Examination of Thyroid Gland Carcinoma Specimens

Resection

Procedure

_ _ _Thyroid lobectomy

_ _ _Right

_ _ _Left

_ _ _Partial thyroidectomy (anything less than a lobectomy)

_ _ _Right

_ _ _Left

_ _ _Total thyroidectomy

_ _ _Total thyroidectomy with central compartment dissection

_ _ _Total thyroidectomy with right neck dissection

_ _ _Total thyroidectomy with left neck dissection

_ _ _Total thyroidectomy with bilateral neck dissection

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

_ _ _Not specified

^* Received

^* _ _ _Fresh

^* _ _ _In formalin

^* _ _ _Other

Specimen Integrity

_ _ _Intact

_ _ _Fragmented

Specimen Size

Right lobe: _ _ _ _ _ _ _ _ _ _ × _ _ _ _ _ _ _ _ _ _ × _ _ _ _ _ _ _ _ _ _ cm

Left lobe: _ _ _ _ _ _ _ _ _ _ × _ _ _ _ _ _ _ _ _ _ × _ _ _ _ _ _ _ _ _ _ cm

Isthmus ± pyramidal lobe: _ _ _ _ _ _ _ _ _ _ × _ _ _ _ _ _ _ _ _ _ × _ _ _ _ _ _ _ _ _ _ cm

Central compartment: _ _ _ _ _ _ _ _ _ _ × _ _ _ _ _ _ _ _ _ _ × _ _ _ _ _ _ _ _ _ _ cm

Right neck dissection: _ _ _ _ _ _ _ _ _ _ × _ _ _ _ _ _ _ _ _ _ × _ _ _ _ _ _ _ _ _ _ cm

Left neck dissection: _ _ _ _ _ _ _ _ _ _ × _ _ _ _ _ _ _ _ _ _ × _ _ _ _ _ _ _ _ _ _ cm

^* Additional dimensions (specify): _ _ _ _ _ _ _ _ _ _ × _ _ _ _ _ _ _ _ _ _ × _ _ _ _ _ _ _ _ _ _ cm

^* Specimen Weight

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

Tumor Focality (select all that apply)

_ _ _Unifocal

_ _ _Multifocal (specify)

_ _ _Ipsilateral

_ _ _Bilateral

_ _ _Midline (isthmus)

Dominant Tumor

Tumor laterality

_ _ _Right lobe

_ _ _Left lobe

_ _ _Isthmus

_ _ _Not specified

Tumor size

Greatest dimension: _ _ _ _ _ _ _ _ _ _ cm

^* Additional dimensions: _ _ _ _ _ _ _ _ _ _ × _ _ _ _ _ _ _ _ _ _ cm

_ _ _Cannot be determined

Histologic type (select all that apply)

_ _ _Papillary carcinoma

Variant, specify

_ _ _Classical (usual)

_ _ _Clear cell variant

_ _ _Columnar cell variant

_ _ _Cribriform-morular variant

_ _ _Diffuse sclerosing variant

_ _ _Follicular variant

_ _ _Macrofollicular variant

_ _ _Microcarcinoma (occult, latent, small, papillary microtumor)

_ _ _Oncocytic or oxyphilic variant

_ _ _Solid variant

_ _ _Tall cell variant

_ _ _Warthin-like variant

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

Architecture

_ _ _Classical (papillary)

_ _ _Cribriform-morular

_ _ _Diffuse sclerosing

_ _ _Follicular

_ _ _Macrofollicular

_ _ _Solid

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

Cytomorphology

_ _ _Classical

_ _ _Clear cell

_ _ _Columnar cell

_ _ _Oncocytic or oxyphilic

_ _ _Tall cell

_ _ _Follicular carcinoma

Variant, specify

_ _ _Clear cell

_ _ _Oncocytic (Hürthle cell)

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

_ _ _Poorly differentiated thyroid carcinomas, including insular carcinoma

_ _ _Medullary carcinoma

_ _ _Undifferentiated (anaplastic) carcinoma

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

_ _ _Carcinoma, type cannot be determined

^* Histologic grade_ _ _

^* _ _ _Not applicable

^* _ _ _GX: Cannot be assessed

^* _ _ _G1: Well differentiated

^* _ _ _G2: Moderately differentiated

^* _ _ _G3: Poorly differentiated

^* _ _ _G4: Undifferentiated

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

Margins

_ _ _Cannot be assessed

_ _ _Margins uninvolved by carcinoma

^* Distance of invasive carcinoma to closest margin: _ _ _ _ _ _ _ _ _ _ mm_ _ _

_ _ _Margin(s) involved by carcinoma

^* Site(s) of involvement: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Tumor capsule

_ _ _Cannot be assessed

_ _ _Totally encapsulated

_ _ _Partially encapsulated

_ _ _None

Tumor capsular invasion

_ _ _Cannot be assessed

_ _ _Not identified

_ _ _Present

Extent

_ _ _Minimal

_ _ _Widely invasive

_ _ _Indeterminate

Lymph-vascular invasion

_ _ _Cannot be assessed

_ _ _Not identified

_ _ _Present

Extent

_ _ _Focal (< 4 vessels)

_ _ _Extensive (≥ 4 vessels)

_ _ _Indeterminate

^* Perineural invasion

^* _ _ _Not identified

^* _ _ _Present

^* _ _ _Indeterminate

Extrathyroidal extension

_ _ _Cannot be assessed

_ _ _Not identified

_ _ _Present

Extent

_ _ _Minimal

_ _ _Extensive

Second Tumor (for multifocal tumors only)

Tumor laterality (select all that apply)

_ _ _Right lobe

_ _ _Left lobe

_ _ _Isthmus

_ _ _Not specified

Tumor size

Greatest dimension: _ _ _ _ _ _ _ _ _ _ cm

^* Additional dimensions: _ _ _ _ _ _ _ _ _ _ × _ _ _ _ _ _ _ _ _ _ cm

_ _ _Cannot be determined

Histologic type (select all that apply)

_ _ _Papillary carcinoma

Variant, specify

_ _ _Classical (usual)

_ _ _Clear cell variant

_ _ _Cribriform-morular variant

_ _ _Diffuse sclerosing variant

_ _ _Follicular variant

_ _ _Macrofollicular variant

_ _ _Microcarcinoma (occult, latent, small, papillary microtumor)

_ _ _Oncocytic or oxyphilic variant

_ _ _Solid variant

_ _ _Tall cell variant

_ _ _Warthin-like variant

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

Architecture

_ _ _Classical (papillary)

_ _ _Cribriform-morular

_ _ _Diffuse sclerosing

_ _ _Follicular

_ _ _Macrofollicular

_ _ _Solid

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

Cytomorphology

_ _ _Classical

_ _ _Clear cell

_ _ _Columnar cell

_ _ _Oncocytic or oxyphilic

_ _ _Tall cell

_ _ _Follicular carcinoma

Variant, specify

_ _ _Clear cell

_ _ _Oncocytic (Hürthle cell)

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

_ _ _Poorly differentiated thyroid carcinomas, including insular carcinoma

_ _ _Medullary carcinoma

_ _ _Undifferentiated (anaplastic) carcinoma

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

_ _ _Carcinoma, type cannot be determined

^* Histologic grade

^* _ _ _Not applicable

^* _ _ _GX: Cannot be assessed

^* _ _ _G1: Well differentiated

^* _ _ _G2: Moderately differentiated

^* _ _ _G3: Poorly differentiated

^* _ _ _G4: Undifferentiated

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

Margins

_ _ _Cannot be assessed

_ _ _Totally encapsulated

_ _ _Partially encapsulated

_ _ _None

Tumor capsular invasion

_ _ _Cannot be assessed

_ _ _Not identified

_ _ _Present

Extent

_ _ _Minimally

_ _ _Widely invasive

_ _ _Indeterminate

Lymph-vascular invasion

_ _ _Cannot be assessed

_ _ _Not identified

_ _ _Present

Extent

_ _ _Focal (< 4 vessels)

_ _ _Extensive (≥ 4 vessels)

_ _ _Indeterminate

^* Perineural invasion

^* _ _ _Not identified

^* _ _ _Present

^* _ _ _Indeterminate

Extrathyroidal extension

_ _ _Cannot be assessed

_ _ _Not identified

_ _ _Present

Extent

_ _ _Minimal

_ _ _Extensive

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

_ _ _pT1: Tumor size ≤ 2 cm, limited to thyroid

_ _ _pT1a: Tumor ≤ 1 cm in greatest dimension, limited to thyroid

_ _ _pT1b: Tumor > 1 cm but ≤ 2 cm in greatest dimension, limited to thyroid

_ _ _pT2: Tumor > 2 cm, but ≤ 4 cm, limited to thyroid

_ _ _pT3: Tumor > 4 cm limited to thyroid, or any tumor with minimal extrathyroid extension (e.g., extension to sternothyroid muscle or perithyroid soft tissues)

_ _ _pT4a: Moderately advanced disease.

Tumor of any size extending beyond thyroid capsule to invade subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve

_ _ _pT4b: Very advanced disease. Tumor invades prevertebral fascia or encases carotid artery or mediastinal vessels

Undifferentiated (anaplastic) carcinoma

_ _ _pT4a: Intrathyroidal undifferentiated carcinoma, surgically resectable

_ _ _pT4b: Extrathyroidal undifferentiated carcinoma, surgically unresectable

Regional lymph nodes (pN)††

_ _ _pNX: Cannot be assessed

_ _ _pN0: No regional lymph node metastasis

_ _ _pN1a: Nodal metastases to level VI (pretracheal, paratracheal, and prelaryngeal/Delphian) lymph nodes

_ _ _pN1b: Metastases to unilateral, bilateral, or contralateral cervical (levels I, II, III, IV, V)

or retropharyngeal or superior mediastinal lymph nodes (level VII)

Specify: Number examined: _ _ _ _ _ _ _ _ _ _

Number involved: _ _ _ _ _ _ _ _ _ _

^* Lymph node, extranodal extension

^* _ _ _Not identified

^* _ _ _Present

^* _ _ _Indeterminate

Distant metastasis (pM)

_ _ _Not applicable

_ _ _pM1: Distant metastasis

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

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

^* Additional Pathologic Findings (select all that apply)

^* _ _ _Adenoma

^* _ _ _Adenomatoid nodule(s) or nodular follicular disease (e.g., nodular hyperplasia, goitrous thyroid)

^* _ _ _Diffuse hyperplasia (Graves disease)

^* _ _ _Thyroiditis

^* _ _ _Advanced

^* _ _ _Focal (nonspecific)

^* _ _ _Palpation

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

^* _ _ _Parathyroid gland(s)

^* _ _ _Within normal limits

^* _ _ _Hypercellular

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

^* _ _ _C-cell hyperplasia

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

^* _ _ _None identified

^* Ancillary Studies

^* Specify type (e.g., histochemistry, immunohistochemistry, DNA analysis): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

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

^* Clinical History (select all that apply)

^* _ _ _Radiation exposure

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

^* _ _ _No

^* _ _ _Indeterminate

^* _ _ _Family history

^* _ _ _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. †Note: There is no category of carcinoma in situ (pTis) relative to carcinomas of thyroid gland. ††Superior mediastinal lymph nodes are considered regional lymph nodes (level VII). 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 Thyroid Gland.” Web posting date October 2009, www.cap.org.