Nasal Cavity and Paranasal Sinuses

Incisional Biopsy, Excisional Biopsy, Resection

Specimen (select all that apply)

_ _ _Nasal cavity

_ _ _Septum

_ _ _Floor

_ _ _Lateral wall

_ _ _Vestibule

_ _ _Paranasal sinus(es), maxillary

_ _ _Paranasal sinus(es), ethmoid

_ _ _Paranasal sinus(es), frontal

_ _ _Paranasal sinus(es), sphenoid

_ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Not specified

Received

_ _ _Fresh

_ _ _In formalin

_ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Procedure (select all that apply)

_ _ _Incisional biopsy

_ _ _Excisional biopsy

_ _ _Resection (specify type)

_ _ _Partial maxillectomy

_ _ _Radical maxillectomy

_ _ _Neck (lymph node) dissection (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Not specified

^* Specimen Integrity

^* _ _ _Intact

^* _ _ _Fragmented

^* Specimen size

Greatest dimensions: _ _ _ _ _ _ _ _ _x _ _ _ _ _ _ _ _ _x _ _ _ _ _ _ _ _ _cm

^* Additional dimensions (if more than 1 part): _ _ _ _ _ _ _ _ _x _ _ _ _ _ _ _ _ _x _ _ _ _ _ _ _ _ _cm

Specimen Laterality

_ _ _Right

_ _ _Left

_ _ _Bilateral

_ _ _Midline

_ _ _Not specified

Tumor Site (select all that apply)

_ _ _Nasal cavity

_ _ _Septum

_ _ _Floor

_ _ _Lateral wall

_ _ _Vestibule

_ _ _Paranasal sinus(es), maxillary

_ _ _Paranasal sinus(es), ethmoid

_ _ _Paranasal sinus(es), frontal

_ _ _Paranasal sinus(es), sphenoid

_ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Not specified

Tumor Focality

_ _ _Single focus

_ _ _Bilateral

_ _ _Multifocal (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Tumor Size

Greatest dimension: _ _ _ _ _ _ _ _ _cm

^* Additional dimensions: _ _ _ _ _ _ _ _ _x _ _ _ _ _ _ _ _ _cm

_ _ _Cannot be determined

^* Tumor Description (select all that apply)

^* Gross subtype

^* _ _ _Polypoid

^* _ _ _Exophytic

^* _ _ _Endophytic

^* _ _ _Ulcerated

^* _ _ _Sessile

^* _ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* Macroscopic Extent of Tumor

^* Specify: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Histologic Type (select all that apply)

_ _ _Squamous cell carcinoma, conventional

_ _ _Keratinizing

_ _ _Nonkeratinizing (formerly cylindrical cell, transitional cell)

_ _ _Variants of squamous cell carcinoma

_ _ _Acantholytic squamous cell carcinoma

_ _ _Adenosquamous carcinoma

_ _ _Basaloid squamous cell carcinoma

_ _ _Papillary squamous cell carcinoma

_ _ _Spindle cell squamous cell carcinoma

_ _ _Verrucous carcinoma

_ _ _Giant cell carcinoma

_ _ _Lymphoepithelial carcinoma (non-nasopharyngeal)

_ _ _Sinonasal undifferentiated carcinoma (SNUC)

_ _ _Adenocarcinoma, nonsalivary gland type

_ _ _Intestinal type

_ _ _Papillary type

_ _ _Colonic type

_ _ _Solid type

_ _ _Mucinous type

_ _ _Mixed type

_ _ _Nonintestinal type

_ _ _Low grade

_ _ _Intermediate grade

_ _ _High grade

_ _ _Carcinomas of minor salivary glands

_ _ _Acinic cell carcinoma

_ _ _Adenoid cystic carcinoma

_ _ _Adenocarcinoma, not otherwise specified (NOS)

_ _ _Low grade

_ _ _Intermediate grade

_ _ _High grade

_ _ _Carcinoma ex-pleomorphic adenoma (malignant mixed tumor)

_ _ _Clear cell adenocarcinoma

_ _ _Epithelial-myoepithelial carcinoma

_ _ _Mucoepidermoid carcinoma

_ _ _Low grade

_ _ _Intermediate grade

_ _ _High grade

_ _ _Myoepithelial carcinoma (malignant myoepithelioma)

_ _ _Oncocytic carcinoma

_ _ _Polymorphous low-grade adenocarcinoma

_ _ _Salivary duct carcinoma

_ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Neuroendocrine carcinoma

_ _ _Typical carcinoid tumor (well-differentiated neuroendocrine carcinoma)

_ _ _Atypical carcinoid tumor (moderately differentiated neuroendocrine carcinoma)

_ _ _Small cell carcinoma (poorly differentiated neuroendocrine carcinoma)

_ _ _Combined (or composite) small cell carcinoma, neuroendocrine type

_ _ _Mucosal malignant melanoma

_ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Carcinoma, type cannot be determined

Histologic Grade

_ _ _Not applicable

_ _ _GX: Cannot be assessed

_ _ _G1: Well differentiated

_ _ _G2: Moderately differentiated

_ _ _G3: Poorly differentiated

_ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _^* Microscopic Tumor Extension

_ _ _^* Specify: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Margins (select all that apply)

_ _ _Cannot be assessed

_ _ _Margins uninvolved by invasive carcinoma

_ _ _Distance from closest margin: _ _ _ _ _ _ _ _ _mm or _ _ _ _ _ _ _ _ _cm

_ _ _Specify margin(s) per origination, if possible: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Margins uninvolved by carcinoma in situ (includes moderate and severe dysplasia†)

_ _ _Distance from closest margin: _ _ _ _ _ _ _ _ _mm or _ _ _ _ _ _ _ _ _cm

_ _ _Specify margin(s), per orientation, if possible: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Margins involved by carcinoma in situ (includes moderate and severe dysplasia†)

_ _ _Specify margin(s), per orientation, if possible: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _Not applicable

_ _ _^* Treatment Effect (applicable to carcinomas treated with neoadjuvant therapy)

^* _ _ _Not identified

^* _ _ _Present (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* _ _ _Indeterminate

Lymph-Vascular Invasion

_ _ _Not identified

_ _ _Present

_ _ _Indeterminate

Perineural Invasion

_ _ _Not identified

_ _ _Present

_ _ _Indeterminate

Lymph Nodes, Extranodal Extension

_ _ _Not identified

_ _ _Present

_ _ _Indeterminate

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: Cannot be assessed

_ _ _pT0: No evidence of primary tumor

_ _ _pTis: Carcinoma in situ

_ _ _For all carcinomas excluding mucosal malignant melanoma

Primary tumor (pT): Maxillary sinus

_ _ _pT1: Tumor limited to maxillary sinus mucosa with no erosion or destruction of bone

_ _ _pT2: Tumor causing bone erosion or destruction including extension into hard palate &/or middle nasal meatus except invasion to posterior wall of maxillary sinus and pterygoid plates

_ _ _pT3: Tumor invades any of the following

Bone of posterior wall of maxillary sinus, subcutaneous tissues, floor or medial wall of orbit, pterygoid fossa, ethmoid sinuses

_ _ _pT4a: Moderately advanced local disease

Tumor invades anterior orbital contents, skin of cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid or frontal sinuses

_ _ _pT4b: Very advanced local disease; tumor invades any of the following

Orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus

Primary tumor (pT): Nasal cavity and ethmoid sinus

_ _ _pT1: Tumor restricted to any 1 subsite, ± bone invasion

_ _ _pT2: Tumor invading 2 subsites in a single region

or extending to involve an adjacent region within nasoethmoidal complex, ± bone invasion

_ _ _pT3: Tumor extends to invade medial wall or floor of orbit, maxillary sinus, palate, or cribriform plate

_ _ _pT4a: Moderately advanced local disease; tumor invades any of the following

Anterior orbital contents, skin of nose or cheek, minimal extension to anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses

_ _ _pT4b: Very advanced local disease; tumor invades any of the following

Orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus

_ _ _Regional lymph nodes (pN)††

_ _ _pNX: Cannot be assessed

_ _ _pN0: No regional lymph node metastasis

_ _ _pN1: Metastasis in a single ipsilateral lymph node, ≤ 3 cm in greatest dimension

_ _ _pN2: Metastasis in a single ipsilateral lymph node > 3 cm but ≤ 6 cm in greatest dimension

or in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension

or in bilateral or contralateral nodes, none > 6 cm in greatest dimension

_ _ _pN2a: Metastasis in single ipsilateral lymph node, > 3 cm but ≤ 6 cm in greatest dimension

_ _ _pN2b: Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension

_ _ _pN2c: Metastasis in midlateral or contralateral lymph nodes, none > 6 cm in greatest dimension

_ _ _pN3: Metastasis in lymph node > 6 cm in greatest dimension

Specify: Number of lymph nodes examined: _ _ _ _ _ _ _ _ _

Number of positive lymph nodes: _ _ _ _ _ _ _ _ _

^* Size of largest positive lymph node: _ _ _ _ _ _ _ _ _

^* Size of associated metastatic focus: _ _ _ _ _ _ _ _ _

^* Position of involved node (level): _ _ _ _ _ _ _ _ _

_ _ _Distant metastasis (pM)

_ _ _Not applicable

_ _ _pM1: Distant metastasis

^* Specify site(s) if known: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* Source of pathologic metastatic specimen (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _For mucosal malignant melanoma

Primary tumor (pT)

_ _ _pT3: Mucosal disease

_ _ _pT4a: Moderately advanced disease; tumor involving deep soft tissue, cartilage, bone, or overlying skin

_ _ _pT4b: Very advanced disease

Tumor involving brain, dura, skull base, lower cranial nerves (IX, X, XI, XII), masticator space, carotid artery, prevertebral space, or mediastinal structures

Regional lymph nodes (pN)

_ _ _pNX: Regional lymph nodes cannot be assessed

_ _ _pN0: No regional lymph node metastases

_ _ _pN1: Regional lymph node metastases present

Distant metastasis (pM)

_ _ _Not applicable

_ _ _pM1: Distant metastasis present

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

^* Source of pathologic metastatic specimen (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* Additional Pathologic Findings (select all that apply)

^* _ _ _None identified

^* _ _ _Carcinoma in situ

^* _ _ _Epithelial dysplasia

_ _ _^* Specify: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* _ _ _Inflammation (specify type): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* _ _ _Squamous metaplasia

^* _ _ _Epithelial hyperplasia

^* _ _ _Colonization

^* _ _ _Fungal

^* _ _ _Bacterial

^* _ _ _Other (specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* Ancillary Studies

^* _ _ _Specify type(s): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* _ _ _Specify result(s): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* Clinical History (select all that apply)

^* _ _ _Neoadjuvant therapy

^* _ _ _Yes (specify type): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

^* _ _ _No

^* _ _ _Indeterminate

^* _ _ _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. †Applicable only to squamous cell carcinoma and histologic variants. ††Metastases at level VII are considered regional lymph node metastases. Midline nodes are considered ipsilateral nodes. Adapted with permission from College of American Pathologists, “Protocol for the Examination of Specimens from Patients with Carcinoma of the Nasal Cavity and Paranasal Sinuses.” Web posting date October 2009, www.cap.org.

Stage Groupings: For All Cancers Except Mucosal Malignant Melanoma

Stage

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

II

T2

N0

M0

III

T1

N1

M0

T2

N1

M0

T3

N0, N1

M0

IVA

T1, T2, T3

N2

M0

T4a

N0, N1, N2

M0

IVB

T4b

Any N

M0

Any T

N3

M0

IVC

Any T

Any N

M1

Adapted from 7th edition AJCC Staging Forms.