Pleura: Resection

Surgical Pathology Cancer Case Summary (Checklist)

Specimen

____ Pleura

____ Other (specify): ______________________________

____ Not specified

Procedure

____ Pleural decortication

____ Pleurectomy

____ Extrapleural pneumonectomy

____ Other (specify): ______________________________

____ Not specified

Specimen Integrity

____ Intact

____ Disrupted

____ Indeterminate

Specimen Laterality

____ Right

____ Left

____ Not specified

Tumor Site (select all that apply)

____ Parietal pleura

____ Visceral pleura

____ Diaphragm

____ Other (specify): ______________________________

____ Not specified

^*Tumor Size (for localized tumors only)

^*Greatest dimension: __________ cm

^*Additional dimensions: __________ x __________ cm

^*____ Cannot be determined

Tumor Focality

____ Localized

____ Diffuse

____ Cannot be determined

Histologic Type

____ Epithelioid mesothelioma

____ Sarcomatoid mesothelioma

____ Biphasic mesothelioma

____ Desmoplastic mesothelioma

____ Other (specify): ______________________________

Tumor Extension (select all that apply)

____ Parietal pleura without involvement of ipsilateral visceral pleura

____ Parietal pleura with focal involvement of ipsilateral visceral pleura

____ Confluent visceral pleural tumor (including fissure)

____ Into but not through diaphragm

____ Lung parenchyma

____ Endothoracic fascia

____ Into mediastinal fat

____ Solitary focus invading soft tissue of chest wall

____ Diffuse or multiple foci invading soft tissue of chest wall

____ Into but not through pericardium

____ Rib(s)

____ Mediastinal organ(s) (specify): ______________________________

____ Other (specify): ______________________________

Margins

____ Not applicable

____ Cannot be assessed

____ Margins negative for mesothelioma

____ Margin(s) involved by mesothelioma

Specify margin(s): ______________________________

Treatment Effect

____ Not applicable

____ Cannot be determined

____ > 50% residual viable tumor

____ < 50% residual viable tumor

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: Primary tumor cannot be assessed

____ pT0: No evidence of primary tumor

____ pT1a: Tumor limited to ipsilateral parietal pleura ± mediastinal or diaphragmatic pleural involvement; no involvement of visceral pleura

____ pT1b: Tumor involves ipsilateral parietal pleura ± mediastinal or diaphragmatic pleural involvement; tumor also involving visceral pleura

____ pT2: Tumor involves each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least 1 of the following features:

Involvement of diaphragmatic muscle

Extension of tumor from visceral pleura into underlying pulmonary parenchyma

____ pT3: Locally advanced but potentially resectable tumor that involves all ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura), with at least 1 of the following features:

Involvement of the endothoracic fascia

Extension into mediastinal fat

Solitary completely resectable focus of tumor extending into soft tissues of chest wall

Nontransmural involvement of pericardium

____ pT4: Locally advanced technically unresectable tumor involving all ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura), with at least 1 of the following features:

Diffuse extension or multifocal masses of tumor in chest wall ± associated rib destruction

Direct transdiaphragmatic extension to peritoneum

Direct extension to contralateral pleura

Direct extension to mediastinal organs

Direct extension into spine

Extension through internal surface of pericardium ± a pericardial effusion

Tumor involving myocardium

Regional lymph nodes (pN)

____ pNX: Regional lymph nodes cannot be assessed

____ pN0: No regional lymph node metastases

____ pN1: Metastases in ipsilateral bronchopulmonary or hilar lymph nodes

____ pN2: Metastases in subcarinal or ipsilateral mediastinal lymph nodes including ipsilateral internal mammary and peridiaphragmatic nodes

____ pN3: Metastases in contralateral mediastinal, contralateral internal mammary, ipsilateral, or contralateral supraclavicular lymph nodes

____ 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): ______________________________

Distant metastasis (pM)

____ Not applicable

____ pM1: Distant metastasis

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

^*Additional Pathologic Findings (select all that apply)

^*____ None identified

^*____ Asbestos bodies

^*____ Pleural plaque

^*____ Pulmonary interstitial fibrosis

^*____ Inflammation (type): ______________________________

^*____ Other (specify): ______________________________

^*Ancillary Studies (select all that apply)

^*____ Immunohistochemical stain(s) result(s) (specify stains): ______________________________

^*____ Histochemical stain(s) result(s) (specify stains): ______________________________

^*____ Electron microscopy results: ______________________________

^*____ Other (specify): ______________________________

^*Clinical History (select all that apply)

^*____ Neoadjuvant therapy

^*____ 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 Malignant Pleural Mesothelioma.” Web posting date: February, 2011, www.cap.org.