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.