size with separate tumor nodule(s) in same lobe

____ PT4: Tumor of any size that invades any of the following: Mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina; or tumor of any size with separate tumor nodule(s) in a different lobe of ipsilateral lung

Regional lymph nodes (pN)

____ pNX: Cannot be assessed

____ pN0: No regional lymph node metastasis

____ pN1: Metastasis in ipsilateral peribronchial &/or ipsilateral hilar lymph nodes, and intrapulmonary nodes, including involvement by direct extension

____ pN2: Metastasis in ipsilateral mediastinal &/or subcarinal lymph node(s)

____ pN3: Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)

____ No nodes submitted or found

Number of lymph nodes examined

Specify: __________

____ Number cannot be determined (explain): ______________________________

Number of lymph nodes involved

Specify: __________

____ Number cannot be determined (explain): ______________________________

If lymph node(s) involved, specify involved nodal station(s): ______________________________

Distant Metastasis (pM)

____ Not applicable

____ pM1a: Separate tumor nodule(s) in contralateral lung; tumor with pleural nodules or malignant pleural (or pericardial) effusion

____ pM1b: Distant metastases (in extrathoracic organs)

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

Additional Pathologic Findings (select all that apply)

^*____ None identified

^*____ Atypical adenomatous hyperplasia

^*____ Squamous dysplasia

^*____ Metaplasia (specify type): ______________________________

^*____ Diffuse neuroendocrine hyperplasia

^*____ Inflammation (specify type): ______________________________

^*____ Emphysema

^*____ Other (specify): ______________________________

^*Ancillary Studies (select all that apply)

^*____ Epidermal growth factor receptor (EGFR) analysis results (Specify method): ______________________________

^*____ KRAS mutational analysis (Specify results): ______________________________

^*____ Other (specify): ______________________________

^*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 Primary Non-Small Cell carcinoma, Small Cell Carcinoma, or Carcinoid Tumor of the Lung.” Web posting date: February, 2011, www.cap.org.