Protocol for the Examination of Mesothelioma Specimens



Protocol for the Examination of Mesothelioma Specimens






















































































































































































































































































































































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: _______×_______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 the chest wall



____ Diffuse or multiple foci invading soft tissue of the 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 the underlying pulmonary parenchyma




____ pT3: Locally advanced but potentially resectable tumor that involves all of the 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 the soft tissues of the chest wall


Nontransmural involvement of the pericardium




____ pT4: Locally advanced, technically unresectable tumor involving all of the 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 the chest wall ± associated rib destruction


Direct transdiaphragmatic extension to the peritoneum


Direct extension to the contralateral pleura


Direct extension to mediastinal organs


Direct extension into the spine


Extension through the internal surface of the pericardium ± pericardial effusion


Tumor involving the myocardium



Regional lymph nodes (pN)




____ pNX: Regional lymph nodes cannot be assessed




____ pN0: No regional lymph node metastases




____ pN1: Metastases in the ipsilateral bronchopulmonary or hilar lymph nodes




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




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




Specify: Number examined: _____




___ Number involved:




____ Number cannot be determined



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 October 2009, www.cap.org.

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Jul 9, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Protocol for the Examination of Mesothelioma Specimens
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