Gastrointestinal Stromal Tumor (GIST): Biopsy

Surgical Pathology Cancer Case Summary (Checklist)

Procedure

____Core needle biopsy

____Endoscopic biopsy

____Other (specify):_____________________________

_____Not specified

^*Specimen Size

^*Greatest dimension: __________cm

^*Additional dimensions: __________ x __________ cm

^*Cannot be determined

Tumor Site

Specify:_____________________________

____Not specified

^*Tumor Size

^*Greatest dimension: __________cm

^*Additional dimensions: __________ x __________cm

^*____Cannot be determined

GIST Subtype

____Spindle cell

____Epithelioid

____Mixed

____Other (specify):______________________________

Mitotic Rate

Specify:__________/50 high-power fields (HPF)

^*Necrosis

^*____Not identified

^*____Present

^*Extent: __________%

^*____Cannot be determined

Histologic Grade

____GX: Grade cannot be assessed

____G1: Low grade; mitotic rate ≤ 5/50 HPF

____G2: High grade; mitotic rate > 5/50 HPF

Risk Assessment

____None

____Very low risk

____Low risk

____Intermediate risk

____High risk

____Overtly metastatic

____Cannot be determined

Distant Metastasis

____Cannot be assessed

____Distant metastasis

Specify site(s), if known:______________________________

Additional Pathologic Findings

Specify:______________________________

Ancillary Studies (select all that apply)

Immunohistochemical studies

____KIT (CD117)

____Positive

____Negative

____Others (specify):______________________________

____Not performed

Molecular genetic studies (e.g., KIT or PDGFRA mutational analysis)

____Submitted for analysis; results pending

____Performed, see separate report:______________________________

____Performed

Specify method(s) and results:______________________________

____Not performed

Pre-biopsy Treatment (select all that apply)

____No therapy

____Systemic therapy performed

Specify type:______________________________

____Therapy performed, type not specified

____Unknown

^*Treatment Effect

^*Specify percentage of viable tumor: __________%

^* 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 Gastrointestinal Stromal Tumor.” Web posting date February 2010, www.cap.org.

Gastrointestinal Stromal Tumor (GIST): Resection

Surgical Pathology Cancer Case Summary (Checklist)

Procedure

____Excisional biopsy

____Resection

Specify type (e.g., partial gastrectomy):______________________________

____Metastasectomy

____Other (specify):___________________________

____Not specified

Tumor Site

Specify (if known):___________________________

____Not specified

Tumor Size

Greatest dimension: _________cm

^*Additional dimensions: __________ x __________cm

____Cannot be determined

Tumor Focality

____Unifocal

____Multifocal

Specify number of tumors:__________

Specify size of tumors:______________________________

GIST Subtype

____Spindle cell

____Epithelioid

____Mixed

____Other (specify):______________________________

Mitotic Rate

Specify: __________/50 HPF

^*Necrosis

^*____Not identified

^*____Present

^*Extent: __________%

^*____Cannot be determined

Histologic Grade

____GX: Grade cannot be assessed

____G1: Low grade; mitotic rate ≤ 5/50 HPF

____G2: High grade; mitotic rate > 5/50 HPF

Risk Assessment

____None

____Very low risk

____Intermediate risk

____High risk

____Overtly malignant/metastatic

____Cannot be determined

Margins

____Cannot be assessed

____Negative for GIST

Distance of tumor from closest margin: __________cm

____Margin(s) positive for GIST

Specify margin(s):_____________________________

Pathologic Staging (pTNM)

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

____m (multiple)

____r (recurrent)

____y (post-treatment)

Primary tumor (pT)

____pTX: Primary tumor cannot be assessed

____pT0: No evidence for primary tumor

____pT1: Tumor ≤ 2 cm

____pT2: Tumor > 2 cm but ≤ 5 cm

____pT3: Tumor > 5 cm but ≤ 10 cm

____pT4: Tumor > 10 cm in greatest dimension

Regional lymph nodes (pN)

____Not applicable

____pM1: Distant metastasis

^*Specify site(s) if known:______________________________

^*Additional Pathologic Findings

^*Specify:______________________________

Ancillary Studies (select all that apply)

Immunohistochemical studies

____KIT (CD117)

____Positive

____Negative

____Others (specify):______________________________

____Not performed

Molecular genetic studies (e.g., KIT or PDGFRA mutational analysis)

____Submitted for analysis; results pending

____Performed, see separate report:______________________________

____Performed

Specify method(s) and results:______________________________

____Not performed

Pre-resection Treatment (select all that apply)

____No therapy

____Previous biopsy or surgery

Specify:______________________________

____Systemic therapy performed

Specify type:______________________________

____Therapy performed, type not specified

____Unknown

^*Treatment Effect

^*Specify percentage of viable tumor: __________%

^* 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 Gastrointestinal Stromal Tumor.” Web posting date February 2010, www.cap.org.