Rhabdomyosarcoma and Related Neoplasms: Resection or Biopsy

Surgical Pathology Cancer Case Summary (Checklist)

Procedure

____Biopsy

____Excision, local

____Excision, radical

____Excision, compartmentectomy

Amputation (specify type):

Other (specify):

____Not specified

Specimen Laterality

____Right

____Left

____Midline

____Indeterminate

____Not specified

Tumor Site

____Bladder/prostate

____Cranial parameningeal

____Extremity

____Genitourinary (not bladder/prostate)

____Head and neck (excluding parameningeal)

____Orbit

____Other(s) (includes trunk, retroperitoneum, etc.)

(Specify) :

____Not specified

Tumor Size

Greatest dimension: cm

*Additional dimensions: x cm

____Cannot be determined

*Tumor Depth for Soft Tissue-based Tumors

*____Dermal

*____Subcutaneous

*____Subfascial

*____Intramuscular

*____Intraabdominal

*____Retroperitoneal

*____Intracranial

*____Organ based

* Other (specify):

*____Cannot be assessed

Histologic Type

____Embryonal, botryoid

____Embryonal, spindle cell

____Embryonal, not otherwise specified (NOS)

____Alveolar

____Mixed embryonal and alveolar rhabdomyosarcoma

(Specify percentage of each type) :

____Rhabdoid rhabdomyosarcoma

____Sclerosing rhabdomyosarcoma

____Undifferentiated sarcoma

____Ectomesenchymoma

____Other (specify):

____Rhabdomyosarcoma, subtype indeterminate

Anaplasia

____Not identified

____Focal (single or few scattered anaplastic cells)

____Diffuse (clusters or sheets of anaplastic cells)

____Indeterminate

____Cannot be assessed

Margins

____Cannot be assessed

____Sarcoma involvement of margins not identified

Distance of sarcoma from closest margin: mm OR cm

Specify margin:

____Indeterminate

Lymph Nodes

____No regional lymph nodes sampled

____Metastatic involvement of regional lymph nodes not identified

____Regional lymph node metastasis present

Specify: Number examined:

Number involved:

Distant Metastasis

____Not applicable

____Distant metastasis present

*Specify site(s), if known:

The Intergroup Rhabdomyosarcoma Study Postsurgical Clinical Grouping System

Note: Clinical information required to definitively assign stage group (e.g., gross residual disease or distant metastatic disease) may not be available to the pathologist. Alternatively, this protocol may not be applicable to some situations (e.g., group IIIA). If applicable, the appropriate stage group may be assigned by the pathologist.

____Not applicable

____Cannot be assessed

Group I

____A) Localized tumor, confined to site of origin, completely resected

____B) Localized tumor, infiltrating beyond site of origin, completely resected

Group II

____A) Localized tumor, gross total resection, but with microscopic residual disease

____B) Locally extensive tumor (spread to regional lymph nodes), completely resected

____C) Locally extensive tumor (spread to regional lymph nodes), gross total resection, but microscopic residual disease

Group III

____A) Localized or locally extensive tumor, gross residual disease after biopsy only

____B) Localized or locally extensive tumor, gross residual disease after major resection (> 50% debulking)

Group IV

____Any size tumor, ± regional lymph node involvement, with distant metastases, with respect to surgical approach to primary tumor

*Modified Site, Size, Metastasis Staging for Rhabdomyosarcoma (for relevant stage) (select all that apply)

Note: Clinical information required to definitively assign stage (e.g., nodal status or distant metastatic disease) may not be available to the pathologist.

*____Not applicable

*____Cannot be assessed

*____Stage I (requires all of the following to be true)

*____Tumor involves orbit, head and neck, or genitourinary site (excluding bladder, prostate, and cranial parameningeal)

*____Tumor metastatic to distant site not identified

*____Stage II (requires all of the following to be true)

*____Tumor does not involve orbit, nonparameningeal head and neck, or nonbladder/nonprostate genitourinary tract

*____Tumor size < 5 cm

*____Tumor involvement of lymph nodes not identified

*____Tumor metastatic to distant site not identified

*____Stage III (select one if applicable)

*____Tumor involves bladder or prostate and is metastatic to regional lymph nodes but distant metastases are not identified

*____Tumor involves site other than orbit, nonparameningeal head and neck, or nonbladder/nonprostate genitourinary tract and is > 5 cm, but distant metastases are not identified

*____Stage IV

*____Distant metastases present

* Additional Pathologic Findings

*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 Rhabdomyosarcoma.” Web posting date October 2009, www.cap.org.