Testis: Radical Orchiectomy

Surgical Pathology Cancer Case Summary (Checklist)

^*Serum Tumor Markers (select all that apply)

(See serum tumor markers [S] classification)

^*____ Unknown

^*____ Serum marker studies within normal limits

^*____ α-fetoprotein (AFP) elevation

^*____ β-subunit of human chorionic gonadotropin (β-hCG) elevation

^*____ Lactate dehydrogenase (LDH) elevation

Specimen Laterality

____ Right

____ Left

____ Both

____ Not specified

Tumor Focality

____ Unifocal

____ Multifocal

Tumor Size

Greatest dimension of main tumor mass: __________ cm

^*Additional dimensions: __________ × __________ cm

Greatest dimensions of additional tumor nodules: __________ cm, __________ cm, etc.

____ Cannot be determined (see comment)

Macroscopic Extent of Tumor (select all that apply)

____ Confined to the testis

____ Invades hilar soft tissues

____ Invades tunica vaginalis (perforates mesothelium)

____ Invades epididymis

____ Invades spermatic cord

____ Other (specify): ______________________________

Histologic Type (select all that apply)

____ Intratubular germ cell neoplasia, unclassified only

____ Seminoma, classic type

____ Seminoma with associated scar

____ Seminoma with syncytiotrophoblastic cells

____ Mixed germ cell tumor (specify components and approximate percentages)

______________________________

______________________________

____ Embryonal carcinoma

____ Yolk sac tumor

____ Choriocarcinoma, biphasic

____ Choriocarcinoma, monophasic

____ Placental site trophoblastic tumor

____ Teratoma

____ Teratoma with a secondary somatic-type malignant component (specify type): ______________________________

____ Monodermal teratoma, carcinoid

____ Monodermal teratoma, primitive neuroectodermal tumor

____ Monodermal teratoma, other (specify): ______________________________

____ Spermatocytic seminoma

____ Spermatocytic seminoma with a sarcomatous component

____ Mixed germ cell-sex cord stromal tumor, gonadoblastoma

____ Mixed germ cell-sex cord stromal tumor, others (specify): ______________________________

____ Testicular scar

____ Scar only

____ Scar with intratubular germ cell neoplasia

____ Sex cord-stromal tumor

____ Leydig cell tumor

____ Sertoli cell tumor

____ Classic

____ Sclerosing

____ Large cell calcifying

____ Granulosa cell tumor

____ Adult-type

____ Juvenile-type

____ Mixed, with components (specify components and approximate percentages)

______________________________

______________________________

____ Unclassified

____ Malignant neoplasm, type cannot be determined

____ Other (specify): ______________________________

Margins

Spermatic cord margin

____ Cannot be assessed

____ Uninvolved by tumor

____ Involved by tumor

Other margin(s)

____ Cannot be assessed

____ Uninvolved by tumor (specify): ______________________________

____ Not applicable

Microscopic Tumor Extension (select all that apply)

^*____ Rete testis

^*____ Epididymis

^*____ Hilar fat

____ Spermatic cord

____ Tunica vaginalis (perforates mesothelium)

____ Scrotal wall

____ None of the above

Lymph-Vascular Invasion

____ Absent

____ Present

____ Indeterminate

Pathologic Staging (pTNM)

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

____ m (multiple)

____ r (recurrent

____ y (post-treatment)

Primary tumor (pT)

____ pTX: Cannot be assessed

____ pT0: No evidence of primary tumor

____ pTis: Intratubular germ cell neoplasia (carcinoma in situ)

____ pT1: Tumor limited to the testis and epididymis without vascular/lymphatic invasion; tumor may invade tunica albuginea gut not tunica vaginalis

____ pT2: Tumor limited to the testis and epididymis with vascular/lymphatic invasion, or tumor extending through the tunica albuginea with involvement of the tunica vaginalis

____ pT3: Tumor invades the spermatic cord with or without vascular/lymphatic invasion

____ pT4: Tumor invades the scrotum with or without vascular/lymphatic invasion

Regional lymph nodes (pN)

____ pNX: Cannot be assessed

____ pN0: No regional lymph node metastasis

____ PN1: Metastasis with a lymph node mass ≤ 2 cm in greatest dimension, or ≤ 5 positive nodes, none > 2 cm in greatest dimension

____ PN2: Metastasis with a lymph node mass >2 cm but not > 5 cm in greatest dimension; or > 5 nodes positive, none > 5 cm; or evidence of extranodal extension of tumor

____ pN3: Metastasis with a lymph node mass > 5 cm in greatest dimension

Specify: Number examined: __________

Number involved: __________

Distant metastasis (pM)

____ Not applicable

____ pM1: Distant metastasis present

____ pM1a: Nonregional nodal or pulmonary metastasis

____ pM1b: Distant metastasis other than to nonregional lymph nodes and lung

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

^*Serum Tumor Markers (S)

^*____ SX: Serum marker studies not available or performed

^*____ S0: Serum marker study levels within normal limits

^*____ S1: LDH < 1.5 X N† and HCG < 5,000 mIU/mL and AFP < 1000 ng/mL

^*____ S2: LDH 1.5-10 X N or HCG 5,000-50,000 mIU/mL or AFP 1,000-10,000 ng/mL

^*____ S3: LDH > 10 X N or HCG > 50,000 mIU/mL or AFP > 10,000 ng/mL

†N indicates the upper limit of normal for the LDH assay

^*Additional Pathologic Findings (select all that apply)

^*____ None identified

^*____ Intratubular germ cell neoplasia

^*____ Hemosiderin-laden macrophages

^*____ Atrophy

^*____ 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 Germ Cell and Sex Cord-Stromal Tumors of the Testis.” Web posting date October 2009, www.cap.org.

Testis: Retroperitoneal Lymphadenectomy

Surgical Pathology Cancer Case Summary (Checklist)

^*Pre-lymphadenectomy Treatment

^*____ Chemo/radiation therapy

^*____ No chemo/radiation therapy

^*____ Unknown

^*Serum Tumor Markers (select all that apply)

^*____ Unknown

^*____ Serum marker studies within normal limits

^*____ α-fetoprotein (AFP) elevation

^*____ β subunit of human chorionic gonadotropin (β-hCG) elevation

^*___ Lactate dehydrogenase (LDH) elevation

^*Specimen Site(s)

^*Specify: ______________________________

^*Number of Nodal Groups Present

^*Specify: __________

^*____ Cannot be determined

Size of Largest Metastatic Deposit in Lymph Node

Greatest dimension: __________ cm

^*Additional dimensions: __________ × __________ cm

Histologic Viability of Tumor (if applicable)

____ Viable teratoma present

____ Viable nonteratomatous tumor present

____ No viable tumor present

Histologic Type of Metastatic Tumor

____ Seminoma, classic type

____ Seminoma with syncytiotrophoblastic cells

____ Mixed germ cell tumor (specify components and approximate percentages)

______________________________

______________________________

____ Embryonal carcinoma

____ Yolk sac tumor

____ Choriocarcinoma, biphasic

____ Choriocarcinoma, monophasic

____ Cystic trophoblastic tumor

____ Placental site trophoblastic tumor

____ Teratoma

____ Teratoma with a secondary somatic-type malignant component (specify type): ______________________________

____ Monodermal teratoma (specify type): ______________________________

____ Spermatocytic seminoma

____ Malignant neoplasm, type cannot be determined

____ Other (specify): ______________________________

Regional Lymph Nodes (pN)

____ pNX: Cannot be assessed

____ pN0: No regional lymph node metastasis

____ PN1: Metastasis with a lymph node mass < 2 cm in greatest dimension, or ≤ 5 positive nodes, none > 2 cm in greatest dimension

____ PN2: Metastasis with a lymph node mass > 2 cm but not > 5 cm in greatest dimension, or > 5 nodes positive, none > 5 cm; or evidence of extranodal extension of tumor

____ pN3: Metastasis in a lymph node > 5 cm in greatest dimension

Specify: Total number examined: __________

Total number involved: __________

Nonregional Lymph Node Metastasis (M1a)

____ Not applicable

____ Not identified

____ Present

^* 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.

Anatomic Stage/Prognostic Groups

Group

Tumor

Node

Metastasis

Serum Tumor Markers

Stage 0

pTis

N0

M0

S0

Stage I

pT1-4

N0

M0

SX

Stage 1A

pT1

N0

M0

S0

Stage IB

pT2

N0

M0

S0

pT3

N0

M0

S0

pT4

N0

M0

S0

Stage IS

Any pT/TX

N0

M0

S1-3 (post-orchiectomy)

Stage II

Any pT/TX

N1, N2, N3

M0

SX

Stage IIA

Any pT/TX

N1

M0

S0

Any pT/TX

N1

M0

S1

Stage IIB

Any pT/TX

N2

M0

S0

Any pT/TX

N2

M0

S1

Stage IIC

Any pT/TX

N3

M0

S0

Any pT/TX

N3

M0

S1

Stage IIIB

Any pT/TX

N1, N2, N3

M0

S2

Any pT/TX

Any N

M1a

S2

Stage IIIC

Any pT/TX

N1, N2, N3

M0

S3

Any pT/TX

Any N

M1a

S3

Any T

Any N

M1b

Any S

Used with the permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer Science and Business Media LLC, www.springerlink.com.